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1. A blood microRNA classifier for the prediction of ICU mortality in COVID-19 patients: a multicenter validation study

Author

David de Gonzalo-Calvo, Marta Molinero, Iván D. Benítez, Manel Perez-Pons, Nadia García-Mateo, Alicia Ortega, Tamara Postigo, María C. García-Hidalgo, Thalia Belmonte, Carlos Rodríguez-Muñoz, Jessica González, Gerard Torres, Clara Gort-Paniello, Anna Moncusí-Moix, Ángel Estella, Luis Tamayo Lomas, Amalia Martínez de la Gándara, Lorenzo Socias, Yhivian Peñasco, Maria Del Carmen de la Torre, Elena Bustamante-Munguira, Elena Gallego Curto, Ignacio Martínez Varela, María Cruz Martin Delgado, Pablo Vidal-Cortés, Juan López Messa, Felipe Pérez-García, Jesús Caballero, José M. Añón, Ana Loza-Vázquez, Nieves Carbonell, Judith Marin-Corral, Ruth Noemí Jorge García, Carmen Barberà, Adrián Ceccato, Laia Fernández-Barat, Ricard Ferrer, Dario Garcia-Gasulla, Jose Ángel Lorente-Balanza, Rosario Menéndez, Ana Motos, Oscar Peñuelas, Jordi Riera, Jesús F. Bermejo-Martin, Antoni Torres, and Ferran Barbé

Subjects
Biomarker, COVID-19, ICU, microRNA, Prognosis, SARS-CoV-2, Diseases of the respiratory system, RC705-779
Abstract

Abstract Background The identification of critically ill COVID-19 patients at risk of fatal outcomes remains a challenge. Here, we first validated candidate microRNAs (miRNAs) as biomarkers for clinical decision-making in critically ill patients. Second, we constructed a blood miRNA classifier for the early prediction of adverse outcomes in the ICU. Methods This was a multicenter, observational and retrospective/prospective study including 503 critically ill patients admitted to the ICU from 19 hospitals. qPCR assays were performed in plasma samples collected within the first 48 h upon admission. A 16-miRNA panel was designed based on recently published data from our group. Results Nine miRNAs were validated as biomarkers of all-cause in-ICU mortality in the independent cohort of critically ill patients (FDR

Published
2023
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2. The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Author

Antoni Torres, Anna Motos, Jordi Riera, Laia Fernández-Barat, Adrián Ceccato, Raquel Pérez-Arnal, Dario García-Gasulla, Oscar Peñuelas, José Angel Lorente, Alejandro Rodriguez, David de Gonzalo-Calvo, Raquel Almansa, Albert Gabarrús, Rosario Menéndez, Jesús F. Bermejo-Martin, Ricard Ferrer, Rosario Amaya Villar, José M. Añón, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Elena Bustamante-Munguira, Jesús Caballero, Cristina Carbajales, Nieves Carbonell, Mercedes Catalán-González, Cristóbal Galbán, Víctor D. Gumucio-Sanguino, Maria del Carmen de la Torre, Emili Díaz, Ángel Estella, Elena Gallego, José Luis García Garmendia, José Garnacho-Montero, José M. Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M. Albaiceta, Mariana Andrea Novo, Yhivian Peñasco, Juan Carlos Pozo-Laderas, Pilar Ricart, Inmaculada Salvador-Adell, Angel Sánchez-Miralles, Susana Sancho Chinesta, Lorenzo Socias, Jordi Solé-Violan, Fernando Suares Sipmann, Luis Tamayo Lomas, José Trenado, Ferran Barbé, and CIBERESUCICOVID Project (COV20/00110, ISCIII)

Subjects
Ventilatory ratio, Mechanical ventilation, COVID-19, SARS-CoV-2, Coronavirus, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0–171.2] to 180.0 [135.4–227.9] mmHg and the ventilatory ratio from 1.73 [1.33–2.25] to 1.96 [1.61–2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01–1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01–1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93–1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation.

Published
2021
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3. Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Author

Iván D. Benítez, Jordi de Batlle, Gerard Torres, Jessica González, David de Gonzalo-Calvo, Adriano D.S. Targa, Clara Gort-Paniello, Anna Moncusí-Moix, Adrián Ceccato, Laia Fernández-Barat, Ricard Ferrer, Dario Garcia-Gasulla, Rosario Menéndez, Anna Motos, Oscar Peñuelas, Jordi Riera, Jesús F. Bermejo-Martin, Yhivian Peñasco, Pilar Ricart, María Cruz Martin Delgado, Luciano Aguilera, Alejandro Rodríguez, Maria Victoria Boado Varela, Fernando Suarez-Sipmann, Juan Carlos Pozo-Laderas, Jordi Solé-Violan, Maite Nieto, Mariana Andrea Novo, José Barberán, Rosario Amaya Villar, José Garnacho-Montero, Jose Luis García-Garmendia, José M. Gómez, José Ángel Lorente, Aaron Blandino Ortiz, Luis Tamayo Lomas, Esther López-Ramos, Alejandro Úbeda, Mercedes Catalán-González, Angel Sánchez-Miralles, Ignacio Martínez Varela, Ruth Noemí Jorge García, Nieves Franco, Víctor D. Gumucio-Sanguino, Arturo Huerta Garcia, Elena Bustamante-Munguira, Luis Jorge Valdivia, Jesús Caballero, Elena Gallego, Amalia Martínez de la Gándara, Álvaro Castellanos-Ortega, Josep Trenado, Judith Marin-Corral, Guillermo M Albaiceta, Maria del Carmen de la Torre, Ana Loza-Vázquez, Pablo Vidal, Juan Lopez Messa, Jose M. Añón, Cristina Carbajales Pérez, Victor Sagredo, Neus Bofill, Nieves Carbonell, Lorenzo Socias, Carme Barberà, Angel Estella, Manuel Valledor Mendez, Emili Diaz, Ana López Lago, Antoni Torres, and Ferran Barbé

