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1. Timing of intubation and ICU mortality in COVID-19 patients: a retrospective analysis of 4198 critically ill patients during the first and second waves

Author

Sara Manrique, Laura Claverias, Mónica Magret, Joan Ramón Masclans, María Bodi, Sandra Trefler, Laura Canadell, Emili Díaz, Jordi Sole-Violan, Elena Bisbal-Andrés, Ruth González Natera, Antonio Albaya Moreno, Montserrat Vallverdu, Juan Carlos Ballesteros, Lorenzo Socias, Federico Gordo Vidal, Susana Sancho, Ignacio Martin-Loeches, and Alejandro Rodriguez

Subjects
SARS-COV2, COVID-19 pneumonia, Timing to intubation, Mechanical ventilation, Anesthesiology, RD78.3-87.3
Abstract

Abstract Background The optimal time to intubate patients with SARS-CoV-2 pneumonia has not been adequately determined. While the use of non-invasive respiratory support before invasive mechanical ventilation might cause patient-self-induced lung injury and worsen the prognosis, non-invasive ventilation (NIV) is frequently used to avoid intubation of patients with acute respiratory failure (ARF). We hypothesized that delayed intubation is associated with a high risk of mortality in COVID-19 patients. Methods This is a secondary analysis of prospectively collected data from adult patients with ARF due to COVID-19 admitted to 73 intensive care units (ICUs) between February 2020 and March 2021. Intubation was classified according to the timing of intubation. To assess the relationship between early versus late intubation and mortality, we excluded patients with ICU length of stay (LOS)

Published
2023
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2. 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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3. 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, and the COVID-19 SEMICYUC Working Group

Subjects
Corticosteroids, COVID-19-associated acute respiratory distress syndrome, Intensive care unit, Mortality, Invasive mechanical ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract 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
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4. Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2022 critically ill patients with COVID-19 in Spain

Author

Alejandro Rodríguez, Manuel Ruiz-Botella, Ignacio Martín-Loeches, María Jimenez Herrera, Jordi Solé-Violan, Josep Gómez, María Bodí, Sandra Trefler, Elisabeth Papiol, Emili Díaz, Borja Suberviola, Montserrat Vallverdu, Eric Mayor-Vázquez, Antonio Albaya Moreno, Alfonso Canabal Berlanga, Miguel Sánchez, María del Valle Ortíz, Juan Carlos Ballesteros, Lorena Martín Iglesias, Judith Marín-Corral, Esther López Ramos, Virginia Hidalgo Valverde, Loreto Vidaur Vidaur Tello, Susana Sancho Chinesta, Francisco Javier Gonzáles de Molina, Sandra Herrero García, Carmen Carolina Sena Pérez, Juan Carlos Pozo Laderas, Raquel Rodríguez García, Angel Estella, Ricard Ferrer, and on behalf of COVID-19 SEMICYUC Working Group

Subjects
Severe SARS-CoV-2 infection, Phenotypes, Risk factors, Prognosis, Machine learning, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The identification of factors associated with Intensive Care Unit (ICU) mortality and derived clinical phenotypes in COVID-19 patients could help for a more tailored approach to clinical decision-making that improves prognostic outcomes. Methods Prospective, multicenter, observational study of critically ill patients with confirmed COVID-19 disease and acute respiratory failure admitted from 63 ICUs in Spain. The objective was to utilize an unsupervised clustering analysis to derive clinical COVID-19 phenotypes and to analyze patient’s factors associated with mortality risk. Patient features including demographics and clinical data at ICU admission were analyzed. Generalized linear models were used to determine ICU morality risk factors. The prognostic models were validated and their performance was measured using accuracy test, sensitivity, specificity and ROC curves. Results The database included a total of 2022 patients (mean age 64 [IQR 5–71] years, 1423 (70.4%) male, median APACHE II score (13 [IQR 10–17]) and SOFA score (5 [IQR 3–7]) points. The ICU mortality rate was 32.6%. Of the 3 derived phenotypes, the A (mild) phenotype (537; 26.7%) included older age ( 65 years), high severity of illness and a higher likelihood of development shock. Crude ICU mortality was 20.3%, 25% and 45.4% for A, B and C phenotype respectively. The ICU mortality risk factors and model performance differed between whole population and phenotype classifications. Conclusion The presented machine learning model identified three clinical phenotypes that significantly correlated with host-response patterns and ICU mortality. Different risk factors across the whole population and clinical phenotypes were observed which may limit the application of a “one-size-fits-all” model in practice.

Published
2021
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5. Mortality comparison between the first and second/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study

Author

Raquel Carbonell, Silvia Urgelés, Alejandro Rodríguez, María Bodí, Ignacio Martín-Loeches, Jordi Solé-Violán, Emili Díaz, Josep Gómez, Sandra Trefler, Montserrat Vallverdú, Josefa Murcia, Antonio Albaya, Ana Loza, Lorenzo Socias, Juan Carlos Ballesteros, Elisabeth Papiol, Lucía Viña, Susana Sancho, Mercedes Nieto, Maria del Carmen Lorente, Oihane Badallo, Virginia Fraile, Fernando Arméstar, Angel Estella, Laura Sanchez, Isabel Sancho, Antonio Margarit, and Gerard Moreno

