20 results on '"Muriel, Alfonso"'
Search Results
2. Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study
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Peñuelas, Oscar, del Campo-Albendea, Laura, de Aledo, Amanda Lesmes González, Añón, José Manuel, Rodríguez-Solís, Carmen, Mancebo, Jordi, Vera, Paula, Ballesteros, Daniel, Jiménez, Jorge, Maseda, Emilio, Figueira, Juan Carlos, Franco, Nieves, Algaba, Ángela, Avilés, Juan Pablo, Díaz, Ricardo, Abad, Beatriz, Canabal, Alfonso, Abella, Ana, Gordo, Federico, García, Javier, Suarez, Jessica García, Cedeño, Jamil, Martínez-Palacios, Basilia, Manteiga, Eva, Martínez, Óscar, Blancas, Rafael, Bardi, Tommaso, Pestaña, David, Lorente, José Ángel, Muriel, Alfonso, Esteban, Andrés, and Frutos-Vivar, Fernando
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- 2021
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3. Inter-country variability over time in the mortality of mechanically ventilated patients
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Peñuelas, Oscar, Muriel, Alfonso, Abraira, Victor, Frutos-Vivar, Fernando, Mancebo, Jordi, Raymondos, Konstantinos, Du, Bin, Thille, Arnaud W., Ríos, Fernando, González, Marco, del-Sorbo, Lorenzo, Ferguson, Niall D., del Carmen Marín, Maria, Pinheiro, Bruno Valle, Soares, Marco Antonio, Nin, Nicolas, Maggiore, Salvatore M., Bersten, Andrew, Amin, Pravin, Cakar, Nahit, Suh, Gee Young, Abroug, Fekri, Jibaja, Manuel, Matamis, Dimitros, Zeggwagh, Amine Ali, Sutherasan, Yuda, Anzueto, Antonio, and Esteban, Andrés
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- 2020
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4. CD4/CD8 ratio and CD8+ T-cell count as prognostic markers for non-AIDS mortality in people living with HIV. A systematic review and meta-analysis.
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Ron, Raquel, Martínez-Sanz, Javier, Herrera, Sabina, Ramos-Ruperto, Luis, Díez-Vidal, Alejandro, Sainz, Talía, Álvarez-Díaz, Noelia, Correa-Pérez, Andrea, Muriel, Alfonso, López-Alcalde, Jesús, Pérez-Molina, José A., Moreno, Santiago, and Serrano-Villar, Sergio
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HIV-positive persons ,CD8 antigen ,PROGNOSIS ,T cells ,BIOMARKERS - Abstract
Background: In people living with HIV (PLHIV), the CD4/CD8 ratio has been proposed as a useful marker for non-AIDS events. However, its predictive ability on mortality over CD4 counts, and the role of CD8+ T-cell counts remain controversial. Methods: We conducted a systematic review and meta-analysis of published studies from 1996 to 2023, including PLHIV on antiretroviral treatment, and reporting CD4/CD8 ratio or CD8+ counts. The primary outcome was non-AIDS mortality or all-cause mortality. We performed a standard random-effects pairwise meta-analysis comparing low versus high CD4/CD8 ratio with a predefined cut-off point of 0.5. (CRD42020170931). Findings: We identified 2,479 studies for screening. 20 studies were included in the systematic review. Seven studies found an association between low CD4/CD8 ratio categories and increased mortality risk, with variable cut-off points between 0.4-1. Four studies were selected for meta-analysis, including 12,893 participants and 618 reported deaths. Patients with values of CD4/CD8 ratio below 0.5 showed a higher mortality risk (OR 3.65; 95% CI 3.04 - 4.35; I2 = 0.00%) compared to those with higher values. While the meta-analysis of CD8+ T-cell counts was not feasible due to methodological differences between studies, the systematic review suggests a negative prognostic impact of higher values (>1,138 to 1,500 cells/uL) in the long term. Conclusions: Our results support the use of the CD4/CD8 ratio as a prognostic marker in clinical practice, especially in patients with values below 0.5, but consensus criteria on ratio timing measurement, cut-off values, and time to event are needed in future studies to get more robust conclusions. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Impact of sedation and analgesia during noninvasive positive pressure ventilation on outcome: a marginal structural model causal analysis