Subjects
COVID-19, Critical Care, Prognosis, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods: Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings: Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p

Published
2022
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4. Correction to: The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Author

Antoni Torres, Anna Motos, Jordi Riera, Laia Fernández-Barat, Adrián Ceccato, Raquel Pérez-Arnal, Dario García-Gasulla, Oscar Peñuelas, José Angel Lorente, Alejandro Rodriguez, David de Gonzalo-Calvo, Raquel Almansa, Albert Gabarrús, Rosario Menéndez, Jesús F. Bermejo-Martin, Ricard Ferrer, Rosario Amaya Villar, José M. Añón, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Elena Bustamante-Munguira, Jesús Caballero, Cristina Carbajales, Nieves Carbonell, Mercedes Catalán-González, Cristóbal Galbán, Víctor D. Gumucio-Sanguino, Maria del Carmen de la Torre, Emili Díaz, Ángel Estella, Elena Gallego, José Luis García Garmendia, José Garnacho-Montero, José M. Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M. Albaiceta, Mariana Andrea Novo, Yhivian Peñasco, Juan Carlos Pozo-Laderas, Pilar Ricart, Inmaculada Salvador-Adell, Angel Sánchez-Miralles, Susana Sancho Chinesta, Lorenzo Socias, Jordi Solé-Violan, Fernando Suares Sipmann, Luis Tamayo Lomas, José Trenado, Ferran Barbé, and CIBERESUCICOVID Project (COV20/00110, ISCIII)

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published
2021
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5. Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Author

Jessica González, Jordi de Batlle, Iván D. Benítez, Gerard Torres, Sally Santisteve, Adriano D.S. Targa, Clara Gort-Paniello, Anna Moncusí-Moix, Maria Aguilà, Fatty Seck, Adrián Ceccato, Ricard Ferrer, Anna Motos, Jordi Riera, Laia Fernández, Rosario Menéndez, José Ángel Lorente, Oscar Peñuelas, Dario Garcia-Gasulla, Yhivian Peñasco, Pilar Ricart, Elena Abril Palomares, Luciano Aguilera, Alejandro Rodríguez, Maria Victoria Boado Varela, Belén Beteré, Juan Carlos Pozo-Laderas, Jordi Solé-Violan, Inmaculada Salvador-Adell, Mariana Andrea Novo, José Barberán, Rosario Amaya Villar, José Garnacho-Montero, José M. Gómez, Aaron Blandino Ortiz, Luis Tamayo Lomas, Alejandro Úbeda, Mercedes Catalán-González, Angel Sánchez-Miralles, Ignacio Martínez Varela, Ruth Noemí Jorge García, Nieves Franco, Víctor D. Gumucio-Sanguino, Elena Bustamante-Munguira, Luis Jorge Valdivia, Jesús Caballero, Elena Gallego, Covadonga Rodríguez, Álvaro Castellanos-Ortega, Josep Trenado, Judith Marin-Corral, Guillermo M. Albaiceta, Maria del Carmen de la Torre, Ana Loza-Vázquez, Pablo Vidal, Jose M. Añón, Cristina Carbajales Pérez, Victor Sagredo, Nieves Carbonell, Lorenzo Socias, Carme Barberà, Angel Estella, Emili Diaz, David de Gonzalo-Calvo, Antoni Torres, Ferran Barbé, María Aguilar Cabello, Victoria Alcaraz-Serrano, Cesar Aldecoa, Cynthia Alegre, Ángela Algaba Calderón, Sergio Álvarez, Antonio Álvarez Ruiz, Ruth Andrea, Maria de Alba Aparicio, Marta Arrieta, J. Ignacio Ayestarán, Joan Ramon Badia, Mariona Badía, Orville Báez Pravia, Ana Balan Mariño, Begoña Balsera, Laura Barbena, Enric Barbeta, Tommaso Bardi, Patricia Barral Segade, Marta Barroso, José Ángel Berezo García, Jesus Bermejo, Judit Bigas, Rafael Blancas, María Luisa Blasco Cortés, María Bodi Saera, Neus Bofill, María Teresa Bouza Vieiro, Leticia Bueno, Juan Bustamante-Munguira, Cecilia del Busto Martínez, David Campi Hermoso, Sandra Campos Fernández, Iosune Cano, Joan Canseco, Pablo Cardinal Fernández, Laura Carrión García, Sulamita Carvalho, Manuel Castellà, Andrea Castellví, Pedro Castro, María José Centelles-Serrano, Ramon Cicuendez Ávila, Catia Cillóniz, Luisa Clar, Cristina Climent, Jordi Codina, Pamela Conde, Sofía Contreras, Raul de Frutos Parra, Raul de Pablo Sánchez, Diego De Mendoza, Yolanda Díaz, María Digna Rivas Vilas, Cristina Dólera Moreno, Irene Dot, Pedro Enríquez Giraudo, Inés Esmorís Arijón, Teresa Farre Monjo, Javier Fernández, Carlos Ferrando, Albert Figueras, Lorena Forcelledo Espina, Enric Franquesa, Àngels Furro, Albert Gabarrus, Cristóbal Galbán, Felipe García, Beatriz García, Emilio García Prieto, Carlos García Redruello, Amaia García Sagastume, Maria Luisa Gascón Castillo, Gemma Gomà, Vanesa Gómez Casal, Silvia Gómez, Carmen Gómez Gonzalez, Federico Gordo, Maria Pilar Gracia, María José Gutierrez Fernández, Alba Herraiz, Rubén Herrán-Monge, Mercedes Ibarz, Silvia Iglesias, Maria Teresa Janer, Gabriel Jiménez, Mar Juan Díaz, Karsa Kiarostami, Juan I. Lazo Álvarez, Miguel León, Alexandre López-Gavín, Desiree Macias Guerrero, Nuria Mamolar Herrera, Rafael Mañez Mendiluce, Cecilia L. Mantellini, Gregorio Marco Naya, Iris Marco Barcos, Pilar Marcos, Enrique Marmol Peis, Marta Martín Cuadrado, María Cruz Martin Delgado, Paula Martín Vicente, María Martínez, Carmen Eulalia Martínez Fernández, Maria Dolores Martínez Juan, Basilisa Martínez Palacios, Juan Fernando Masa Jimenez, Joan Ramon Masclans, Emilio Maseda, Eva María Menor Fernández, Priscila Metora Banderas, Olga Minguez, Mar Miralbés, Josman Monclou, Juan Carlos Montejo-González, Neus Montserrat, María Mora Aznar, Dulce Morales, Sara Guadalupe Moreno Cano, David Mosquera Rodríguez, Rosana Muñoz-Bermúdez, José María Nicolás, Ramon Nogue Bou, Rafaela Nogueras Salinas, Marta Ocón, Ana Ortega, Sergio Ossa, Pablo Pagliarani, Francisco Parrilla, José Pedregosa-Díaz, Leire Pérez Bastida, Purificación Pérez, Felipe Pérez-García, Gloria Pérez Planelles, Eva Pérez Rubio, David Pestaña Laguna, Javier Prados, Andrés Pujol, Núria Ramon Coll, Gloria Renedo Sanchez-Giron, Ferran Roche-Campo, Laura Rodriguez, Felipe Rodríguez de Castro, Silvia Rodríguez, Covadonga Rodríguez Ruiz, Jorge Rubio, Alberto Rubio López, Ángela Leonor Ruiz-García, Miriam Ruiz Miralles, Pablo Ryan Murúa, Eva Saborido Paz, Ana Salazar Degracia, Miguel Sanchez, Ana Sánchez, Susana Sancho Chinesta, Bitor Santacoloma, Maria Teresa Sariñena, Marta Segura Pensado, Lidia Serra, Mireia Serra-Fortuny, Ainhoa Serrano Lázaro, Lluís Servià, Laura Soliva, Carla Speziale, Adrián Tormos, Mateu Torres, Celia Tranque-Liberal, Sandra Trefler, Javier Trujillano, Rafaela Vaca, Estela Val, Luis Valdivia Ruiz, Montserrat Vallverdú, Maria Van der Hofstadt Martin-Montalvo, Sabela Vara Adrio, Nil Vázquez, Javier Vengoechea, Clara Vilà-Vilardel, Judit Vilanova, Tatiana Villada Warrington, Hua Yang, Minlan Yang, and Ana Zapatero

