Modelación de la intrusión patógena a través de fallos y su implicación en la red de distribución de agua

La calidad del agua para el consumo humano es uno de los temas vigentes por parte de los gestores de los sistemas de abastecimiento y de centros de investigación en el entorno de la hidráulica urbana. Este aspecto es abordado desde distintos puntos de vista, motivado por las consecuencias que implica el consumo de agua contaminada; por tratarse de la protección de la salud pública, es indispensable tener mayor conocimiento en todas las formas en las que es vulnerable el agua potable. Las redes de distribución de agua, como toda obra de ingeniería presentan una vida útil, en la mayoría de las poblaciones urbanas se tienen instalaciones que han cumplido con ella y como consecuencia de circunstancias adversas se pueden ir incrementando los problemas físicos en las conducciones con el paso del tiempo. Entre otros factores identificados en esta problemática se encuentra el fenómeno de la intrusión patógena. En este trabajo se analiza la intrusión como un evento relacionado directamente con las fugas de agua en las conducciones. Este tipo de intrusión se produce cuando las condiciones de presión son adversas en la instalación. Así pues, la situación de las fugas se considera un factor determinante en el rendimiento hidráulico de la red, y además puede representar un riesgo para la calidad del agua en el suministro y por ende para la salud pública. La metodología planteada se ha basado en reproducir los eventos adversos que generan intrusión. El interés de realizar estos trabajos es debido a que en la mayoría de las investigaciones se plantean que la cuantificación de los volúmenes de intrusión es un factor fundamental para el control en la gestión de este tipo de adversidades. En este sentido se realizaron modelos físicos y numéricos en CFD, creando escenarios presentes en las redes de distribución. Se ha realizado la representación física y numérica de las condiciones más adversas para la generación de la intrusión en este aspecto. De esta forma se abordaron los casos en donde los eventos pueden ser más agresivos con la calidad del agua. Finalmente, al tener las herramientas numéricas validadas se pueden reproducir escenarios puntuales donde la vulnerabilidad de la red este comprometida y con ello tener mayor conocimiento de las posibles situaciones que podrían darse durante eventos imprevistos o por cuestiones de gestión en la distribución debida al abastecimiento intermitente.Mora Rodríguez, JDJ. (2011). Modelación de la intrusión patógena a través de fallos y su implicación en la red de distribución de agua [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/11239Palanci

Intrusion problematic during water supply systems' operation

[EN] Intrusion through leaks occurrence is a phenomenon when external fluid comes into water pipe systems. This phenomenon can cause contamination problems in drinking pipe systems. Hence, this paper focuses on the entry of external fluids across small leaks during normal operation conditions. This situation is especially important in elevated points of the pipe profile. Pressure variations can origin water volume losses and intrusion of contaminants into the drinking water pipes. This work focuses in obtaining up the physical representation on a specific case intrusion in a pipe water system. The combination of two factors is required to generate this kind of intrusion in a water supply system: on one hand the existence of at least a leak in the system; on the other hand, a pressure variation could occur during the operation of the system due to consumption variation, pump start-up or shutdown. The potential of intrusion during a dynamic or transient event is here analyzed. To obtain this objective an experimental case study of pressure transient scenario is analyzed with a small leak located nearby the transient source.This article has been made possible through actions of the DIHMA researchers, involved in the following projects: DANAIDES: Desarrollo de herramientas de simulación para la caracterización hidráulica de redes de abastecimiento a través de indicadores de calidad del agua. REF. DPI2007-63424. Ministerio de Educación y Ciencia de España. To Generalitat Valenciana for the scholarship for stays in centers of investigation out of the community valencian BEFPI2010. The authors wants to acknowledge to FCT through projects PTDC/ECM/64821, 65731 and 68694/2006, CEHIDRO and the Hydro-systems research centre from the Department of Civil Engineering, at Instituto Superior Técnico.Mora Rodríguez, JDJ.; López Jiménez, PA.; Ramos, HM. (2011). Intrusion problematic during water supply systems' operation. International Journal of Energy and Environment. 2(3):391-400. http://hdl.handle.net/10251/38072S3914002