Subjects
Public aspects of medicine, RA1-1270
Abstract

ABSTRACT: Background: It is unclear whether the changes in critical care throughout the pandemic have improved the outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the intensive care units (ICUs). Methods: We conducted a retrospective cohort study in adults with COVID-19 pneumonia admitted to 73 ICUs from Spain, Andorra and Ireland between February 2020 and March 2021. The first wave corresponded with the period from February 2020 to June 2020, whereas the second/third waves occurred from July 2020 to March 2021. The primary outcome was ICU mortality between study periods. Mortality predictors and differences in mortality between COVID-19 waves were identified using logistic regression. Findings: As of March 2021, the participating ICUs had included 3795 COVID-19 pneumonia patients, 2479 (65·3%) and 1316 (34·7%) belonging to the first and second/third waves, respectively. Illness severity scores predicting mortality were lower in the second/third waves compared with the first wave according with the Acute Physiology and Chronic Health Evaluation system (median APACHE II score 12 [IQR 9–16] vs 14 [IQR 10–19]) and the organ failure assessment score (median SOFA 4 [3–6] vs 5 [3–7], p

Published
2021
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6. Timing of intubation and ICU mortality in COVID-19 patients: a retrospective analysis of 4198 critically ill patients during the first and second waves

Author

Manrique, Sara, Claverias, Laura, Magret, Mónica, Masclans, Joan Ramón, Bodi, María, Trefler, Sandra, Canadell, Laura, Díaz, Emili, Sole-Violan, Jordi, Bisbal-Andrés, Elena, Natera, Ruth González, Moreno, Antonio Albaya, Vallverdu, Montserrat, Ballesteros, Juan Carlos, Socias, Lorenzo, Vidal, Federico Gordo, Sancho, Susana, Martin-Loeches, Ignacio, and Rodriguez, Alejandro

Published
2023
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7. Reliability and reproducibility of clinical phenotypes developed during the first wave of COVID-19: A validation study in critically ill patients from the second and third wave

Author

Alejandro Rodriguez, Josep Gómez, Alvaro Franquet, Sandra Trefler, Emili Díaz, Jordi Solé-Violán, Rafael Zaragoza, Elisabeth Papiol, Borja Suberviola, Montserralt Vallverdú, María Jimenez-Herrera, Antonio Albaya-Moreno, Alfonso Canabal Berlanga, María del Valle Ortíz, Juan Carlos Ballesteros, Lucía López Amor, Susana Sancho Chinesta, Juan Carlos Pozo Laderas, Angel Estella, Ignacio Martín-Loeches, and María Bodi

Abstract

Background: During the first wave of the COVID-19 pandemic, different clinical phenotypes were published. However, none of them have been validated in subsequent waves, so their current validity is unknown. The aim of the study is to validate the unsupervised cluster model developed during the first pandemic wave in a cohort of critically ill patients from the second and third pandemic waves. Methods: Retrospective, multicentre, observational study of critically ill patients with confirmed COVID-19 disease and acute respiratory failure admitted from 74 Intensive Care Units (ICU) in Spain. To validate our original phenotypes model, we assigned a phenotype to each patient of the validation cohort using the same medoids, the same number of clusters (n= 3), the same number of variables (n= 25) and the same discretisation used in the development cohort. The performance of the classification was determined by Silhouette analysis and general linear modelling. The prognostic models were validated, and their performance was measured using accuracy test and area under curve (AUC)ROC. Results: The database included a total of 2,033 patients (mean age 63[53-92] years, 1643(70.5%) male, median APACHE II score (12[9-16]) and SOFA score (4[3-6]) points. The ICU mortality rate was 27.2%. Although the application of unsupervised cluster analysis classified patients in the validation population into 3 clinical phenotypes. Phenotype A (n=1,206 patients, 59.3%), phenotype B (n=618 patients, 30.4%) and phenotype C (n=506 patients, 24.3%), the characteristics of patients within each phenotype were significantly different from the original population. Furthermore, the silhouette coefficients were close to or below zero and the inclusion of phenotype classification in a regression model did not improve the model performance (accuracy =0.78, AUC=0.78) with respect to a standard model (accuracy = 0.79, AUC=0.79) or even worsened when the model was applied to patients within each phenotype (accuracy = 0.80, AUC 0.77 for Phenotype A, accuracy=0.73, AUC= 0.67 for phenotype B and accuracy= 0.66 , AUC= 0.76 for phenotype C ) Conclusion: Models developed using machine learning techniques during the first pandemic wave cannot be applied with adequate performance to patients admitted in subsequent waves without prior validation. Trial Registration: The study was retrospectively registered (NCT 04948242) on June 30, 2021

Published
2023
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8. A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

Author

María Blasco Cortes, María Jiménez Herrera, Manuel Ruiz-Botella, Emili Diaz, Josep Gómez Alvarez, Josep Maria Bonell Goytisolo, Fernando Arméstar, Angel Estella, Susana Sancho Chinesta, Ignacio Martin-Loeches, Juan Carlos Pozo Laderas, Ruth Jorge García, Sandra Trefler, G. Moreno, Fátima Martín Serrano, María Bodí, Mercedes Nieto, Ricard Ferrer, Lorenzo Socias-Crespi, Ana Loza, Alejandro Rodriguez, Judith Marin-Corral, Antonio Albaya-Moreno, Jordi Solé-Violán, Laura Sánchez Montori, Pablo Vidal Cortés, Asunción Marques Parra, Ana Mª Casamitjana Ortega, Virginia Fraile Gutiérrez, Josefa Murcia Paya, Virginia Hidalgo, Lorena Forcelledo Espina, María deAlba-Aparicio, and Immaculada Vallverdú Perapoch

