Potential biomarkers predictors of mortality in COVID-19 patients in the Emergency Department

NATALIA F. PASCUAL GÓMEZ, IVÁN MONGE LOBO, INMACULADA GRANERO CREMADES, ANGELS FIGUEROLA TEJERINA, FERNANDO RAMASCO RUEDA, ANDRÉS VON WERNITZ TELEKI, FRANCISCO MANUEL ARRABAL CAMPOS, M. ÁNGELES SANZ DE BENITO

Published: 13 July 2020

http://www.doi.org/10.37201/req/060.2020

Objective. Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk.
Method. Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score.
Results. A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%).
Conclusions. Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.

Rev Esp Quimioter 2020; 33(4): 267-273 [Texto completo PDF]

Debut pediátrico de fascitis necrotizante   

(Necrotizing fasciitis pediatric debut)

ROCÍO CABRA-RODRÍGUEZ, MARÍA JOSÉ RUÍZ-MÁRQUEZ

Published: 6 July 2020

http://www.doi.org/10.37201/req/036.2020

LETTER TO THE EDITOR

Rev Esp Quimioter 2020; 33(5): 383-384 [Texto completo PDF]

Hemophagocytic syndrome in patients infected with the human immunodeficiency virus: A study of 15 consecutive patients

LAURA SUÁREZ-HORMIGA, MARÍA-NIEVES JAÉN-SÁNCHEZ, EDWIN-ANDRÉS VERDUGO-ESPINOSA, CRISTINA CARRANZA-RODRÍGUEZ, PILAR-MICHELE HERNÁNDEZ-CABRERA, ELENA PISOS-ÁLAMO, ADELA FRANCÉS-URMENETA, JOSÉ-LUIS PÉREZ-ARELLANO

Published: 19 June 2020

http://www.doi.org/10.37201/req/037.2020

Objectives. Hemophagocytic syndrome (HPS) is characterized by various clinical and biological data derived from cytokine hyperproduction and cell proliferation. The objectives of this study were to evaluate the epidemiological, etiological, clinical and evolutionary characteristics of patients diagnosed with hemophagocytic syndrome and HIV infection, as well as their comparison with data from the literature.
Methods. A retrospective descriptive observational study was performed, including all adult patients with a diagnosis of HPS and HIV infection treated in the Infectious Diseases and Tropical Medicine Unit of the Hospital Universitario Insular, Las Palmas, Gran Canaria from June 1, 1998 to December 31, 2018.
Results. An analysis of this series of case reports of 15 patients showed a higher percentage of males than females, with a mean age of 42 years. With respect to the diagnostic criteria for HPS, presence of fever, cytopenias and hyperferritinemia were a constant in all patients. Clinical neurological manifestations were frequent and clinical respiratory signs and symptoms absent. HPS was confirmed in some patients who were not severely immune-depressed and had undetectable viral loads. Furthermore, 40% of cases were not receiving ART. The most frequent triggering causes of HPS were viral, especially HHV-8. In addition, two new HPS triggers were identified: Blastocystis dermatitidis and Mycobacterium chelonae.
Conclusion. Administration of treatment in HPS is arbitrary. This, together with the high mortality rate and the fact that it is underdiagnosed, indicates the importance of conducting future studies.

Rev Esp Quimioter 2020; 33(4): 249-257 [Full-text PDF]

Impact of Spanish Public Health Measures on Emergency Visits and COVID- 19 diagnosed cases during the pandemic in Madrid   

FRANCISCO JAVIER MARTÍN-SÁNCHEZ, ADRIÁN VALLS CARBÓ, AMANDA LÓPEZ PICADO, CARMEN MARTÍNEZ-VALERO, JUANDE D. MIRANDA, JOSÉ MARÍA LEAL POZULEO, JUAN GONZÁLEZ DEL CASTILLO

Published: 10 June 2020

http://www.doi.org/10.37201/req/053.2020

Introduction. Changes in Public Health recommendations may have changed the number of emergency visits and COVID-19 diagnosed cases in an Emergency Department in Madrid.
Material and methods. This retrospective case series study included all consecutive patients in a tertiary and urban ED in Madrid from 1st to 31st March. The sample was divided: NonCOVID-19, Non-investigated COVID-19, Possible COVID-19, Probable COVID-19, Confirmed COVID-19. Differences between public health periods were tested by ANOVA for each cohort, and by ANCOVA including the number of PCR tests (%) as covariate.
Results. A total of 7,163 (4,071 Non-COVID-19, 563 Non-investigated COVID-19, 870 Possible, 648 Probable and 1,011 Confirmed COVID-19) cases were included. Public Health measurements applied during each period showed a clear effect on the case proportion for the five cohorts.
Conclusion. The variability of case definitions and diagnostic test criteria may have impact on the number of emergency visits and COVID-19 diagnosed cases in Emergency Department.

Rev Esp Quimioter 2020; 33(4): 274-277 [Full-text PDF]

High-dose trivalent influenza vaccine. Efficacy and effectiveness 

ÁNGEL GIL DE MIGUEL, ESTHER REDONDO MARGUELLO, JAVIER DÍEZ DOMINGO, RAÚL ORTIZ DE LEJARAZU, FEDERICO MARTINÓN TORRES

Published: 9 June 2020

http://www.doi.org/10.37201/req/043.2020

Seasonal influenza is a major public health problem, particularly in older people. Influenza vaccine is the most effective way to prevent influenza virus infection and its complications, but due to immunosenescence, older people do not respond efficiently to immunization. In 2009, a high-dose trivalent influenza vaccine (IIV3-HD), containing four times more antigen than the standard-dose vaccine, was approved in the United States for the immunization of people aged 65 years and over. Numerous clinical trials, carried out at different seasons and using different methodologies, have shown that the IIV3-HD vaccine is, as well as safe, more immunogenic and more effective than the standard-dose vaccine in preventing influenza virus infection and its complications in older people. This paper reviews the available evidence on the efficacy and effectiveness of the IIV3-HD influenza vaccine in the elderly, with information from randomized clinical trials, as well as observational studies of real-world clinical practice and in systematic reviews/meta-analyses.

Rev Esp Quimioter 2020; 33(4): 226-239 [Texto completo PDF]