Desarrollo de metodologías de apoyo basadas en el uso de plataformas virtuales de enseñanza para asignaturas de planes de estudio en extinción

En este trabajo se presenta una experiencia sobre la aplicación de diversas metodologías de apoyo cuyo objetivo principal es ofrecer a los alumnos de la Escuela Técnica Superior de Ingenieros Navales (ETSIN) de la Universidad Politécnica de Madrid (UPM) pertenecientes a un Plan de Estudios en extinción (Plan 2002) y del que ya han dejado e recibir clases presenciales en los primeros cursos, las herramientas adecuadas por medio de la plataforma virtual Moodle, para que puedan prepararse con garantías de éxito los exámenes finales de estas asignaturas, evitando cambiar obligatoriamente de plan de estudios. Se pretende dar a conocer a los profesores de las asignaturas sin docencia, la posibilidad de diseñar una metodología con tres niveles distintos de aprendizaje, solicitar el alta en el espacio virtual de enseñanza de aquellas asignaturas que no figuren en la plataforma virtual y poner a disposición del alumno el material necesario para lograr superar la asignatura. Los objetivos principales para el alumno son posibilitar el aprendizaje autónomo mediante recursos docentes y actividades alojados en la plataforma virtual, de forma que pueda estudiar la asignatura según el nivel de seguimiento que exija la misma

Validation of a Computational Fluid Dynamics Model for a Novel Residence Time Distribution Analysis in Mixing at Cross-Junctions