Subjects
medicine.medical_specialty, Multivariate analysis, Coronavirus disease 2019 (COVID-19), Population, Disease, SARS-CoV2-pneumonia, Critical Care and Intensive Care Medicine, Fenotipos clínicos, Article, law.invention, law, Internal medicine, Medicine, Corticosteroids, education, Mortalidad en UCI, ComputingMethodologies_COMPUTERGRAPHICS, ICU Mortality, education.field_of_study, business.industry, Proportional hazards model, COVID-19, neumonía por SARS-CoV-2, Phenotype, Intensive care unit, Corticoides, Phenotypes, Agrupamiento no supervisado, Observational study, Unsupervised clustering, business
Abstract

Graphical abstract Fx1, Objetivo: Evaluar si el uso de corticoesteroides (Cs) se asocia con la mortalidad en la unidad de cuidados intensivos (UCI) en la población global y dentro de los fenotipos clínicos predeterminados Diseño: Análisis secundario de estudio multicéntrico observacional Ámbito: UCI Pacientes: Pacientes adultos con COVID-19 confirmado ingresados en 63 UCIs de España Intervención: Corticoides vs. no Corticoides Variables de interés principales: A partir del análisis no supervisado de grupos, 3 fenotipos clínicos fueron derivados y clasificados como: A: grave, B: critico and C: potencialmente mortal. Se efectuó un análisis multivariado después de un propensity optimal full matching (PS) y una regresión ponderada de Cox (HR) y análisis de Fine-Gray (sHR) para evaluar el impacto del tratamiento con Cs sobre la mortalidad en la población general y en cada fenotipo clínico. Resultados: Un total de 2.017 pacientes fueron analizados, 1.171(58%) con Cs. Después del PS, el uso de Cs no se relacionó significativamente con la mortalidad en UCI (OR:1.0,95%CI:0.98-1.15). Cs fueron administrados en 298/537(55.5%) pacientes del fenotipo “A” y no se observó asociación significativa con la mortalidad (HR=0.85[0.55-1.33]). Un total de 338/623(54.2%) pacientes del fenotipo “B” recibieron Cs sin efecto significativo sobre la mortalidad (HR=0.72[0.49-1.05]). Finalmente, 535/857(62.4%) pacientes del fenotipo “C” recibieron Cs. En este fenotipo, se evidenció un efecto protector de los Cs sobre la mortalidad HR (0.75[0.58-0.98]). Conclusión: Nuestros hallazgos alertan sobre el uso indiscriminado de Cs a dosis moderadas en todos los pacientes críticos con COVID-19. Solamente pacientes con elevado estado de inflamación podrían beneficiarse con el tratamiento con Cs.

Published
2023

9. Timing of Intubation and ICU Mortality in COVID-19 Patients: A Preplanned Retrospective Analysis of 4198 Critically Ill Patients

Author

Sara Manrique, Laura Claverias, Mónica Magret, Joan Ramon Masclans, María Bodi, Sandra Trefler, Laura Canadell, Emili Diaz, Jordi Sole-Violan, Elena Bisbal-Andrés, Ruth Gonzalez, Antonio Albaya, Monserrat Vallverdu, Juan Carlos Ballesteros, Lorenzo Socias, Federico Gordo, Susana Sancho, Ignacio Martín Loeches, Alejandro Rodriguez, and SEMICYUC Working group

Abstract

Background Optimal time to intubate patients with SARS-CoV-2 pneumonia is controversial. Whereas some authors recommend trying noninvasive respiratory support before intubate, others argue that delaying intubation can cause patient-self-induced lung injury and worsen the prognosis. We hypothesized that delayed intubation would increase the risk mortality in COVID-19 patients.Methods This preplanned retrospective observational study used prospectively collected data from adult patients with COVID-19 and respiratory failure admitted to 73 intensive care units between February 2020 and March 2021. Patients with limitations on life support and those with missing data were excluded. We collected demographic, laboratory, clinical variables and outcomes. Intubation was classified as 1) Very early: before or at ICU admission; 2) Early: < 24 hours after ICU admission; or 3) Late: ≥24 hours after ICU admission. We compared the early group versus those intubated late, using chi-square tests for categorical variables and the Mann-Whitney U for continuous variables. To assess the relationship between early versus late intubation and mortality, we used multivariable binary logistic regression. Statistical significance was set at pResults We included 4198 patients [median age, 63 (54‒71) years; 70.8% male; median SOFA score, 4 (3‒7); median APACHE score, 13 (10‒18)], and median PaO2/FiO2, 131 (100‒190)]; intubation was very early in 2024 (48.2%) patients, early in 928 (22.1%), and late in 441 (10.5%). ICU mortality was 30.2% and median ICU stay was 14 (7‒28) days. Although patients in the late group were younger [62 vs. 64, respectively, p2 at admission (116 vs. 100, respectively, pConclusions Delaying intubation beyond the first 24 hours of admission in patients with COVID-19 pneumonia increases the risk of mortality.Trial registration: clinical-Trial.gov (NCT 04948242)

Published
2022
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10. Impact of a Non-Invasive Respiratory Support Strategy and Switches in Therapy During Acute Respiratory Failure Due to SARS-CoV-2