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Muriel, Alfonso, Peñuelas, Oscar, Frutos-Vivar, Fernando, Arroliga, Alejandro C., Abraira, Victor, Thille, Arnaud W., Brochard, Laurent, Nin, Nicolás, Davies, Andrew R., Amin, Pravin, Du, Bin, Raymondos, Konstantinos, Rios, Fernando, Violi, Damian A., Maggiore, Salvatore M., Soares, Marco Antonio, González, Marco, Abroug, Fekri, Bülow, Hans-Henrik, Hurtado, Javier, Kuiper, Michael A., Moreno, Rui P., Zeggwagh, Amine Ali, Villagómez, Asisclo J., Jibaja, Manuel, Soto, Luis, D’Empaire, Gabriel, Matamis, Dimitrios, Koh, Younsuck, Anzueto, Antonio, Ferguson, Niall D., and Esteban, Andrés
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- 2015
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6. Randomised controlled trial of a prognostic assessment and management pathway to reduce the length of hospital stay in normotensive patients with acute pulmonary embolism
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Jimenez, David, Rodriguez, Carmen, Leon, Francisco, Jara-Palomares, Luis, Lopez-Reyes, Raquel, Ruiz-Artacho, Pedro, Elias, Teresa, Otero, Remedios, Garcia-Ortega, Alberto, Rivas-Guerrero, Agustina, Abelaira, Jaime, Jimenez, Sonia, Muriel, Alfonso, Morillo, Raquel, Barrios, Deisy, Le Mao, Raphael, Yusen, Roger D, Bikdeli, Behnood, Monreal, Manuel, Lobo, Jose Luis, and IPEP investigators
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OUTPATIENT ,MORTALITY ,EARLY MOBILIZATION ,BURDEN ,COSTS - Abstract
The length of hospital stay ( LOS ) for acute pulmonary embolism ( PE ) varies considerably. Whether the upfront use of a PE prognostic assessment and management pathway is effective in reducing the LOS remains unknown.
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- 2021
7. Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism.
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Jaureguízar, Ana, Jiménez, David, Bikdeli, Behnood, Ruiz-Artacho, Pedro, Muriel, Alfonso, Tapson, Victor, López-Reyes, Raquel, Valero, Beatriz, Kenet, Gili, Monreal, Manuel, and Registro Informatizado de la Enfermedad TromboEmbólica Investigators
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PULMONARY embolism ,HEART beat ,DEATH rate ,MORTALITY ,REFERENCE values - Abstract
Background: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known.Research Question: Does an association exist between baseline HR and PE outcome across the continuum of HR values?Study Design and Methods: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes.Results: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%.Interpretation: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE. [ABSTRACT FROM AUTHOR]- Published
- 2022
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8. Driving Pressure Is a Risk Factor for ARDS in Mechanically Ventilated Subjects Without ARDS.
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Roca, Oriol, Peñuelas, Oscar, Muriel, Alfonso, García-de-Acilu, Marina, Laborda, César, Sacanell, Judit, Riera, Jordi, Raymondos, Konstantinos, Bin Du, Thille, Arnaud W., Ríos, Fernando, González, Marco, del-Sorbo, Lorenzo, Marín, Maria del Carmen, Soares, Marco Antonio, Valle Pinheiro, Bruno, Nin, Nicolas, Maggiore, Salvatore M., Bersten, Andrew, and Amin, Pravin
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LUNG injuries ,STATISTICS ,RESEARCH ,SCIENTIFIC observation ,CONFIDENCE intervals ,MECHANICAL ventilators ,POSITIVE end-expiratory pressure ,AIRWAY (Anatomy) ,PATIENTS ,RESPIRATORY measurements ,CONTINUING education units ,MEDICAL cooperation ,MANN Whitney U Test ,FISHER exact test ,ADULT respiratory distress syndrome ,ARTIFICIAL respiration ,RISK assessment ,T-test (Statistics) ,CHI-squared test ,DATA analysis ,LOGISTIC regression analysis ,ODDS ratio ,LONGITUDINAL method ,DISEASE risk factors - Abstract
BACKGROUND: Driving pressure (DP) has been described as a risk factor for mortality in patients with ARDS. However, the role of DP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. METHODS: This was a post hoc analysis of a multicenter, prospective, observational, international study that included subjects who were on mechanical ventilation for > 12 h. Our objective was to evaluate the association between DP on the first day of mechanical ventilation with the development of ARDS. To assess the effect of DP, a logistic regression analysis was performed when adjusting for other potential risk factors. Validation of the results obtained was performed by using a bootstrap method and by repeating the same analyses at day 2. RESULTS: A total of 1,575 subjects were included, of whom 65 (4.1%) developed ARDS. The DP was independently associated with ARDS (odds ratio [OR] 1.12, 95% CI 1.07-1.18 for each cm H