Subjects
Pulmonary and Respiratory Medicine
Published
2023
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6. Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study

Author

Jesús F Bermejo-Martin, Nadia García-Mateo, Anna Motos, Salvador Resino, Luis Tamayo, Pablo Ryan Murua, Elena Bustamante-Munguira, Elena Gallego Curto, Alejandro Úbeda-Iglesias, María del Carmen de la Torre, Ángel Estella, Sandra Campos-Fernández, Ignacio Martínez Varela, Felipe Pérez-García, Lorenzo Socias, Juan López Messa, Pablo Vidal-Cortés, Víctor Sagredo Meneses, Milagros González-Rivera, Nieves Carbonell, David de Gonzalo-Calvo, María Cruz Martín Delgado, Luis Jorge Valdivia, Caridad Martín-López, Ruth Noemí Jorge García, Emilio Maseda, Ana Loza-Vázquez, David J Kelvin, Ferrán Barbé, Antoni Torres, Alicia Ortega, Amanda de la Fuente, Raquel Almansa, Tamara Postigo, Noelia Jorge, Ana P Tedim, Laura González-González, Lara Sánchez Recio, Wysali Trapiello, José Ángel Berezo, Rubén Herrán-Monge, Jesús Blanco, Pedro Enríquez, Isidoro Martínez, María Martín-Vicente, María José Muñoz-Gómez, Vicente Más, Mónica Vázquez, Olga Cano, Amalia Martínez de la Gándara, Covadonga Rodríguez, Gloria Andrade, Gloria Renedo, Juan Bustamante-Munguira, Ramón Cicuendez Ávila, María Salgado-Villén, Enrique Berruguilla-Pérez, Estel Güell, Fernando Javier Casadiego Monachello, María Recuerda Núñez, Juan Manuel Sánchez Calvo, Yhivian Peñasco-Martín, María Teresa García Unzueta, Adrián Ceccato, Laia Fernández-Barat, María Teresa Bouza Vieiro, Ana Moreno-Romero, Leire Pérez Bastida, Lorena del Río-Carbajo, Noelia Albalá Martínez, José Manuel Gómez, María Luisa Blasco, Jesús Caballero, Carme Barberà, Jessica González, María Teresa Nieto, Jorge Nieto-del Olmo, Estefanía Prol-Silva, Joan Canseco-Ribas, Jose María Eiros, Instituto de Salud Carlos III, Canadian Institutes of Health Research, Li Ka Shing Foundation, European Society of Clinical Microbiology and Infectious Diseases, Centro de Investigación Biomédica en Red - CIBERES (Enfermedades Respiratorias), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), and Unión Europea. Fondo Social Europeo (ESF/FSE)

Subjects
Microbiology (medical), Infectious Diseases, Spain, Virology, COVID-19, Microbiology
Abstract

Background: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. Methods: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero (2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. Findings: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16-0·55; p