Author

Judith Marin-Corral, FJ Parrilla, Andrea Castellví, Purificación Pérez-Terán, Lucía Picazo, Sergi Pascual-Guardia, Alejandro Rodriguez Oviedo, Juan Carlos Ballesteros, Susana Sancho, Lorenzo Socias, Emili Díaz, Antonio Albaya Moreno, Candelaria de Haro, Oriol Roca, Marcos I. Restrepo, and Joan Ramón Masclans

Subjects
History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published
2022
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11. Additional file 1 of Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2022 critically ill patients with COVID-19 in Spain

Author

Rodríguez, Alejandro, Ruiz-Botella, Manuel, Martín-Loeches, Ignacio, Herrera, María Jimenez, Solé-Violan, Jordi, Gómez, Josep, Bodí, María, Trefler, Sandra, Papiol, Elisabeth, Díaz, Emili, Suberviola, Borja, Vallverdu, Montserrat, Mayor-Vázquez, Eric, Moreno, Antonio Albaya, Berlanga, Alfonso Canabal, Sánchez, Miguel, Ortíz, María Del Valle, Ballesteros, Juan Carlos, Iglesias, Lorena Martín, Marín-Corral, Judith, Ramos, Esther López, Valverde, Virginia Hidalgo, Tello, Loreto Vidaur Vidaur, Chinesta, Susana Sancho, Molina, Francisco Javier Gonzáles De, García, Sandra Herrero, Pérez, Carmen Carolina Sena, Laderas, Juan Carlos Pozo, García, Raquel Rodríguez, Estella, Angel, and Ferrer, Ricard

Subjects
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, ComputingMilieux_COMPUTERSANDEDUCATION, Data_FILES, ComputerApplications_COMPUTERSINOTHERSYSTEMS
Abstract

Additional file 1. Supplementary online content.

Published
2021
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12. A Differential Therapeutic Consideration for use of Corticosteroids According to Established COVID-19 Clinical Phenotypes in Critically Ill Patients

Author

Moreno, Gerard, primary, Botella, Manuel Ruíz-, additional, Martin-Loeches, Ignacio, additional, Alvarez, Josep Gómez, additional, Herrera, María Jiménez, additional, Saera, María Amparo Bodí, additional, Armestar, Fernando, additional, Parra, Asunción Marques -, additional, Estella, Angel, additional, Trefler, Sandra, additional, García, Ruth Jorge, additional, Payá, Josefa Murcia, additional, Cortes, Pablo Vidal, additional, Díaz, Emili, additional, Ferrer, Ricard, additional, Moreno, Antonio Albaya, additional, Crespi, Lorenzo Socias, additional, Goytisolo, Josep María Bonell, additional, Chinesta, Susana Sancho, additional, Loza, Ana, additional, Espina, Lorena Forcelledo, additional, Laderas, Juan Carlos Pozo, additional, deAlba-Aparicio, María, additional, Montori, Laura Sánchez, additional, Perapoch, Inmaculada Vallverdu, additional, Hidalgo, Virginia, additional, Gutiérrez, Virginia Fraile, additional, Ortega, Ana María Casamitjana, additional, Serrano, Fátima Martín, additional, Nieto, Mercedes, additional, Cortes, Marisa Blasco, additional, Marín-Corral, Judith, additional, Solé-Violan, Jordi, additional, and Rodriguez, Alejandro, additional

Published
2021
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13. Deploying Machine Learning to Validate Clinical Phenotypes and Factors Associated with Mortality Risk in 2,022 Critically Ill Patients with COVID-19 in Spain

Author

Alejandro Rodriguez Oviedo, Manuel Ruíz-Botella, Ignacio Matín-Loeches, Jordi Solé-Violan, Josep Gómez, María Bodí, Sandra Trefler, Elisabeth Papiol, Emili Díaz, Borja Suberviola, Montserrat Vallverdú, Eric Mayor-Vazquez, Antonio Albaya Moreno, Alfonso Canabal Berlanga, Miguel Sánchez García, María del Valle Ortíz, Juan Carlos Ballesteros, Lorena Martín Iglesias, Judith Marín-Corral, Esther López Ramos, Virgina Hidalgo Valverde, Loreto Vidaur, Susana Sancho Chinesta, Francisco Javier González de Molina, Sandra Herrero García, Carmen Carolina Sena Perez, Juan Carlos Pozo Laderas, Raquel Rodríguez García, Angel Estella, and Ricard Ferrer

Published
2020
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14. Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2,022 critically ill patients with COVID-19 in Spain

Author

Rodríguez, Alejandro, primary, Botella, Manuel Ruiz, additional, Matín-Loeches, Ignacio, additional, Herrera, María Jiménez, additional, Solé-Violan, Jordi, additional, Gómez, Josep, additional, Bodí, María, additional, Trefler, Sandra, additional, Papiol, Elisabeth, additional, Díaz, Emili, additional, Suberviola, Borja, additional, Vallverdú, Montserrat, additional, Mayor-Vázquez, Eric, additional, Moreno, Antonio Albaya, additional, Berlanga, Alfonso Canabal, additional, Sánchez, Miguel, additional, Ortíz, María del Valle, additional, Ballesteros, Juan Carlos, additional, Iglesias, Lorena Martín, additional, Marín-Corral, Judith, additional, Ramos, Esther López, additional, Valverde, Virgina Hidalgo, additional, Tello, Loreto Vidaur, additional, Chinesta, Susana Sancho, additional, de Molina, Francisco Javier González, additional, García, Sandra Herrero, additional, Perez, Carmen Carolina Sena, additional, Laderas, Juan Carlos Pozo, additional, García, Raquel Rodríguez, additional, Estella, Angel, additional, and Ferrer, Ricard, additional