[EN] In Water Distribution Networks, the chlorine control is feasible with the use of water quality simulation codes. EPANET is a broad domain software and several commercial computer software packages base their models on its methodology. However, EPANET assumes that the solute mixing at cross-junctions is ¿complete and instantaneous¿. Several authors have questioned this model. In this paper, experimental tests are developed while using Copper Sulphate as tracer at different operating conditions, like those of real water distribution networks, in order to obtain the Residence Time Distribution and its behavior in the mixing as a novel analysis for the cross-junctions. Validation tests are developed in Computational Fluid Dynamics, following the k-# turbulence model. It is verified that the mixing phenomenon is dominated by convection, analyzing variation of Turbulent Schmidt Number vs. experimental tests. Having more accurate mixing models will improve the water quality simulations to have an appropriate control for chlorine and possible contaminants in water distribution networks.To CONACYT for the Master and Ph.D. scholarships (417824 and 703220) to D.H.-C. and the Ph.D. scholarship (294038) to M.R.; To Universidad de Guanajuato for the financial support of the project No. 100/2018 of J.L.N.; To Engineering Division, Campus Guanajuato and Geomatics and Hydraulics Engineering Department for the financial support of this project; and finally, to SEP-PRODEP and UG for the financial support to publish this paper.Hernandez Cervantes, D.; Delgado Galván, XV.; Nava, JL.; López Jiménez, PA.; Rosales, M.; Mora Rodríguez, JDJ. (2018). Validation of a Computational Fluid Dynamics Model for a Novel Residence Time Distribution Analysis in Mixing at Cross-Junctions. Water. 10(6):1-18. https://doi.org/10.3390/w10060733S118106Mercier Shanks, C., Sérodes, J.-B., & Rodriguez, M. J. (2013). Spatio-temporal variability of non-regulated disinfection by-products within a drinking water distribution network. Water Research, 47(9), 3231-3243. doi:10.1016/j.watres.2013.03.033Vasconcelos, J. J., Rossman, L. A., Grayman, W. M., Boulos, P. F., & Clark, R. M. (1997). Kinetics of chlorine decay. Journal - American Water Works Association, 89(7), 54-65. doi:10.1002/j.1551-8833.1997.tb08259.xOzdemir, O. N., & Ucak, A. (2002). Simulation of Chlorine Decay in Drinking-Water Distribution Systems. Journal of Environmental Engineering, 128(1), 31-39. doi:10.1061/(asce)0733-9372(2002)128:1(31)Knobelsdorf Miranda, J., & Mujeriego Sahuquillo, R. (1997). Crecimiento bacteriano en las redes de distribución de agua potable: una revisión bibliográfica. Ingeniería del agua, 4(2). doi:10.4995/ia.1997.2719Wang, W., Ye, B., Yang, L., Li, Y., & Wang, Y. (2007). Risk assessment on disinfection by-products of drinking water of different water sources and disinfection processes. Environment International, 33(2), 219-225. doi:10.1016/j.envint.2006.09.009Parks, S. L. I., & VanBriesen, J. M. (2009). Booster Disinfection for Response to Contamination in a Drinking Water Distribution System. Journal of Water Resources Planning and Management, 135(6), 502-511. doi:10.1061/(asce)0733-9496(2009)135:6(502)Hernández Cervantes, D., Mora Rodríguez, J., Delgado Galván, X., Ortiz Medel, J., & Jiménez Magaña, M. R. (2015). Optimal use of chlorine in water distribution networks based on specific locations of booster chlorination: analyzing conditions in Mexico. Water Supply, 16(2), 493-505. doi:10.2166/ws.2015.161Weickgenannt, M., Kapelan, Z., Blokker, M., & Savic, D. A. (2010). Risk-Based Sensor Placement for Contaminant Detection in Water Distribution Systems. Journal of Water Resources Planning and Management, 136(6), 629-636. doi:10.1061/(asce)wr.1943-5452.0000073Rathi, S., & Gupta, R. (2013). Monitoring stations in water distribution systems to detect contamination events. ISH Journal of Hydraulic Engineering, 20(2), 142-150. doi:10.1080/09715010.2013.857470Seth, A., Klise, K. A., Siirola, J. D., Haxton, T., & Laird, C. D. (2016). Testing Contamination Source Identification Methods for Water Distribution Networks. Journal of Water Resources Planning and Management, 142(4), 04016001. doi:10.1061/(asce)wr.1943-5452.0000619Xuesong, Y., Jie, S., & Chengyu, H. (2017). Research on contaminant sources identification of uncertainty water demand using genetic algorithm. Cluster Computing, 20(2), 1007-1016. doi:10.1007/s10586-017-0787-6Rathi, S., & Gupta, R. (2015). Optimal sensor locations for contamination detection in pressure-deficient water distribution networks using genetic algorithm. Urban Water Journal, 14(2), 160-172. doi:10.1080/1573062x.2015.1080736Sandoval, M. A., Fuentes, R., Walsh, F. C., Nava, J. L., & de León, C. P. (2016). Computational fluid dynamics simulations of single-phase flow in a filter-press flow reactor having a stack of three cells. Electrochimica Acta, 216, 490-498. doi:10.1016/j.electacta.2016.09.045Castañeda, L. (2017). Computational Fluid Dynamic Simulations of Single-Phase Flow in a Spacer-Filled Channel of a Filter-Press Electrolyzer. International Journal of Electrochemical Science, 7351-7364. doi:10.20964/2017.08.09Song, I., Romero-Gomez, P., & Choi, C. Y. (2009). Experimental Verification of Incomplete Solute Mixing in a Pressurized Pipe Network with Multiple Cross Junctions. Journal of Hydraulic Engineering, 135(11), 1005-1011. doi:10.1061/(asce)hy.1943-7900.0000095Romero-Gomez, P., Lansey, K. E., & Choi, C. Y. (2010). Impact of an incomplete solute mixing model on sensor network design. Journal of Hydroinformatics, 13(4), 642-651. doi:10.2166/hydro.2010.123Yu, T. C., Shao, Y., & Shen, C. (2014). Mixing at Cross Joints with Different Pipe Sizes in Water Distribution Systems. Journal of Water Resources Planning and Management, 140(5), 658-665. doi:10.1061/(asce)wr.1943-5452.0000372Shao, Y., Jeffrey Yang, Y., Jiang, L., Yu, T., & Shen, C. (2014). Experimental testing and modeling analysis of solute mixing at water distribution pipe junctions. Water Research, 56, 133-147. doi:10.1016/j.watres.2014.02.053Mompremier, R., Pelletier, G., Fuentes Mariles, Ó. A., & Ghebremichael, K. (2015). Impact of incomplete mixing in the prediction of chlorine residuals in municipal water distribution systems. Journal of Water Supply: Research and Technology - Aqua, 64(8), 904-914. doi:10.2166/aqua.2015.148McKenna, S. A., O’Hern, T., & Hartenberger, J. (2009). Detailed Investigation of Solute Mixing in Pipe Joints through High Speed Photography. Water Distribution Systems Analysis 2008. doi:10.1061/41024(340)88Ho, C. K., & O’Rear, L. (2009). Evaluation of solute mixing in water distribution pipe junctions. Journal - American Water Works Association, 101(9), 116-127. doi:10.1002/j.1551-8833.2009.tb09964.xChoi, C. Y., Shen, J. Y., & Austin, R. G. (2009). Development of a Comprehensive Solute Mixing Model (AZRED) for Double-Tee, Cross, and Wye Junctions. Water Distribution Systems Analysis 2008. doi:10.1061/41024(340)89Rosales, M., Pérez, T., & Nava, J. L. (2016). Computational fluid dynamic simulations of turbulent flow in a rotating cylinder electrode reactor in continuous mode of operation. Electrochimica Acta, 194, 338-345. doi:10.1016/j.electacta.2016.02.076Moncho-Esteve, I. J., Palau-Salvador, G., Brevis, W., Vaas, M. O., & López-Jiménez, P. A. (2015). Numerical simulation of the hydrodynamics and turbulent mixing process in a drinking water storage tank. Journal of Hydraulic Research, 53(2), 207-217. doi:10.1080/00221686.2014.98945