Published
2023

7. Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study

Author

Gerard Moreno, Raquel Carbonell, Ignacio Martin-Loeches, Jordi Solé-Violán, Eudald Correig i Fraga, Josep Gómez, Manuel Ruiz-Botella, Sandra Trefler, María Bodí, Josefa Murcia Paya, Emili Díaz, Pablo Vidal-Cortes, Elisabeth Papiol, Antonio Albaya Moreno, Susana Sancho Chinesta, Lorenzo Socias Crespi, María del Carmen Lorente, Ana Loza Vázquez, Rebeca Vara Arlanzon, María Teresa Recio, Juan Carlos Ballesteros, Ricard Ferrer, Elisabeth Fernandez Rey, Marcos I. Restrepo, Ángel Estella, Antonio Margarit Ribas, Neus Guasch, Luis F. Reyes, Judith Marín-Corral, Alejandro Rodríguez, the COVID-19 SEMICYUC Working Group, Institut Català de la Salut, [Moreno G, Carbonell R] Universitat Autònoma de Barcelona, Bellaterra, Spain. Critical Care Department, Joan XXIII University Hospital, 43005 Tarragona, Spain. [Martin-Loeches I] Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, Dublin, Ireland. [Solé-Violán J] Critical Care Department, Doctor Negrín University Hospital, Gran Canaria, Spain. [Correig i Fraga E] Department of Biostatistics, University of Rovira i Virgili (URV), Reus, Spain. [Gómez J] Universitat Autònoma de Barcelona, Bellaterra, Spain. Critical Care Department, Joan XXIII University Hospital, 43005 Tarragona, Spain. Tarragona Health Data Research Working Group (THeDaR), Joan XXIII University Hospital, Tarragona, Spain. [Papiol E] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Ferrer R] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Xoc, Disfunció Orgànica i Ressuscitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
ARDS, medicine.medical_specialty, COVID-19 (Malaltia) - Mortalitat, terapéutica::terapéutica::tratamiento de urgencia::resucitación::terapéutica::respiración artificial [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Critical Care and Intensive Care Medicine, Otros calificadores::Otros calificadores::/efectos adversos [Otros calificadores], Respiració artificial - Complicacions, law.invention, chemistry.chemical_compound, Tocilizumab, law, Therapeutics::Therapeutics::Emergency Treatment::Resuscitation::Therapeutics::Respiration, Artificial [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Anesthesiology, Internal medicine, Other subheadings::Other subheadings::Other subheadings::/mortality [Other subheadings], medicine, Other subheadings::Other subheadings::/adverse effects [Other subheadings], virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES], Corticosteroids, Intensive care unit, Mortality, Invasive mechanical ventilation, COVID-19-associated acute respiratory distress syndrome, Survival analysis, Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad [Otros calificadores], business.industry, RC86-88.9, Research, Retrospective cohort study, Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES], Medical emergencies. Critical care. Intensive care. First aid, medicine.disease, chemistry, Propensity score matching, business, Cohort study
Abstract

COVID-19-associated acute respiratory distress syndrome; Corticosteroids; Intensive care unit Síndrome de dificultad respiratoria aguda asociado a COVID-19; Corticosteroides; Unidad de cuidados intensivos Síndrome de dificultat respiratòria aguda associada a la COVID-19; Corticosteroides; Unitat de cures intensives Background Some unanswered questions persist regarding the effectiveness of corticosteroids for severe coronavirus disease 2019 (COVID-19) patients. We aimed to assess the clinical effect of corticosteroids on intensive care unit (ICU) mortality among mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients. Methods This was a retrospective study of prospectively collected data conducted in 70 ICUs (68 Spanish, one Andorran, one Irish), including mechanically ventilated COVID-19-associated ARDS patients admitted between February 6 and September 20, 2020. Individuals who received corticosteroids for refractory shock were excluded. Patients exposed to corticosteroids at admission were matched with patients without corticosteroids through propensity score matching. Primary outcome was all-cause ICU mortality. Secondary outcomes were to compare in-hospital mortality, ventilator-free days at 28 days, respiratory superinfection and length of stay between patients with corticosteroids and those without corticosteroids. We performed survival analysis accounting for competing risks and subgroup sensitivity analysis. Results We included 1835 mechanically ventilated COVID-19-associated ARDS, of whom 1117 (60.9%) received corticosteroids. After propensity score matching, ICU mortality did not differ between patients treated with corticosteroids and untreated patients (33.8% vs. 30.9%; p = 0.28). In survival analysis, corticosteroid treatment at ICU admission was associated with short-term survival benefit (HR 0.53; 95% CI 0.39–0.72), although beyond the 17th day of admission, this effect switched and there was an increased ICU mortality (long-term HR 1.68; 95% CI 1.16–2.45). The sensitivity analysis reinforced the results. Subgroups of age