Published
2021
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15. Deploying Machine Learning to Validate Clinical Phenotypes and Factors Associated with Mortality risk in 2,022 Critically Ill Patients with COVID-19 in Spain

Author

Rodríguez, Alejandro, primary, Botella, Manuel Ruiz, additional, Matín-Loeches, Ignacio, additional, Herrera, María Jiménez, additional, Solé-Violan, Jordi, additional, Gómez, Josep, additional, Bodí, María, additional, Trefler, Sandra, additional, Papiol, Elisabeth, additional, Díaz, Emili, additional, Suberviola, Borja, additional, Vallverdú, Montserrat, additional, Mayor-Vázquez, Eric, additional, Moreno, Antonio Albaya, additional, Berlanga, Alfonso Canabal, additional, Sánchez, Miguel, additional, Ortíz, María del Valle, additional, Ballesteros, Juan Carlos, additional, Iglesias, Lorena Martín, additional, Marín-Corral, Judith, additional, Ramos, Esther López, additional, Valverde, Virgina Hidalgo, additional, Tello, Loreto Vidaur, additional, Chinesta, Susana Sancho, additional, de Molina, Francisco Javier González, additional, García, Sandra Herrero, additional, Perez, Carmen Carolina Sena, additional, Laderas, Juan Carlos Pozo, additional, García, Raquel Rodríguez, additional, Estella, Angel, additional, and Ferrer, Ricard, additional

Published
2020
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16. Community-Acquired Respiratory Coinfection in Critically Ill Patients With Pandemic 2009 Influenza A(H1N1) Virus

Author

Antonio Albaya, Ignacio Martin-Loeches, Rosa María Granada, Amparo Paredes, Ana Sanchez-Corral, Alejandro Rodríguez, Inés Navarrete, Pilar Luque, Emili Diaz, Enrique Cerdá, Christian Villavicencio, Jordi Rello, R. Catalán, and Rafael Zaragoza

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Illness, Orthomyxoviridae, Comorbidity, Critical Care and Intensive Care Medicine, medicine.disease_cause, Virus, Influenza A Virus, H1N1 Subtype, Internal medicine, Influenza, Human, Streptococcus pneumoniae, Pandemic, Prevalence, medicine, Influenza A virus, Humans, Prospective Studies, Intensive care medicine, Respiratory Tract Infections, Retrospective Studies, biology, business.industry, Respiratory disease, Middle Aged, biology.organism_classification, medicine.disease, Respiration, Artificial, Community-Acquired Infections, Intensive Care Units, Spain, Coinfection, Regression Analysis, Female, Viral disease, Cardiology and Cardiovascular Medicine, business
Abstract

Little is known about the impact of community-acquired respiratory coinfection in patients with pandemic 2009 influenza A(H1N1) virus infection.This was a prospective, observational, multicenter study conducted in 148 Spanish ICUs.Severe respiratory syndrome was present in 645 ICU patients. Coinfection occurred in 113 (17.5%) of patients. Streptococcus pneumoniae (in 62 patients [54.8%]) was identified as the most prevalent bacteria. Patients with coinfection at ICU admission were older (47.5±15.7 vs 43.8±14.2 years, P.05) and presented a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score (16.1±7.3 vs 13.3±7.1, P.05) and Sequential Organ Failure Assessment (SOFA) score (7.0±3.8 vs 5.2±3.5, P.05). No differences in comorbidities were observed. Patients who had coinfection required vasopressors (63.7% vs 39.3%, P.05) and invasive mechanical ventilation (69% vs 58.5%, P.05) more frequently. ICU length of stay was 3 days longer in patients who had coinfection than in patients who did not (11 [interquartile range, 5-23] vs 8 [interquartile range 4-17], P=.01). Coinfection was associated with increased ICU mortality (26.2% vs 15.5%; OR, 1.94; 95% CI, 1.21-3.09), but Cox regression analysis adjusted by potential confounders did not confirm a significant association between coinfection and ICU mortality.During the 2009 pandemics, the role played by bacterial coinfection in bringing patients to the ICU was not clear, S pneumoniae being the most common pathogen. This work provides clear evidence that bacterial coinfection is a contributor to increased consumption of health resources by critical patients infected with the virus and is the virus that causes critical illness in the vast majority of cases.

Published
2011
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17. Impact of early oseltamivir treatment on outcome in critically ill patients with 2009 pandemic influenza A