Using ultrafine particles from a coal washing plant in metallurgical coke production

Blending ultrafine particles from a coal washing plant was studied for coke production by briquetting using 6%w coal tar as binder. The ultrafine coal particles were characterised and a pilot coking test was made in a Koppers’ furnace. Coke quality was evaluated by proximate analysis, stability (micum 10 and micum 40), coke reactivity index (CRI) with CO2 and the coke’s mechanical strength after reaction with carbon dioxide (CSR index). Briquetting results showed that was possible to obtain coke having 19.0 % CRI and 75.6% CSR, these being the characteristics required in metallurgical processes.Se estudió el aprovechamiento en mezclas de ultrafinos provenientes de una planta de lavado de carbón para la producción de coque por el proceso de briquetación, utilizando 6% en peso de alquitrán de carbón como aglomerante. Se caracterizaron las materias primas y se realizó una prueba piloto de coquización en un horno tipo Koppers. Se determinó la calidad del coque por pruebas de análisis próximo, estabilidad (Micum 10, M10 y Micum 40, M40), índice de reactividad del coque al CO2 (CRI) y de resistencia después de la reacción con dióxido de carbono (CSR). Los resultados mostraron que la briquetación permite obtener un coque con un CRI de 19,0% y un CSR de 75,6%, características requeridas en los procesos metalúrgicos