Published
2021

8. Remdesivir and survival outcomes in critically ill patients with COVID-19: A multicentre observational cohort study

Author

Catia Cillóniz, Anna Motos, Tatiana Castañeda, Albert Gabarrús, Ferran Barbé, Antoni Torres, Víctor D. Gumucio-Sanguino, Rafael Mañez, Jordi Solé-Violan, Felipe Rodríguez de Castro, Fernando Suarez-Sipmann, Ruth Noemí Jorge García, María Mora Aznar, Mateu Torres, María Martinez, Cynthia Alegre, Jordi Riera, Sofía Contreras, Juan Manuel Pericas, Ricard Ferrer, Jesús Caballero, Javier Trujillano, Montse Vallverdú, Miguel León, Mariona Badía, Begoña Balsera, Lluís Servià, Judit Vilanova, Silvia Rodríguez, Neus Montserrat, Silvia Iglesias, Javier Prados, Sula Carvalho, Mar Miralbés, Josman Monclou, Gabriel Jiménez, Jordi Codina, Estela Val, Pablo Pagliarani, Jorge Rubio, Dulce Morales, Andrés Pujol, Àngels Furro, Beatriz García, Gerard Torres, Javier Vengoechea, David de Gonzalo-Calvo, Jessica González, Silvia Gomez, José M. Gómez, Nieves Franco, José Barberán, Guillermo M Albaiceta, Lorena Forcelledo Espina, Emilio García Prieto, Paula Martín Vicente, Cecilia del Busto Martínez, Pablo Vidal-Cortés, José Luis García Garmendia, María Aguilar Cabello, Carmen Eulalia Martínez Fernández, Nieves Carbonell, María Luisa Blasco Cortés, Ainhoa Serrano Lázaro, Mar Juan Díaz, Aaron Blandino Ortiz, Rosario Menendez, Luis Jorge Valdivia, María Victoria Boado, Susana Sancho Chinesta, Maria del Carmen de la Torre, Ignacio Martínez Varela, María Teresa Bouza Vieiro, Inés Esmorís Arijón, David Campi Hermoso, Rafaela Nogueras Salinas, Teresa Farre Monjo, Ramon Nogue Bou, Gregorio Marco Naya, Carme Barberà, Núria Ramon Coll, Mercedes Catalán-González, Juan Carlos Montejo-González, Gloria Renedo Sanchez-Giron, Juan Bustamante-Munguira, Elena Bustamante-Munguira, Ramon Cicuendez Avila, Nuria Mamolar Herrera, Raquel Almansa, Alicia Ortega, Jesús Bermejo-Martin, Víctor Sagredo, Jose Añon, Alexander Agrifoglio, Lucia Cachafeiro, Emilio Maseda, Lorenzo Socias, Mariana Andrea Novo, Albert Figueras, Maria Teresa Janer, Laura Soliva, Marta Ocón, Luisa Clar, J Ignacio Ayestarán, Yhivian Peñasco, Sandra Campos Fernández, Mireia Serra-Fortuny, Eva Forcadell-Ferreres, Immaculada Salvador-Adell, Neus Bofill, Berta Adell-Serrano, Josep Pedregosa Díaz, Núria Casacuberta-Barberà, Luis Urrelo-Cerrón, Àngels Piñol-Tena, Ferran Roche-Campo, Amalia Martínez de la Gándara, Pablo Ryan Murúa, Covadonga Rodríguez Ruíz, Laura Carrión García, Juan I Lazo Álvarez, José Ángel Lorente, Ana Loza-Vázquez, Desire Macias Guerrero, Arturo Huerta, Daniel Tognetti, Carlos García Redruello, David Mosquera Rodríguez, Eva María Menor Fernández, Sabela Vara Adrio, Vanesa Gómez Casal, Marta Segura Pensado, María Digna Rivas Vilas, Amaia García Sagastume, Raul de Pablo Sánchez, David Pestaña Laguna, Tommaso Bardi, Rosario Amaya Villar, Carmen Gómez Gonzalez, Maria Luisa Gascón Castillo, José Garnacho-Montero, María Luisa Cantón-Bulnes, Judith Marin-Corral, Cristina Carbajales Pérez, Joan Ramon Masclans, Ana Salazar Degracia, Judit Bigas, Rosana Muñoz-Bermúdez, Clara Vilà-Vilardel, Francisco Parrilla, Irene Dot, Ana Zapatero, Yolanda Díaz, María Pilar Gracia, Purificación Pérez, Andrea Castellví, Cristina Climent, Lidia Serra, Laura Barbena, Iosune Cano, Pilar Ricart, Alba Herraiz, Pilar Marcos, Laura Rodríguez, Maria Teresa Sariñena, Ana Sánchez, Alejandro Úbeda, María Cruz Martin Delgado, Elena Gallego, Juan Fernando Masa Jimenez, Gemma Gomà, Emi Díaz, Mercedes Ibarz, Diego De Mendoza, Enric Barbeta, Victoria Alcaraz-Serrano, Joan Ramon Badia, Manuel Castella, Leticia Bueno, Adrian Ceccato, Andrea Palomeque, Laia Fernandez Barat, Pamela Conde, Javier Fernández, Albert Gabarrus, Karsa Kiarostami, Alexandre López-Gavín, Cecilia L Mantellini, Carla Speziale, Nil Vázquez, Hua Yang, Minlan Yang, Carlos Ferrando, Pedro Castro, Marta Arrieta, Jose Maria Nicolas, Rut Andrea, Marta Barroso, Raquel Pérez, Sergio Álvarez, Dario Garcia-Gasulla, Adrián Tormos, Luis Tamayo Lomas, Cesar Aldecoa, Rubén Herrán-Monge, José Ángel Berezo García, Pedro Enríquez Giraudo, Pablo Cardinal Fernández, Alberto Rubio López, Orville Báez Pravia, Juan López Messa, Leire Pérez Bastida, Antonjo Alvarez Ruiz, José Trenado, Anna Parera Pous, Cristóbal Galbán, Ana López Lago, Eva Saborido Paz, Patricia Barral Segade, Ana Balan Mariño, Manuel Valledor Mendez, Raúl de Frutos, Luciano Aguilera, Felipe Pérez-García, Esther López-Ramos, Ángela Leonor Ruiz-García, Belén Beteré, Rafael Blancas, Cristina Dólera, Gloria Perez Planelles, Enrique Marmol Peis, Maria Dolores Martinez Juan, Miriam Ruiz Miralles, Eva Perez Rubio, Maria Van der Hofstadt Martin-Montalvo, Ángel Sánchez-Miralles, Tatiana Villada Warrington, Juan Carlos Pozo-Laderas, Angel Estrella, Sara Guadalupe Moreno Cano, Federico Gordo, Basilisa Martinez Palacios, Maite Nieto, Maria Teresa Nieto, Sergio Ossa, Ana Ortega, Miguel Sanchez, and Bitor Santacoloma