Author

José Albofedo-Sánchez, M. Blasco Navalpotro, Paloma Dorado Regil, S. Tormo, Luis Regalado, Eduardo Palencia, A. Tellería, Raul José González, J.M. Añón, Antonio Jareño, Jose Ramon Iruretagoyena Amiano, Elena Gallego, Angel Arenzana, Cecilia Hermosa, Laura Macaya, Luis Álvarez–Rocha, R. Granada, Antonio Albaya, Carlos Velayos, Dolores Ocaña Fernández, Ignacio Amestarán, Josep Ballus, Emilio Robles-Musso, José Mª Molina, Sonia Gómez-Rosado, Carlos Pey, Fernándo Bueno, Luis Miguel Prado López, Iñaki Catalán, Rosa María Díaz, Ana Trujillo, B. Santamaría, Virgilio Paricio, Antonia Socias, José Luis Ballesteros, Julio Canabal, J.C. Pozo, César Pérez–Calvo, Mónica Magret, B. Suberviola, P. Ugarte, Joaquim Ramón Cervelló, S Barbadillo, Loreto Vidaur, Pedro Ibañez, Bárbara Baladín, Pilar Luque, J Nolla, José Cuñat, Juan C. Figueira, Fernando Barcenilla, S. Garrido Ramírez de Arellano, Sisón, Fernando Arméstar, Arantxa Lander, M. Martín, Inés Navarrete, Antonio Cárdenas, M. Cruz Soriano, Miguel Angel Díaz Castellanos, Diego de Mendoza, Javier Pérez, Francisco del Río, Medhi Zaheri Beryanaki, Miguel González, I. Jimenez Urra, David Hernandez, Sandra Trefler, Lisardo Iglesias, Antonio Álvarez Terrero, JJ Díaz, Marta Ortíz, Francisco Álvarez-Lerma, A. Liétor, Concepción Vaquero, Susana Altaba, Isidro Prieto, M. Badia, Ángel Sánchez-Miralles, Almudena Simón, Nerea López de Arbina, Mª Jesús Huertos, Zoran Josic, M. I. Marquina Lacueva, Santiago Macias, J. Nava, C. Ferri, José A. Pastor, Rafael Sierra, Antoli Ribas, Quiroga, Ignacio Martin-Loeches, Eleuterio Merayo, Santiago Freita, Nieves Carrasco, L. Macaya Redin, Ana María Rojo López, F. Felices Abad, Patricia Albert, Leonardo Lorente, Rafael Caballero, Sergio Ruiz-Santana, Javier Martins, José M. Bonell, Eva Vilaboy, Juan B. López Messa, Xavier Balanzó, José Luna, Cristóbal León, Abilio Arrascaeta, M. C. Martín, Joaquim Páez, Ana Loza, Juliá-Narváez José, José Garnacho-Montero, Jordi Almirall, Zulema Ferreras, Elena Arnau, L. Cabre, Guillermo Sevilla, S. García, José Eugenio Guerrero, R. Guerrero, Enrique Marquez, José Luis Monzón, Yolanda Fernández, A. del Castillo, Thiago Lisboa, Teresa Recio, Asunción Marques, Ignacio Sánchez, Lluis Llopart, M. Rodriguez, José Pomares, Marcío Borges-Sa, José Blanquer, Juan Carlos Montejo, Mercedes Díaz, Carmen González, Rosa Mª Catalán, Fernández del Cabo, Rafael Mañez, Enrique Ferres, Bernardo Gil Rueda, Alejandro Algora, Jesús Blanco Varela, L. Canadell, Jordi Rello, Alberto Manzano, A. Andaluz Ojeda, Jaime Benitez Peyrat, Félix Goñi, Rafael Zaragoza, Miquel Ferrer, Eduard Mesalles, A. Alonso, Alberto Fernández-Zapata, Frutos Del Nogal Sáez, Alejandro Rodríguez, Águeda García-Rodríguez, Ignacio González, Antonio Pasilla, A. Vazquez, Zulema Paez, Assumpta Rovira, Alberto Sandiumenge, M. F. Esteban, Dolores Ocaña, Josu Insansti, José F. Prieto, Pedro Cobo, Manuel Alvarez, Luis Arnaiz, Javier Cebrian, Carlos Castillo Arenal, Ricard Jordà Marcos, Manuel Luis Avellanas, Emili Diaz, Santiago Alberto Picos, Juan Carlos Vergara, Montserrat Valverdú-Vidal, J. J. Cáceres, Enrique Maraví-Poma, Diego López, Juan Bonastre, Esteban Fernández, P. Galdós, Sofía Martínez, Bernabé Alvarez-Sánchez, Fabiola Tena Ezpeleta, Ana de Pablo, R. Ramos, Eva Maria Saborido, Roberto Reig Valero, Enrique Cerdá, S. Sánchez-Alonso, Mercedes Catalán, Victor Jose López-Ciudad, M. Ortiz Piquer, Mariano Martínez, Amparo Paredes, Belén Agrela Romero, Jordi Vallés, M. Palamo, Jos M. Latour, J. González de Molina, Francisco Gurri, Jose Mª Montón, Juan José Díaz, Ana Díaz Lamas, Álvaro García, Josep Mª Sirvent, Jose Ángel Berezo, Mª José García-Ramos, Sergio Manuel Butí, Federico Gordo, Lorenzo Socias, Manuel Rodríguez-Carvajal, Mª Lourdes Cordero, Mercedes Palomar, Fernando García-López, Cecilia Carbayo, Pilar Martínez, R. Hinojosa, Dolores Vila, Francisco Lobato, Francisco Fernández, Juan Cortez, Pedro Olaechea, M. Ángel García, Mª Jesús López Pueyo, Antoni Torres, Beatriz Galván, Mª Carmen García-Torrejón, J. A. Cambronero, Bárbara Balandin Moreno, A. Canabal, Sergio F. Martínez, Nagore González, A. Belenger, Francisco Mariscal, P. Marco, Luis Marina, Francisco García, Mª Luisa Gómez Grande, S. Sánchez-Morcillo, Javier Fierro, and C. Guía