Incomplete Mixing Model at Cross-Junctions in Epanet by Polynomial Equations

[EN] In Water Distribution Networks (WDN), the water quality could become vulnerable due to several operational and temporal factors. Epanet is a hydraulic and water quality simulation software, widely used, to preserve the control of chemical disinfectants in WDN among other capabilities. Several researchers have shown that the flow mixing at Cross-Junctions (CJs) is not complete as Epanet assumes for the cases of two contiguous inlets and outlets. This paper presents a methodology to obtain the outlet concentrations in CJs based on experimental scenarios and a validated Computational Fluid Dynamics (CFD) model. In this work, the results show that the Incomplete Mixing Model (IMM) based on polynomial equations, represents in a better way the experimental scenarios. Therefore, the distribution of the concentration could be in different proportions in some sectors of the network. Some comparisons were made with the complete mixing model and the Epanet-Bulk Advective Mixing (BAM), obtaining relative errors of 90% in some CJs.To CONACYT for the scholarship of the first author Daniel Hernández; to Rubén Martínez, laboratory technician of the Universidad de Guanajuato, and to PROMEP projects of authors Jesús Mora, Xitlali Delgado, and Antonio Arciniega.Hernández Cervantes, D.; López Jiménez, PA.; Arciniega Nevárez, JA.; Delgado Galván, X.; Jiménez Magaña, MR.; Pérez-Sánchez, M.; Mora Rodríguez, JDJ. (2021). Incomplete Mixing Model at Cross-Junctions in Epanet by Polynomial Equations. Water. 13(4):1-20. https://doi.org/10.3390/w13040453S120134Knobelsdorf Miranda, J., & Mujeriego Sahuquillo, R. (1997). Crecimiento bacteriano en las redes de distribución de agua potable: una revisión bibliográfica. Ingeniería del agua, 4(2). doi:10.4995/ia.1997.2719Grbčić, L., Kranjčević, L., Lučin, I., & Sikirica, A. (2021). Large Eddy Simulation of turbulent fluid mixing in double-tee junctions. Ain Shams Engineering Journal, 12(1), 789-797. doi:10.1016/j.asej.2020.06.004Hernández-Cervantes, D., Delgado-Galván, X., Nava, J., López-Jiménez, P., Rosales, M., & Mora Rodríguez, J. (2018). Validation of a Computational Fluid Dynamics Model for a Novel Residence Time Distribution Analysis in Mixing at Cross-Junctions. Water, 10(6), 733. doi:10.3390/w10060733Mompremier, R., Pelletier, G., Fuentes Mariles, Ó. A., & Ghebremichael, K. (2015). Impact of incomplete mixing in the prediction of chlorine residuals in municipal water distribution systems. Journal of Water Supply: Research and Technology - Aqua, 64(8), 904-914. doi:10.2166/aqua.2015.148Shao, Y., Jeffrey Yang, Y., Jiang, L., Yu, T., & Shen, C. (2014). Experimental testing and modeling analysis of solute mixing at water distribution pipe junctions. Water Research, 56, 133-147. doi:10.1016/j.watres.2014.02.053Paez, N., Saldarriaga, J., & Bohorquez, J. (2017). Water Quality Modeling Considering Incomplete Mixing in Extended Periods. Procedia Engineering, 186, 54-60. doi:10.1016/j.proeng.2017.03.207Ho, C. K. (2008). Solute Mixing Models for Water-Distribution Pipe Networks. Journal of Hydraulic Engineering, 134(9), 1236-1244. doi:10.1061/(asce)0733-9429(2008)134:9(1236)Yu, T. C., Shao, Y., & Shen, C. (2014). Mixing at Cross Joints with Different Pipe Sizes in Water Distribution Systems. Journal of Water Resources Planning and Management, 140(5), 658-665. doi:10.1061/(asce)wr.1943-5452.0000372Shao, Y., Zhao, L., Yang, Y. J., Zhang, T., & Ye, M. (2019). Experimentally Determined Solute Mixing under Laminar and Transitional Flows at Junctions in Water Distribution Systems. Advances in Civil Engineering, 2019, 1-10. doi:10.1155/2019/3686510Austin, R. G., Waanders, B. van B., McKenna, S., & Choi, C. Y. (2008). Mixing at Cross Junctions in Water Distribution Systems. II: Experimental Study. Journal of Water Resources Planning and Management, 134(3), 295-302. doi:10.1061/(asce)0733-9496(2008)134:3(295)Song, I., Romero-Gomez, P., & Choi, C. Y. (2009). Experimental Verification of Incomplete Solute Mixing in a Pressurized Pipe Network with Multiple Cross Junctions. Journal of Hydraulic Engineering, 135(11), 1005-1011. doi:10.1061/(asce)hy.1943-7900.0000095Romero-Gomez, P., Choi, C. Y., van Bloemen Waanders, B., & McKenna, S. (2008). Transport Phenomena at Intersections of Pressurized Pipe Systems. Water Distribution Systems Analysis Symposium 2006. doi:10.1061/40941(247)155Romero-Gomez, P., Ho, C. K., & Choi, C. Y. (2008). Mixing at Cross Junctions in Water Distribution Systems. I: Numerical Study. Journal of Water Resources Planning and Management, 134(3), 285-294. doi:10.1061/(asce)0733-9496(2008)134:3(285)Ho, C. K., & O’Rear, L. (2009). Evaluation of solute mixing in water distribution pipe junctions. Journal - American Water Works Association, 101(9), 116-127. doi:10.1002/j.1551-8833.2009.tb09964.xAndrade, M. A., Rojano, F., Romero-Gomez, P., & Choi, C. Y. (2011). Integrated Water Quality Modeling of Water Distribution Systems. Water Distribution Systems Analysis 2010. doi:10.1061/41203(425)63Hernández Cervantes, D., Mora Rodríguez, J., Delgado Galván, X., Ortiz Medel, J., & Jiménez Magaña, M. R. (2015). Optimal use of chlorine in water distribution networks based on specific locations of booster chlorination: analyzing conditions in Mexico. Water Supply, 16(2), 493-505. doi:10.2166/ws.2015.161Boccelli, D. L., Tryby, M. E., Uber, J. G., & Summers, R. S. (2003). A reactive species model for chlorine decay and THM formation under rechlorination conditions. Water Research, 37(11), 2654-2666. doi:10.1016/s0043-1354(03)00067-8Jabari Kohpaei, A., & Sathasivan, A. (2011). Chlorine decay prediction in bulk water using the parallel second order model: An analytical solution development. Chemical Engineering Journal, 171(1), 232-241. doi:10.1016/j.cej.2011.03.03