Subjects
Microbiology (medical), Infectious Diseases
Published
2022

9. Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19

Author

Victor Daniel Gumucio, Aida Monge, Adrián Ceccato, Maria del Carmen de la Torre, Amara Carratalá, Rosario Amaya Villar, Gonzalo Labarca, Anna Moncusí-Moix, Angel Estella, José Manuel Gómez, José Luis García Garmendia, María Zuil, Juan Lopez Messa, Ana Loza-Vázquez, Judith Marin-Corral, Sally Santisteve, Cristóbal Galbán, Jessica González, Paola Carmona, Jordi Solé-Violán, Pilar Ricart Martí, Carme Barberà, Ferran Barbé, Elena Bustamante-Munguira, Ignacio Martínez Varela, Ferran Roche-Campo, Cristina Carbajales, Jordi Riera, Aaron Blandino Ortiz, Iván Benítez, Arturo Huerta, David de Gonzalo-Calvo, Oscar Peñuelas, Ricard Ferrer, José Garnacho-Montero, Emili Diaz, Jesus F. Bermejo-Martin, Ana Motos, Antoni Torres, Susana Sancho Chinesta, Jesús Caballero, Luis Tamayo Lomas, Guillermo M. Albaiceta, Angel Sánchez-Miralles, Mercedes Catalán-González, Laia Fernandez, Ruth Noemí Jorge García, José Trenado, Nieves Carbonell, Yhivian Peñasco, Amalia Martínez de la Gándara, José Barberán, Rosario Menéndez, Lucía Pinilla, José M. Añón, Clara Gort-Paniello, Fernando Suares Sipmann, Mariana Andrea Novo, Elena Gallego, Gerard Torres, Dario Garcia-Gasulla, Lorenzo Socias, and Juan Carlos Pozo-Laderas

Subjects
Pulmonary and Respiratory Medicine, Mechanical ventilation, medicine.medical_specialty, ARDS, Lung, business.industry, medicine.medical_treatment, Critical Care and Intensive Care Medicine, medicine.disease, Pulmonary function testing, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, Interquartile range, Internal medicine, Diffusing capacity, Medicine, Lung volumes, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Prospective cohort study
Abstract

Background More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear. Research Question What are the major long-term pulmonary sequelae in critical patients who survive COVID-19? Study Design and Methods Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging. Results One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay. Interpretation Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.

Published
2021
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10. Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study

Author

Antoni, Torres, Ana, Motos, Catia, Cillóniz, Adrián, Ceccato, Laia, Fernández-Barat, Albert, Gabarrús, Jesús, Bermejo-Martin, Ricard, Ferrer, Jordi, Riera, Raquel, Pérez-Arnal, Dario, García-Gasulla, Oscar, Peñuelas, José Ángel, Lorente, David, de Gonzalo-Calvo, Raquel, Almansa, Rosario, Menéndez, Andrea, Palomeque, Rosario Amaya, Villar, José M, Añón, Ana, Balan Mariño, Carme, Barberà, José, Barberán, Aaron, Blandino Ortiz, Maria Victoria, Boado, Elena, Bustamante-Munguira, Jesús, Caballero, María Luisa, Cantón-Bulnes, Cristina, Carbajales Pérez, Nieves, Carbonell, Mercedes, Catalán-González, Raul, de Frutos, Nieves, Franco, Cristóbal, Galbán, Víctor D, Gumucio-Sanguino, Maria Del Carmen, de la Torre, Emili, Díaz, Ángel, Estella, Elena, Gallego, José Luis, García Garmendia, José M, Gómez, Arturo, Huerta, Ruth Noemí Jorge, García, Ana, Loza-Vázquez, Judith, Marin-Corral, María Cruz, Martin Delgado, Amalia, Martínez de la Gándara, Ignacio, Martínez Varela, Juan, López Messa, Guillermo M, Albaiceta, Maite, Nieto, Mariana Andrea, Novo, Yhivian, Peñasco, Felipe, Pérez-García, Juan Carlos, Pozo-Laderas, Pilar, Ricart, Victor, Sagredo, Angel, Sánchez-Miralles, Susana, Sancho Chinesta, Mireia, Serra-Fortuny, Lorenzo, Socias, Jordi, Solé-Violan, Fernando, Suarez-Sipmann, Luis, Tamayo Lomas, José, Trenado, Alejandro, Úbeda, Luis Jorge, Valdivia, Pablo, Vidal, Ferran, Barbé, and Bitor, Santacoloma

Subjects
Infecciones por coronavirus, Critical Illness, Enfermedad transmisible, COVID-19, Critical Care and Intensive Care Medicine, Respiration, Artificial, COVID-19 Drug Treatment, Tratamiento médico, Intensive Care Units, Adrenal Cortex Hormones, Intensive care, Corticosteroids, Humans, Steroids, Precision Medicine, Critically ill
Abstract

Purpose: Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19. Methods: Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated. Results: Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14-1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61-0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia. Conclusion: Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful. Instituto de Salud Carlos III de Madrid (ISCIII) (COV20/00110) Centro de Investigacion Biomedica En Red-Enfermedades Respiratorias (CIBERES) Instituto de Salud Carlos III European Commission Miguel Servet 2020: CP20/00041 Instituto de Salud Carlos III (PI19/00207) 41.787 JCR (2022) Q1, 2/35 Critical Care Medicine 4.344 SJR (2022) Q1, 2/98 Critical Care and Intensive Care Medicine No data IDR 2022 UEM