2 O of DP increase, P < .001). The same results were observed at day 2 (OR 1.14, 95% CI 1.07-1.21; P < .001) and after bootstrap validation (OR 1.13, 95% CI 1.04-1.22; P < .001). When taking the prevalence of ARDS in the lowest quartile of DP (≤9 cm H2 O) as a reference, the subjects with DP > 12-15 cm H2 O and those with DP > 15 cm H2 O presented a higher probability of ARDS (OR 3.65, 95% CI 1.32-10.04 [P 5 .01] and OR 7.31, 95% CI, 2.89-18.50 [P < .001], respectively). CONCLUSIONS: In the subjects without ARDS, a higher level of DP on the first day of mechanical ventilation was associated with later development of ARDS. (ClinicalTrials.gov registration NCT02731898.) [ABSTRACT FROM AUTHOR]- Published
- 2021
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9. Risk Factors and Relation with Mortality of a New Acquisition and Persistence of Pseudomonas aeruginosa in COPD Patients.
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Martínez-García, Miguel Ángel, Faner, Rosa, Oscullo, Grace, de la Rosa-Carrillo, David, Soler-Cataluña, Juan Jose, Ballester, Marta, Muriel, Alfonso, and Agusti, Alvar
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BRONCHIECTASIS ,PSEUDOMONAS aeruginosa ,OBSTRUCTIVE lung diseases ,MORTALITY ,PHYSICIANS ,HAEMOPHILUS influenzae - Abstract
The isolation of Pseudomonas aeruginosa (PA) in patients with chronic obstructive pulmonary disease (COPD) is associated with increased mortality. Yet, factors associated with first PA sputum isolation, and PA persistence have not been investigated before. The objective of the present study was to investigate risk factors for new acquisition and persistence of PA infection and their relationship with all-cause mortality in patients with COPD. Post-hoc analysis of prospectively collected cohort of 170 COPD patients (GOLD II-IV) who were free of previous PA isolation and followed up every 3-6 months for 85 [50.25-110.25] months. PA was isolated for the first time in 41 patients (24.1%) after 36 [12-60] months of follow-up. Risk factor for first PA isolation were high cumulative smoking exposure, severe airflow limitation, previous severe exacerbations, high fibrinogen levels and previous isolation of Haemophilus Influenzae. PA was isolated again one or more times during follow-up in 58.5% of these patients. This was significantly associated with the presence of CT bronchiectasis and persistence of severe exacerbations, whereas the use of inhaled antibiotic treatment after the first PA isolation (at the discretion of the attending physician) reduced PA persistence. During follow-up, 79 patients (46.4%) died. A single PA isolation did not increase mortality, but PA persistence did (HR 3.06 [1.8-5.2], p = 0.001). We conclude that PA occurs frequently in clinically stable COPD patients, risk factors for a first PA isolation and PA persistence are different, and the latter (but not the former) is associated with increased all-cause mortality. [ABSTRACT FROM AUTHOR]
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- 2021
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10. Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients.
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Wernly, Bernhard, Bruno, Raphael Romano, Frutos-Vivar, Fernando, Peñuelas, Oscar, Rezar, Richard, Raymondos, Konstantinos, Muriel, Alfonso, Bin Du, Thille, Arnaud W., Ríos, Fernando, González, Marco, del-Sorbo, Lorenzo, Marín, Maria del Carmen, Pinheiro, Bruno Valle, Soares, Marco Antonio, Nin, Nicolas, Maggiore, Salvatore M., Bersten, Andrew, Kelm, Malte, and Amin, Pravin
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MORTALITY risk factors ,STATISTICS ,SURVIVAL ,CONFIDENCE intervals ,ANALYSIS of variance ,MORTALITY ,MULTIPLE regression analysis ,AGE distribution ,RETROSPECTIVE studies ,ARTIFICIAL respiration ,TREATMENT effectiveness ,RISK assessment ,CRITICAL care medicine ,DESCRIPTIVE statistics ,DATA analysis ,LOGISTIC regression analysis ,ODDS ratio ,DATA analysis software ,LONGITUDINAL method ,OLD age - Abstract
BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H
2 O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.) [ABSTRACT FROM AUTHOR]- Published
- 2021
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11. Effects of tocilizumab on mortality in hospitalized patients with COVID-19: a multicentre cohort study.