Creatine Kinase Elevation in Autosomal Dominant Polycystic Kidney Disease Patients on Tolvaptan Treatment

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of end-stage kidney disease. Currently, tolvaptan is the only treatment that has proven to delay disease progression. The most notable side effect of this therapy is drug-induced liver injury; however, recently, there have been two reports of creatine kinase (CK) elevation in ADPKD patients on tolvaptan treatment. We set out to monitor and determine the actual incidence of CK elevation and evaluate its potential association with other clinical factors. Methods: This is an observational retrospective multicenter study performed in rapidly progressive ADPKD patients on tolvaptan treatment from Barcelona, Spain. Laboratory tests, demographics, treatment dose, and reported symptoms were collected from October 2018 to March 2021. Results: Ninety-five patients initiated tolvaptan treatment during follow-up. The medication had to be discontinued in 31 (32.6%) patients, primarily due to aquaretic effects (12.6%), elevated liver enzymes (8.4%), and symptomatic or persistently elevated CK levels (3.2%). Moreover, a total of 27 (28.4%) patients had elevated CK levels, with most of them being either transient (12.6%), mild and asymptomatic (4.2%), or resolved after dose reduction (3.2%) or temporary discontinuation (2.1%). Conclusion: We pre-sent the largest cohort that has monitored CK levels in a real-life setting, finding them elevated in 28.4% of patients. More research and monitoring will help us understand the clinical implications and the pathophysiological mechanism of CK elevation in this population

Creatine Kinase Elevation in Autosomal Dominant Polycystic Kidney Disease Patients on Tolvaptan Treatment