Published
2022

11. Role of Viral Storm in Critical COVID-19 Illness: A Prospective Cohort Multicentric Study

Author

Jesus F. Bermejo-Martin, Nadia García Mateo, Anna Motos, Salvador Resino, Luis Tamayo, Pablo Ryan, Elena Bustamante-Munguira, Elena Gallego Curto, Alejandro Úbeda-Iglesias, María del Carmen de la Torre, Angel Estella, Sandra Campos-Fernández, Ignacio Martínez Varela, Felipe Pérez-García, Lorenzo Socias, Juan López Messa, Pablo Vidal-Cortés, Víctor Sagredo Meneses, Milagros González-Rivera, Nieves Carbonell, David de Gonzalo-Calvo, María Cruz Martín Delgado, Luis Jorge Valdivia, Caridad Martín-López, Ruth Noemí Jorge García, Emilio Maseda, Ana Loza-Vázquez, david kelvin, Ferran Barbé, Antoni Torres, and CIBERES-UCI-COVID Group

Subjects
History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published
2022
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12. ICU-Acquired Pneumonia is a Risk Factor of a Poor Health Post-Covid-19 Syndrome

Author

José Luis García Garmendia, David de Gonzalo-Calvo, Laia Fernández-Barat, Elena Gallego, Pilar Ricart, Jesus F. Bermejo-Martin, Dario Garcia-Gasulla, Juan Lopez Messa, Ana Loza-Vázquez, Ignacio Martínez Varela, Cristina Carbajales, Víctor D. Gumucio Sanguino, Rosario Amaya Villar, José Barberán, Guillermo M. Albaiceta, Carme Barberà, Lorenzo Socias, Luis Urrelo-Cerrón, Emili Diaz, Raquel Pérez, Yhivian Peñasco, Anna Motos, Amalia Martínez de la Gándara, Ruth Noemí Jorge García, Aaron Blandino Ortiz, José A. Lorente, Jesús Caballero, Ignacio Martin-Loeches, Jordi Riera, Jessica González, Antoni Torres, Elena Bustamante-Munguira, Mariana Andrea Novo, Rosario Menéndez, Alejandro Rodriguez, Judith Marin-Corral, Adrian Ceccato, Luis Tamayo Lomas, Pablo Vidal, Oscar Peñuelas, Ricard Ferrer, Angel Sánchez-Miralles, Maria del Carmen de la Torre, Cristóbal Galbán, Nieves Carbonell, Ferran Barbé, Albert Gabarrus, Susana Sancho Chinesta, Mercedes Catalán-González, Jordi Solé-Violán, José Manuel Gómez, José Garnacho-Montero, and Luciano Aguilera

Subjects
Pneumonia, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Medicine, Risk factor, business, medicine.disease, Intensive care medicine
Abstract

Background. Some patients who had previously presented with COVID-19 have been reported to develop persistent COVID-19 symptoms. Whilst this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the prevalence and risk factors and characteristics of persistent COVID_19 . On other hand these patients have very often intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence in the poor health post-Covid 19 syndrome in ICU discharged patientsMethods: This prospective, multicentre and observational study was done across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1,255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP) Patients requiring invasive mechanical ventilation had persistent, post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, and development of ICUAP were independent risk factors for persistent poor health post-COVID-19.Conclusions: Persistent, post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay and the onset of ICUAP comprised all independent risk factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-Covid 19

Published
2021
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13. Initial Antifungal Strategy Reduces Mortality in Critically Ill Patients With Candidemia: A Propensity Score-Adjusted Analysis of a Multicenter Study*

Author

Dolores Arias-Verdú, Ana Loza-Vázquez, Monica Gordon, Angel Estella, José Garnacho-Montero, Paula Ramirez, Ana Díaz-Martín, Jesús Rodriguez-Gomez, Rafael Sierra, Jose Luis García-Garmendía, Marina Rodríguez-Delgado, and Luisa Cantón-Bulnes

Subjects
0301 basic medicine, Antifungal, medicine.medical_specialty, genetic structures, Echinocandin, medicine.drug_class, 030106 microbiology, Critical Care and Intensive Care Medicine, intensive care unit, 03 medical and health sciences, de-escalation therapy, polycyclic compounds, medicine, Intensive care medicine, Critically ill, business.industry, candidemia, Retrospective cohort study, bacterial infections and mycoses, mortality, antifungal therapy, Multicenter study, Propensity score matching, Observational study, business, Fluconazole, medicine.drug
Abstract

Objective: The objective of this study was to evaluate the impact of the empirical therapy with fluconazole or an echinocandin on 30- and 90-day mortality in critically ill patients with candidemia. The outcome of patients in whom the empirical echinocandin was deescalated to fluconazole was also assessed. Design: Retrospective, observational multicenter study. Setting: Medical and surgical ICUs in nine Spanish hospitals. Patients: Adult patients ( 18 yr) with an episode of Candida bloodstream infection during ICU admission from January 2011 to April 2016. Interventions: Patient characteristics, infection-related variables, therapeutic interventions, and metastatic complications were reviewed. A propensity score-adjusted multivariable analysis was performed to identify the risk factors significantly associated with 30-day and 90-day mortality. Measurements and Main Results: A total of 294 patients were diagnosed of candidemia in the participant ICUs. Sixty patients were excluded (other antifungals in the primary therapy or the patient died without empirical antifungal therapy). The study group comprised 115 patients who received fluconazole (30-day mortality, 37.4%) and 119 patients treated empirically with an echinocandin (30-day mortality, 31.9%). The use of an echinocandin in the empirical therapy was a protective factor for 30-day (odds ratio, 0.32; 95% CI, 0.16-0.66; p = 0.002) and 90-day mortality (odds ratio, 0.50; 95% CI, 0.27-0.93; p = 0.014) in the propensity score- adjusted multivariable analysis. Deescalation of the empirical echinocandin to fluconazole was not associated with a higher mortality or the occurrence of long-term complications. Conclusions: Empirical use of an echinocandin in critically ill patients with documented candidemia reduces mortality at 30 and 90 days significantly. Deescalation of the empirical echinocandin to fluconazole is safe and effective in fluconazole-susceptible infections.

