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To investigate whether serum albumin levels within 24 h of admission correlate with outcomes in community-acquired pneumonia (CAP).Observational analysis of a prospective cohort of adults with CAP requiring hospitalization from 1995 through 2011. Serum albumin level was the independent variable. The primary end point was 30-day mortality.During the study period, 3463 patients with CAP required hospitalization. The median value of albumin was 31 g/L (IQR 28-35). As levels of serum albumin decrease, the risk of complications significantly increases (P.001). Decreased albumin levels were also associated with prolonged time to reach clinical stability (P.001), prolonged hospital stay (P.001), ICU admission (P.001), the need for mechanical ventilation (P.001), and 30-day mortality (P.001). After adjusting for potential confounders in a multivariate logistic regression analysis, serum albumin levels at admission (-5 g/L decrease) were independently associated with a higher risk of 30-day mortality (OR 2.11, 95% CI 1.73-2.56). For predicting primary end point, hypoalbuminemia (30 g/L) significantly increased the area under ROC curves of PSI and CURB-65 scores (P ≤ .02), and identified those patients with higher risk of complications classified into low- and high-risk groups by these scores.Serum albumin level within 24 h of admission is a good prognostic marker in CAP. Physicians should consider albumin level when evaluating the severity of illness in patients with CAP.

Recent changes in the management of patients with haematological malignancies might have influenced the aetiology, characteristics, antimicrobial resistance and outcomes of bloodstream infection (BSI) during neutropenia. We compared 272 episodes of BSI in adult neutropenic patients with cancer prospectively collected from January 1991 to December 1996 (first period), when quinolone prophylaxis was used, with 283 episodes recorded from January 2006 to March 2010 (second period), when antibacterial prophylaxis was stopped. Patients in the second period were significantly older and were more likely to have graft-versus-host disease and a urinary catheter in place, whereas the presence of a central venous catheter, parenteral nutrition, corticosteroids and antifungal and quinolone prophylaxis, were more frequent in the first period. More patients in the first period had mucositis and soft-tissue infection as the origin of BSI, but an endogenous source was more common during the second. Gram-positive BSI was more frequent in the first period (64% versus 41%; p

Resumen Fundamento y objetivo Describir nuestra cohorte de pacientes con nefritis lupica mesangial proliferativa y su seguimiento a largo plazo, con especial atencion a los factores de mal pronostico. Pacientes y metodo Se evaluaron 27 pacientes de forma retrospectiva y controlados en el Servicio de Medicina Interna del Hospital Universitario de Bellvitge entre 1974 y 2010. Se realizo un control al ano, a los 3 y a los 5 anos de la biopsia. Resultados Habia 22 mujeres (81,5%), con una edad media (DE) en el momento del diagnostico de la nefritis de 34,83 (13,45) anos. Al ano de la biopsia 21 pacientes habian alcanzado la remision parcial o completa (80,77%) y a los 5 anos de control 21 pacientes (77,77%) estaban en remision. Cuatro pacientes sufrieron transformacion a otra clase histologica. Recidivaron 7 pacientes (29,63%). En estos 36 anos de seguimiento fallecieron 7 pacientes, 3 de ellos por causas relacionadas con el lupus eritematoso sistemico. Conclusiones El factor pronostico mas claramente relacionado con una mala respuesta es el inicio de la nefritis por encima de los 45 anos, por lo que se deberia valorar el uso de inmunodepresores de entrada asociados a glucocorticoides en estos pacientes.

Little information is available on the changes over time in community-acquired pneumonia (CAP) management and their impact on 30-day mortality in hospitalized patients. We performed a prospective, observational study of non-severely immunosuppressed hospitalized adults with CAP from 1995 to 2014. A total of 4558 patients were included. Thirty-day mortality decreased from 9.6% in the first study period (1995–99) to 4.1% in the last period (2010–14); with a progressive downward trend (–0.2% death/year; p for trend = 0.003). Over time, patients were older (p 0.02), had more co-morbidities (p 0.037), more frequently presented severe illness according to the Pneumonia Severity Index (p