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of end-stage kidney disease. Currently, tolvaptan is the only treatment that has proven to delay disease progression. The most notable side effect of this therapy is drug-induced liver injury; however, recently, there have been two reports of creatine kinase (CK) elevation in ADPKD patients on tolvaptan treatment. We set out to monitor and determine the actual incidence of CK elevation and evaluate its potential association with other clinical factors. This is an observational retrospective multicenter study performed in rapidly progressive ADPKD patients on tolvaptan treatment from Barcelona, Spain. Laboratory tests, demographics, treatment dose, and reported symptoms were collected from October 2018 to March 2021. Ninety-five patients initiated tolvaptan treatment during follow-up. The medication had to be discontinued in 31 (32.6%) patients, primarily due to aquaretic effects (12.6%), elevated liver enzymes (8.4%), and symptomatic or persistently elevated CK levels (3.2%). Moreover, a total of 27 (28.4%) patients had elevated CK levels, with most of them being either transient (12.6%), mild and asymptomatic (4.2%), or resolved after dose reduction (3.2%) or temporary discontinuation (2.1%). We pre­sent the largest cohort that has monitored CK levels in a real-life setting, finding them elevated in 28.4% of patients. More research and monitoring will help us understand the clinical implications and the pathophysiological mechanism of CK elevation in this population

Las Comisiones de Monumentos y las Sociedades Arqueológicas como instrumentos para la construcción del pasado europeo

Coordinadores: Trinidad Tortosa Rocamora y Gloria Mora.Las Comisiones de Monumentos o de Antigüedades y las Sociedades Arqueológicas aparecen en el contexto europeo del siglo XIX como verdaderos instrumentos, en origen, de la gestión arqueológica percibida como una cuestión nacional. Aprovechando el interés que esta temática ha suscitado en los últimos años en nuestro país hemos querido cotejar las diferentes fases de este proceso con las situaciones confirmadas en otros países como Portugal, Francia e Italia. El debate, sin duda, nos llevará a reflexionar sobre los mitos de la arqueología que, a veces, por otros caminos diferentes a las vías académicas, convierten determinados temas en auténticos baluartes de la identidad nacional.Peer reviewe

Predicting Clinical Outcome with Phenotypic Clusters in COVID-19 Pneumonia: An Analysis of 12,066 Hospitalized Patients from the Spanish Registry SEMI-COVID-19

(1) Background: Different clinical presentations in COVID-19 are described to date, from mild to severe cases. This study aims to identify different clinical phenotypes in COVID-19 pneumonia using cluster analysis and to assess the prognostic impact among identified clusters in such patients. (2) Methods: Cluster analysis including 11 phenotypic variables was performed in a large cohort of 12,066 COVID-19 patients, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish Society of Internal Medicine (SEMI)-COVID-19 Registry. (3) Results: Of the total of 12,066 patients included in the study, most were males (7052, 58.5%) and Caucasian (10,635, 89.5%), with a mean age at diagnosis of 67 years (standard deviation (SD) 16). The main pre-admission comorbidities were arterial hypertension (6030, 50%), hyperlipidemia (4741, 39.4%) and diabetes mellitus (2309, 19.2%). The average number of days from COVID-19 symptom onset to hospital admission was 6.7 (SD 7). The triad of fever, cough, and dyspnea was present almost uniformly in all 4 clinical phenotypes identified by clustering. Cluster C1 (8737 patients, 72.4%) was the largest, and comprised patients with the triad alone. Cluster C2 (1196 patients, 9.9%) also presented with ageusia and anosmia; cluster C3 (880 patients, 7.3%) also had arthromyalgia, headache, and sore throat; and cluster C4 (1253 patients, 10.4%) also manifested with diarrhea, vomiting, and abdominal pain. Compared to each other, cluster C1 presented the highest in-hospital mortality (24.1% vs. 4.3% vs. 14.7% vs. 18.6%; p 20 bpm, lower PaO2/FiO2 at admission, higher levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH), and the phenotypic cluster as independent factors for in-hospital death. (4) Conclusions: The present study identified 4 phenotypic clusters in patients with COVID-19 pneumonia, which predicted the in-hospital prognosis of clinical outcomes