Subjects
Microbiology (medical), Adult, Male, medicine.medical_specialty, Oseltamivir, Time Factors, medicine.drug_class, medicine.medical_treatment, Critical Illness, Antiviral Agents, law.invention, chemistry.chemical_compound, Influenza A Virus, H1N1 Subtype, law, Internal medicine, Influenza, Human, medicine, Humans, Pharmacology (medical), Prospective Studies, Prospective cohort study, Pharmacology, Mechanical ventilation, Neuraminidase inhibitor, business.industry, Middle Aged, medicine.disease, Intensive care unit, Surgery, Pneumonia, Infectious Diseases, Treatment Outcome, chemistry, Propensity score matching, Cohort, Female, business
Abstract

Received 8 October 2010; returned 9 November 2010; revised 2 December 2010; accepted 6 December 2010Objectives: The impact of oseltamivir on mortality in critically ill patients with 2009 pandemic influenza A(2009 H1N1) is not clear. The main objective of this study was to investigate the relationship between thetiming of antiviral administration and intensive care unit (ICU) outcomes.Methods: Prospective, observational study of a cohort of ICU patients with confirmed 2009 H1N1 infection.Clinical data, treatment and outcome were compared between patients receiving early treatment (ET) withoseltamivir, initiated within 2 days, and patients administered late treatment (LT), initiated after this timepoint.Multivariate analysis and propensity score were used to determine the effect of oseltamivir on ICU mortality.Results: Six hundred and fifty-seven patients were enrolled. Four hundred and four (61.5%) patients requiredmechanical ventilation (MV; mortality 32.6%). Among them, 385 received effective antiviral therapy andwere included in the study group. All patients received oseltamivir for a median duration of 10 days (interquar-tile range 8–14 days). Seventy-nine (20.5%) ET patients were compared with 306 LT patients. The two groupswere comparable in terms of main clinical variables. ICU length of stay (22.7+16.7 versus 18.4+14.2 days;P¼0.03), hospital length of stay (34.0+20.3 versus 27.2+18.2 days; P¼0.001) and MV days (17.4+15.2versus 14.0+12.4; P¼0.04) were higher in the LT group. ICU mortality was also higher in LT (34.3%) than inET (21.5%; OR¼1.9; 95% CI 1.06–3.41). A multivariate model identified ET (OR¼0.44; 95% CI 0.21–0.87) asan independent variable associated with reduced ICU mortality. These results were confirmed by propensityscore analysis (OR¼0.44; 95% CI 0.22–0.90; P,0.001).Conclusions: Our findings suggest that early oseltamivir administration was associated with favourableoutcomes among critically ill ventilated patients with 2009 H1N1 virus infection.Keywords: antiviral treatment, prognosis, pneumonia

Published
2011

18. Effects of nitric oxide synthase inhibition on the cardiovascular response to low output shock

Author

Pablo Jorge, L. Landin, E. Renes, José A. Lorente, D. Liste, Miguel Delgado, Paloma Canas, and Antonio Albaya

Subjects
medicine.medical_specialty, Haemodynamic response, Cardiac Output, Low, Shock, Cardiogenic, Critical Care and Intensive Care Medicine, Arginine, Cardiovascular System, Nitroarginine, Dexamethasone, Nitric oxide, chemistry.chemical_compound, Intensive care, Internal medicine, medicine, Animals, Prospective Studies, Analysis of Variance, Sheep, biology, business.industry, Oxygen transport, Nitric oxide synthase, Disease Models, Animal, medicine.anatomical_structure, Endocrinology, chemistry, Vascular resistance, biology.protein, medicine.symptom, Nitric Oxide Synthase, business, Vasoconstriction, medicine.drug
Abstract

Objective : To study the role of nitric oxide in the cardiovascular response to a model of a low output syndrome. Design : Prospective animal study. Setting : Animal research laboratory. Subjects : Sheep anesthetized with pentobarbital, mechanically ventilated, and monitored with pulmonary arterial and peripheral arterial catheters. Interventions : A low output state was induced by inflating a balloon-tip catheter placed in the right atrium. Cardiac index was maintained at 1 L/min/m 2 throughout the experiment in three groups of sheep : a) control (n = 6) ; b) LNNA group (pretreated with the nitric oxide synthase inhibitor N ω -nitro-L-arginine [LNNA, 100 mg/kg, iv bolus, n = 6]) ; and c) dexamethasone group (pretreated with dexamethasone (6 mg/kg, intravenous bolus, n = 6). Dexamethasone is an inhibitor of the induction of nitric oxide synthase. LNNA or dexamethasone were administered 15 mins before inducing the low output state. Measurements and Main Results : Hemodynamic and oxygen transport variables, and plasma lactate and pyruvate concentrations, were measured at baseline and during the next 3 hrs. For a comparable decrease in cardiac index and oxygen delivery in all groups, the LNNA group had less hypotension and a more marked increase in systemic vascular resistance as compared with the control group. Oxygen consumption and oxygen extraction were higher in the LNNA group as compared with the control group at 30 and 60 mins. Plasma lactate concentration increased significantly less in the LNNA group than in the control and the dexamethasone groups during the observation period. Conclusions : Inhibition of nitric oxide synthesis during a severe low output state in sheep is associated with a better hemodynamic response, as evidenced by a greater vasoconstriction, and signs of less marked tissue hypoxia. It is likely that inhibition of nitric oxide synthesis in this model leads to an imbalance between the tonic relaxing action of nitric oxide and the influences of vasoconstrictor agents.