Published
2018

14. Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study

Author

Luis Felipe Reyes, Alejandro Rodriguez, Yuli V. Fuentes, Sara Duque, Esteban García-Gallo, Alirio Bastidas, Cristian C. Serrano-Mayorga, Elsa D. Ibáñez-Prada, Gerard Moreno, Paula C. Ramirez-Valbuena, Gustavo Ospina-Tascon, Glenn Hernandez, Edwin Silva, Ana Maria Díaz, Manuel Jibaja, Magdalena Vera-Alarcon, Emili Díaz, María Bodí, Jordi Solé-Violán, Ricard Ferrer, Antonio Albaya-Moreno, Lorenzo Socias, William Figueroa, Jose L. Lozano-Villanueva, Fabio Varón-Vega, Ángel Estella, Ana Loza-Vazquez, Ruth Jorge-García, Isabel Sancho, Manu Shankar-Hari, Ignacio Martin-Loeches, LIVEN-Covid, and SEMICYUC Study Group

Subjects
Medicine, Science
Abstract

Abstract Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40–2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98–1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes. Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.

Published
2023
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15. Peritonitis candidiásica

Author

Cristóbal León Gil, Alejandro Ubeda, and Ana Loza Vázquez

Subjects
Microbiology (medical), business.industry, Abdominal Infection, Exogenous bacteria, Peritonitis, Dehiscence, medicine.disease, Microbiology, Sepsis, Etiology, Medicine, Colonization, business, Pathogen
Abstract

Candida spp. is a component of the endogenous flora of the digestive tract and can consequently form part of the etiology of almost any type of abdominal infection. Candida spp. is therefore frequently isolated in polymicrobial secondary peritonitis due to intestinal suture dehiscence. In these cases, there is no clear consensus on when Candida spp. isolation in peritoneal drainage fluid represents infection rather than colonization. The general recommendation is to interpret that there is infection when the sample containing the pathogen is intraoperative or has been obtained directly from the intraabdominal collection. When Candida spp. is cultured in samples from subsequently obtained drainage fluid, colonization is a possibility. However, when these cultures are accompanied by signs of sepsis, the patient shows severity criteria or Candida spp. is repeatedly isolated, most intensivists decide to begin antifungal therapy. This treatment is similar for candidemias, disseminated invasive candidiasis and Candida peritonitis.

Published
2010
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16. Efficacy and safety of caspofungin in critically ill patients. ProCAS Study

Author

Cristóbal, León-Gil, Alejandro, Ubeda-Iglesias, Ana, Loza-Vázquez, María Victoria, de la Torre, Juan M, Raurich-Puigdevall, Bernabé, Alvarez-Sánchez, Carlos, Ortiz-Leyva, José María, Domínguez-Roldán, Lorenzo, Socías-Crespi, José, Garnacho-Montero, and J C, Villar

Subjects
Male, Cross Infection, Antifungal Agents, Critical Illness, Comorbidity, Middle Aged, Echinocandins, Immunocompromised Host, Intensive Care Units, Lipopeptides, Postoperative Complications, Treatment Outcome, Caspofungin, Drug Resistance, Fungal, Risk Factors, Spain, Catheter-Related Infections, Aspergillosis, Humans, Candidiasis, Invasive, Drug Therapy, Combination, Female, Prospective Studies, Aged
Abstract

Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA). ProCAS is a study sponsored by the Working Group of the Infectious Diseases of the Spanish Society of Intensive Care Medicine, which analyzes the effectiveness and safety of caspofungin in routine clinical practice conditions in the critically ill.A prospective, multicenter, observational study designed to estimate the clinical effectiveness and safety of caspofungin acetate in the treatment of IC and IA in patients refractory to or intolerant of conventional antifungal therapy. The assessment of effectiveness both clinic and the microbiological was carried out at the end of the treatment with caspofungin.We included 98 patients, 62 IC proven, 25 probable and 11 IA probable, from 24 centers during 2005 and 2006. Treatment with caspofungin monotherapy was performed in 89.8% of cases and as first line therapy in 54.1%. The favorable clinical response obtained for IC, probable IC, and probable IA was 91.9, 84, and 81.8%, respectively. The microbiological response was favorable in 74.6, 68, and 54.6% for proven cases of IC, probable IC, and probable IA, respectively. No serious adverse effects were observed.In routine clinical practice conditions, caspofungin is effective and safe for the treatment of invasive fungal infections (IC/IA). The efficacy and safety profile was similar to that observed in published clinical trials.

Published
2013

17. [Candida peritonitis]

Author

Alejandro, Ubeda, Ana Loza, Vázquez, and Cristóbal León, Gil

Subjects
Antifungal Agents, Bacteria, Peritonitis, Intestines, Case-Control Studies, Sepsis, Surgical Wound Dehiscence, Prevalence, Ascitic Fluid, Drainage, Humans, Surgical Wound Infection, Candidiasis, Invasive, Hospital Mortality, Fungemia, Candida, Retrospective Studies
Abstract

Candida spp. is a component of the endogenous flora of the digestive tract and can consequently form part of the etiology of almost any type of abdominal infection. Candida spp. is therefore frequently isolated in polymicrobial secondary peritonitis due to intestinal suture dehiscence. In these cases, there is no clear consensus on when Candida spp. isolation in peritoneal drainage fluid represents infection rather than colonization. The general recommendation is to interpret that there is infection when the sample containing the pathogen is intraoperative or has been obtained directly from the intraabdominal collection. When Candida spp. is cultured in samples from subsequently obtained drainage fluid, colonization is a possibility. However, when these cultures are accompanied by signs of sepsis, the patient shows severity criteria or Candida spp. is repeatedly isolated, most intensivists decide to begin antifungal therapy. This treatment is similar for candidemias, disseminated invasive candidiasis and Candida peritonitis.

Published
2010

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