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Martínez-Sanz, Javier, Muriel, Alfonso, Ron, Raquel, Herrera, Sabina, Pérez-Molina, José A., Moreno, Santiago, and Serrano-Villar, Sergio
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COVID-19 , *HOSPITAL patients , *TOCILIZUMAB , *STATISTICAL models , *DRUG efficacy , *HOSPITAL mortality - Abstract
Tocilizumab has been proposed as a candidate therapy for patients with severe coronavirus disease 2019 (COVID-19), especially among those with higher systemic inflammation. We investigated the association between receipt of tocilizumab and mortality in a large cohort of hospitalized patients. In this cohort study of patients hospitalized with COVID-19 in Spain, the primary outcome was time to death and the secondary outcome time to intensive care unit (ICU) admission or death. We used inverse probability weighting to fit marginal structural models adjusted for time-varying covariates to determine the causal relationship between receipt of tocilizumab and outcome. Data from 1229 patients were analysed, with 261 patients (61 deaths) in the tocilizumab group and 969 patients (120 deaths) in the control group. In the adjusted marginal structural models, a significant interaction between receipt of tocilizumab and high C-reactive protein (CRP) levels was detected. Tocilizumab was associated with decreased risk of death (adjusted hazard ratio 0.34, 95% confidence interval 0.16–0.72, p 0.005) and ICU admission or death (adjusted hazard ratio 0.39, 95% confidence interval 0.19–0.80, p 0.011) among patients with baseline CRP >150 mg/L but not among those with CRP ≤150 mg/L. Exploratory subgroup analyses yielded point estimates that were consistent with these findings. In this large observational study, tocilizumab was associated with a lower risk of death or ICU admission or death in patients with higher CRP levels. While the results of ongoing clinical trials of tocilizumab in patients with COVID-19 will be important to establish its safety and efficacy, our findings have implications for the design of future clinical trials. [ABSTRACT FROM AUTHOR]
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- 2021
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12. Implications of Abnormal Troponin Levels With Normal Right Ventricular Function in Normotensive Patients With Acute Pulmonary Embolism.
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Mirambeaux, Rosa, Le Mao, Raphael, Muriel, Alfonso, Pintado, Beatriz, Pérez, Andrea, Velasco, Diurbis, Lobo, José Luis, Barrios, Deisy, Morillo, Raquel, Bikdeli, Behnood, and Jiménez, David
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PULMONARY embolism ,TROPONIN ,GUIDELINES - Abstract
Among patients with pulmonary embolism (PE), various permutations of normal or abnormal cardiac troponin results and normal or abnormal echocardiographic right ventricular function are encountered in clinical practice. We aimed to explore whether there is a true gradient of risk based on troponin and echocardiographic results. This study included normotensive patients with PE from the PROgnosTic valuE of CT scan in hemodynamically stable patients with acute symptomatic pulmonary embolism (PROTECT) study. Patients were categorized as having -Troponin/-Echo, -Troponin/+Echo, +Troponin/-Echo, and +Troponin/+Echo. The primary outcome was 30-day "complicated course," including death from any cause, hemodynamic collapse, or recurrent PE. Secondary outcomes included individual adverse event rates. Of the 834 patients who had echocardiographic and troponin results, 569 patients (68%) had -Troponin/-Echo, 126 patients (15%) had -Troponin/+Echo, 74 patients (8.9%) had +Troponin/-Echo, and 65 patients (7.8%) had +Troponin/+Echo. The incidence of 30-day complicated course was 4.6% in patients with -Troponin/-Echo, 11.9% in patients with -Troponin/+Echo, 13.5% in patients with +Troponin/-Echo, and 16.9% in patients with +Troponin/+Echo (P for trend <0.001). In the subgroup of patients with a high-risk sPESI (i.e., intermediate-risk according to the ESC guidelines) (n = 527), the incidence of 30-day complicated course was 14.9% in patients with -Troponin/+Echo, 18.5% in patients with +Troponin/-Echo, and 17.5% in patients with +Troponin/+Echo (P for trend <0.01). In patiens with PE, there seems to be a risk gradient based on troponin and echocardiographic results. This study did not detect a significant risk difference in those with +Troponin/-Echo compared with -Troponin/+Echo. [ABSTRACT FROM AUTHOR]
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- 2020
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13. Mortalidad en lista de espera para trasplante renal
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Hernández, Domingo, Castro-de la Nuez, Pablo, Muriel, Alfonso, Ruiz-Esteban, Pedro, and Alonso, Manuel
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Kidney transplantation ,Trasplante renal ,Lista de espera ,Mortalidad ,Waiting list ,Diálisis ,Comorbidity ,Riesgo competitivo ,Mortality ,Competing risk ,Comorbilidad ,Dialysis - Abstract
El trasplante renal (Tx) representa el tratamiento de elección para los pacientes con enfermedad renal crónica avanzada (ERC), pero la escasez de órganos disponibles para aquellos con gran comorbilidad puede incrementar significativamente la mortalidad en enfermos candidatos a Tx. Esto constituye un problema sanitario preocupante, dado el incremento de los pacientes incidentes y prevalentes con ERC, especialmente de aquellos con ERC secundaria a entidades de gran comorbilidad como la diabetes y la hipertensión arterial. Asimismo, este hecho puede incrementar el número de pacientes en lista de espera (LE) y disparar sus cifras de mortalidad. Por tanto, actualmente resulta pertinente identificar las causas de muerte y los factores de riesgo de mortalidad en esta población, conocer las barreras que limitan el acceso al Tx y aplicar modelos predictivos de mortalidad en aras de mejorar los resultados de estos enfermos en términos de supervivencia. En esta revisión sobre la mortalidad de los pacientes en LE se abordarán los siguientes aspectos: 1) la magnitud de este problema y la importancia de algunos datos epidemiológicos; 2) los factores de riesgo de mortalidad en estos enfermos y las barreras que existen para el acceso al Tx que pudieran incrementar la mortalidad en esta población; 3) evaluación del riesgo de muerte de los pacientes en diálisis a partir de la comorbilidad; y 4) valoración de la mortalidad en LE mediante análisis de regresión de riesgos competitivos y la generación de un modelo de riesgo compuesto, incluyendo la comorbilidad y otros factores urémicos. Renal transplantation (Tx) represents the treatment of choice for patients with advanced chronic kidney disease (ACKD), but the shortage of available organs for those with a high level of comorbidity can significantly increase mortality in patients who are candidates for Tx. This constitutes a worrying health care problem, given the increase in incident and prevalent patients with ACKD, and is especially concerning amongst those with ACKD that is secondary to conditions with a high level of comorbidity, such as diabetes or arterial hypertension. In addition, this can increase the number of patients on the waiting list (WL) and cause the rapid raising of mortality figures. Therefore, nowadays it is relevant to identify the causes of death and the mortality risk factors in this population, to know the barriers that limit access to Tx and to apply predictive mortality models, with the aim of improving survival rates from these illnesses. In this review on the mortality of the patients on the WL, the following aspects will be addressed: 1) the magnitude of this problem and the importance of certain epidemiological data; 2) the mortality risk factors in these patients and the barriers that exist against access to Tx, which could increase mortality rates amongst this population; 3) evaluation of the risk of death in patients on dialysis from comorbidity; 4) assessment of mortality on the WL, via regression analysis of competitive risks, and the generation of a compound risk model, which includes comorbidity and other uraemic factors.
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- 2015
14. Prediction and Outcome of Intensive Care Unit-Acquired Paresis.
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Peñuelas, Oscar, Muriel, Alfonso, Frutos-Vivar, Fernando, Fan, Eddy, Raymondos, Konstantinos, Rios, Fernando, Nin, Nicolás, Thille, Arnaud W., González, Marco, Villagomez, Asisclo J., Davies, Andrew R., Du, Bin, Maggiore, Salvatore M., Matamis, Dimitrios, Abroug, Fekri, Moreno, Rui P., Kuiper, Michael A., Anzueto, Antonio, Ferguson, Niall D., and Esteban, Andrés
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HEMIPLEGIA , *ACUTE kidney failure , *ARTIFICIAL respiration , *CONFIDENCE intervals , *CROSS infection , *INFANT weaning , *INSULIN , *INTENSIVE care units , *MEDICAL screening , *MORTALITY , *HEALTH outcome assessment , *PROBABILITY theory , *QUADRIPLEGIA , *SEPSIS , *STEROIDS , *STRETCH reflex , *TENDONS , *MULTIPLE regression analysis , *SECONDARY analysis , *RELATIVE medical risk , *STATISTICAL models , *DESCRIPTIVE statistics , *DISEASE risk factors - Abstract
Background: Intensive care unit-acquired paresis (ICUAP) is associated with poor outcomes. Our objective was to evaluate predictors for ICUAP and the short-term outcomes associated with this condition. Methods: A secondary analysis of a prospective study including 4157 mechanically ventilated adults in 494 intensive care units from 39 countries. After sedative interruption, patients were screened for ICUAP daily, which was defined as the presence of symmetric and flaccid quadriparesis associated with decreased or absent deep tendon reflexes. A multinomial logistic regression was used to create a predictive model for ICUAP. Propensity score matching was used to estimate the relationship between ICUAP and short-term outcomes (ie, weaning failure and intensive care unit [ICU] mortality). Results: Overall, 114 (3%) patients had ICUAP. Variables associated with ICUAP were duration of mechanical ventilation (relative risk ratio [RRR] per day, 1.10; 95% confidence interval [CI] 1.08-1.12), steroid therapy (RRR 1.8; 95% CI, 1.2-2.8), insulin therapy (RRR 1.8; 95% CI 1.2-2.7), sepsis (RRR 1.9; 95% CI: 1.2 to 2.9), acute renal failure (RRR 2.2; 95% CI 1.5-3.3), and hematological failure (RRR 1.9; 95% CI: 1.2-2.9). Coefficients were used to generate a weighted scoring system to predict ICUAP. ICUAP was significantly associated with both weaning failure (paired rate difference of 22.1%; 95% CI 9.8-31.6%) and ICU mortality (paired rate difference 10.5%; 95% CI 0.1-24.0%). Conclusions: Intensive care unit-acquired paresis is relatively uncommon but is significantly associated with weaning failure and ICU mortality. We constructed a weighted scoring system, with good discrimination, to predict ICUAP in mechanically ventilated patients at the time of awakening. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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15. Missing Scheduled Visits in the Outpatient Clinic as a Marker of Short-Term Admissions and Death.
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Colubi, María Martínez, Pérez-Elias, María Jesús, Elias, Laura, Pumares, Maria, Muriel, Alfonso, Zamora, Ana Moreno, Casado, Jose Luis, Dronda, Fernando, López, Dolores, and Moreno, Santiago
- Abstract
Introduction: It is not uncommon for patients with HIV infection to miss scheduled visits in outpatient clinics without justifying the failure to appear or reschedule the appointment. Few studies have assessed the impact of inconsistent follow-ups on resource use and disease outcomes in this patient population. Objective: To assess the effect of missing scheduled visits to the outpatient clinic on the health outcomes of HIV-infected patients. Methods: Between January and June 2006, we conducted a prospective observational study monitoring assistance at an outpatient HIV/AIDS clinic of a tertiary hospital within a public health care system in a developed country. The short-term subsequent events (deaths and admissions) of the population were observed from January to December 2006. Results: Of the 1,733 HIV patients who were scheduled in the outpatient clinic, 103 met the criteria of missing scheduled visit (5.9%). Hospital admissions and mortality rates were significantly higher in the missing scheduled visit group compared to non-missing scheduled visits (27.2% vs 8.9%; P<.001 and 5.8% vs 0.7%; P<.001, respectively). Patients with missing scheduled visits had a higher risk of hospital admissions (odds ratio [OR] 2.4; 95% Cl, 1.4-4) and mortality (OR 6.7; 95% Cl, 2.2-18.5) adjusted by age, CD4 cell count, HIV stage, and category of transmission. Conclusions: Missing scheduled visits was an independent predicting factor for hospital admission and mortality. It is warranted to monitor and implement resources to reduce missed appointments. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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16. Performance of the third-generation models of severity scoring systems (APACHE IV, SAPS 3 and MPM-III) in acute kidney injury critically ill patients.
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Costa e Silva, Verônica Torres, de Castro, Isac, Liaño, Fernando, Muriel, Alfonso, Rodríguez-Palomares, José R., and Yu, Luis
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ACUTE kidney failure ,CRITICALLY ill ,CLINICAL trials ,MORTALITY ,INTENSIVE care units ,KIDNEY diseases ,LONGITUDINAL method ,DIAGNOSIS ,PATIENTS - Abstract
Background. Severity scores are useful to guarantee similar disease severity among groups in clinical trials and to enable comparison between different studies. The aim of this study was to assess the performance of the third generation models of severity scoring systems [simplified acute physiology score (SAPS) 3, acute physiology and chronic health evaluation (APACHE) IV and mortality probability model (MPM)-III] in acute kidney injury (AKI) patients in the intensive care unit (ICU).Methods. Three hundred and sixty-six consecutive AKI critically ill patients were prospectively assessed in six ICUs of an academic tertiary care center. Scores were applied on AKI diagnosis day (DD) and on the day of nephrology consultation (NCD). Discrimination was assessed by area under the receiver operating characteristic curve (AUCROC) and calibration by Hosmer–Lemeshow (HL) goodness-of-fit test.Results. Hospital mortality rate was 67.8%. SAPS 3 general and Central and South America (CSA) customized equations presented identical good discrimination (AUCROC curve: 0.80 on NCD) and satisfactory HL tests on both analyzed days (P > 0.100). CSA SAPS 3 equation predicted mortality more accurately [standardized mortality ratio (SMR) on NCD = 1.00 (95% confidence interval (CI) 0.84–1.34)]. APACHE IV and MPM-III scores presented similar discrimination compared to SAPS 3 on both analyzed days (P > 0.05). APACHE IV presented satisfactory HL tests over time (P > 0.100) but underestimated mortality [SMR on DD = 1.92 (95% CI 1.61–2.23); SMR on NCD = 1.46 (95% CI 1.48–1.96)]. MPM-III showed unsatisfactory HL test results (P = 0.027 on DD; P = 0.045 on NCD) and underestimated mortality [SMR on NCD = 2.09 (95% CI 1.48–1.96)].Conclusions. SAPS 3, especially the geographical customized equation, presented good discrimination and calibration performances, accurately predicting mortality in this group of AKI critically ill patients. [ABSTRACT FROM PUBLISHER]
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- 2011
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17. Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism.
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Jimenez, David, Aujesky, Drahomir, Moores, Lisa, Gomez, Vicente, Lobo, Jose Luis, Uresandi, Fernando, Otero, Remedies, Monreal, Manuel, Muriel, Alfonso, and Yusen, Roger D.
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PULMONARY embolism ,PROGNOSIS ,MORTALITY ,OUTPATIENT medical care ,MEDICAL care - Abstract
The article discusses a research study about the simplification of the Pulmonary Embolism Severity Index (PESI) for prognostication in patients with acute symptomatic pulmonary embolism. Findings revealed no difference in the prognostic accuracy of the original and simplified PESI scores. In the simplified PESI, patients classified as low risk had a lower 30-day mortality compared in the high-risk group. A retrospective external validation of the simplified PESI in an independent multinational cohort of outpatients also revealed a lower 30-day mortality.
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- 2010
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18. Propensity-Score Analysis Reveals that Sex is Not a Prognostic Factor for Mortality in Intensive Care Unit-Admitted Patients with Septic Bacteremia.
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Ponce-Alonso, Manuel, Fernández-Félix, Borja M., Halperin, Ana, Rodríguez-Domínguez, Mario, Sánchez-Díaz, Ana M., Cantón, Rafael, Muriel, Alfonso, Zamora, Javier, and del Campo, Rosa
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INTENSIVE care patients , *HOSPITAL mortality , *BACTEREMIA , *PROGNOSIS , *INTENSIVE care units , *COMMUNICABLE diseases - Abstract
• Sepsis was more common in males than females • Males with sepsis presented higher disease severity than females • Sex did not affect mortality in patients with sepsis and admitted to intensive care units Men have been considered to have a higher incidence of infectious diseases, with controversy over the possibility that sex could influence the prognosis of the infection. This study aimed to explore this assumption in patients admitted to the intensive care unit (ICU) with septic bacteremia. A retrospective analysis (2006-2017) of septic patients with microbiologically confirmed bacteremia (n=440) was performed. Risk of ICU and in-hospital mortality in males versus females was compared by univariate analysis and a propensity score analysis integrating their clinical characteristics. Sepsis more frequently occurred in males (80.2% vs 76.1%) as well as in-hospital (48.0% vs 41.3%) and ICU (39.9% vs 36.5%) mortality. Univariate analyses showed that males had a higher Charlson comorbidity index and worse McCabe prognostic score. However, the propensity score in 296 matched patients demonstrated that females had higher risk of both ICU (OR 1.39; 95% CI 0.89-2.19) and in-hospital mortality (OR 1.18; 95% CI 0.77-1.83), but without statistical significance. Males with sepsis had worse clinical characteristics when admitted to the ICU, but sex had no influence on mortality. These data contribute to helping reduce the sex-dependent gap present in healthcare provision. [ABSTRACT FROM AUTHOR]
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- 2021
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19. Evolution Over Time of Ventilatory Management and Outcome of Patients With Neurologic Disease.
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Tejerina, Eva E., Pelosi, Paolo, Robba, Chiara, Peñuelas, Oscar, Muriel, Alfonso, Barrios, Deisy, Frutos-Vivar, Fernando, Raymondos, Konstantinos, Du, Bin, Thille, Arnaud W., Ríos, Fernando, González, Marco, del-Sorbo, Lorenzo, Marín, Maria del Carmen, Valle Pinheiro, Bruno, Antonio Soares, Marco, Nin, Nicolas, Maggiore, Salvatore M., Bersten, Andrew, and Amin, Pravin
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NEUROLOGICAL disorders , *ARTIFICIAL respiration , *STROKE , *TIME management , *HEMORRHAGIC stroke , *PROGNOSIS , *ISCHEMIC stroke - Abstract
Objectives: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality.Design: Secondary analysis of three prospective, observational, multicenter studies.Setting: Cohort studies conducted in 2004, 2010, and 2016.Patients: Adult patients who received mechanical ventilation for more than 12 hours.Interventions: None.Measurements and Main Results: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma.Conclusions: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease. [ABSTRACT FROM AUTHOR]- Published
- 2021
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20. Outcome of patients with acute symptomatic pulmonary embolism and psychiatric disorders.
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Velasco, Diurbis, Jiménez, David, Bikdeli, Behnood, Muriel, Alfonso, Marchena, Pablo Javier, Tzoran, Inna, Malý, Radovan, López-Reyes, Raquel, Riera-Mestre, Antoni, and Monreal, Manuel
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MENTAL illness , *HYPERCOAGULATION disorders , *PULMONARY embolism , *LOGISTIC regression analysis , *ODDS ratio , *SENSITIVITY analysis - Abstract
To address the association between psychiatric disorders and short-term outcomes after acute symptomatic pulmonary embolism (PE). We identified adults with PE enrolled in the RIETE registry between December 1, 2013, and January 31, 2019. Using multinomial regression, we assessed the association between a history of psychiatric disorders and the outcomes of all-cause mortality, PE-related mortality, and venous thromboembolism recurrence and bleeding rates through 30 days after initiation of treatment. We also examined the impact of depression on all-cause and PE-specific mortality. Among 13,120 patients diagnosed with acute PE, 16.1% (2115) had psychiatric disorders and 4.2% died within the first 30-days of follow-up. Patients with psychiatric disorders had increased odds for all-cause (adjusted odds ratio [ OR ] 1.50; 95% CI, 1.21 to 1.86; P < 0.001) and PE-related mortality (adjusted OR 1.64; 95% CI, 1.09 to 2.48; P = 0.02) compared to those without psychiatric disorders. Multinomial logistic regression showed a non-significant trend toward lower risk of recurrences for patients with psychiatric disorders (adjusted OR 0.49; 95% CI, 0.21 to 1.15; P = 0.10). Psychiatric disorders were not significantly associated with increased odds for major bleeds during follow-up (adjusted OR 1.09; 95% CI, 0.85 to 1.40; P = 0.49). Results were consistent in a sensitivity analysis that only considered patients with a diagnosis of depression. In patients with acute PE, history of psychiatric disorders might predict all-cause and PE-related death in the ensuing month after diagnosis. • If psychiatric disorders are associated with prognosis after PE, interventions might be worth testing to mitigate outcomes. • In patients with PE, history of psychiatric disorders is a predictor of death in the ensuing month after diagnosis. • Depression was associated with a 1.4-fold increase in the odds of 30-day all-cause mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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