Published
1996

19. Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis

Author

Alejandro H. Rodríguez, Francesc X. Avilés-Jurado, Emili Díaz, Philipp Schuetz, Sandra I. Trefler, Jordi Solé-Violán, Lourdes Cordero, Loreto Vidaur, Ángel Estella, Juan C. Pozo Laderas, Lorenzo Socias, Juan C. Vergara, Rafael Zaragoza, Juan Bonastre, José E. Guerrero, Borja Suberviola, Catia. Cilloniz, Marcos I. Restrepo, Ignacio Martín-Loeches, Pedro Cobo, Javier Martins, Cecilia Carbayo, Emilio Robles-Musso, Antonio Cárdenas, Javier Fierro, Dolores Ocaña Fernández, Rafael Sierra, Mª Jesús Huertos, Mª Luz Carmona Pérez, Juan Carlos Pozo Laderas, R. Guerrero, Juan Carlos Robles, Melissa Echevarría León, Alberto Bermejo Gómez, Enrique Márquez, Manuel Rodríguez-Carvajal, José Pomares, José Luis Ballesteros, Olga Moreno Romero, Yolanda Fernández, Francisco Lobato, José F. Prieto, José Albofedo-Sánchez, Pilar Martínez, María Victoria de la Torre, María Nieto, Estefanía Camara Sola, Miguel Angel Díaz Castellanos, Guillermo Sevilla Soler, Carlos Ortiz Leyba, José Garnacho-Montero, Rafael Hinojosa, Esteban Fernández, Ana Loza, Cristóbal León, Samuel González López, Angel Arenzana, Dolores Ocaña, Inés Navarrete, Medhi Zaheri Beryanaki, Ignacio Sánchez, Manuel Pérez Alé, Ana Mª Poullet Brea, Juan Francisco Machado Casas, Carlos Serón, Manuel Luis Avellanas, Arantxa Lander, S. Garrido Ramírez de Arellano, M.I. Marquina Lacueva, Pilar Luque, Elena Plumed Serrano, Juan Francisco Martín Lázaro, Carlos Sánchez Polo, Isabel Gutiérrez Cia, Belén Jiménez Bartolomé, Carlos López Nuñez, Ignacio González, José Ignacio Tomás Marsilla, Clara Jaques Andrés, Pablo Gtiérrez Ibañes, Pilar Araujo Aguilar, Jose Mª Montón, Paloma Dorado Regil, Lisardo Iglesias, Carmen Pascual González, Brígida Quindós Fernández, Lorena Martín Iglesias, Lucía Viña Soria, Raquel Yano Escudero, Mª del Rosario Mtnez Revuelta, null Quiroga, Águeda García-Rodríguez, Marta Martín Cuadrado, Ana Luz Balán Mariño, Pedro Ibánez, Marcío Borges-Sa, A. Socias, A. Del Castillo, Ricard Jordà Marcos, Cristina Muñoz, José M. Bonell, Ignacio Amestarán, M. Angeles González López, Cecilia Vilanova Pàmies, José Ma. Bonell Goytisolo, José Antonio Morales Carbonero, Rossana Pérez Senoff, Marta Generelo López de Medrano, Sergio Ruiz-Santana, Juan José Díaz, Catalina Sánchez Ramírez, Montse Sisón, David Hernández, Ana Trujillo, Luis Regalado, Sonia Rodríguez Fndez, Leonardo Lorente, Judith Cabrera Rivero, Mª Luisa Mora Quintero, Mar Martín, Sergio Martínez, J.J. Cáceres, Manuel Sanchez Palacio, null Marcos, D. García Rodríguez, María Ripoll Leria, P. Ugarte, Fernando García-López, Rafael Sánchez Iniesta, Angel Álvaro Alonso, Antonio Padilla, Basi Martínez Palacios, Mª Luisa Gómez Grande, Ma. Carmen Martín Rodríguez, Hasania Adbel-Hadi Álvarez, Alfonso Ambros Checa, Higinio Martín Hernández, Antonio Albaya, Alberto Silva Obregón, Carlos Marian Crespo, Carlos Armendariz Estrella, Carmen Benito Puncel, Eduardo Quirós Oyargue, Alfonso Canabal, Luis Marina, Ismael López de Toro, Almudena Simón, José María Añón, Juan B. López Messa, Mª Jesús López Pueyo, Ortíz María del valle Sergio Ossa Echeverri, Zulema Ferreras, Juan C. Ballesteros Herraez, Santiago Macias, José Ángel Berezo, Jesús Blanco Varela, Pablo Blanco Schweizer, Angela González Salamanca, Luis Tamayo Lomas, Andaluz Ojeda Anzález, Ramón Cicuéndez Avila, Pérez G. Francisco Javier, Antonio Álvarez Terrero, Fabiola Tena Ezpeleta, Christian Sala, Oliverio López, Zulema Paez, Álvaro García, Demetrio Carriedo Ule, Miriam Riesco Crespo, Jesús Pino Rebolledo, Nicolás Hidalgo Andrés, Ana Carolina Caballero Zirena, Belén Román García, Juan Bautista López Messa, María del Valle Ortiz, Sergio Ossa Echeverri, Rosa Mª Catalán, Miquel Ferrer, Antoni Torres, Catia Cilloniz, Sandra Barbadillo Ansorregui, Lluís Cabré, Ignacio Baeza, Assumpta Rovira, Francisco Álvarez-Lerma, Antonia Vázquez, Joan Nolla, Francisco Fernández, Joaquim Ramón Cervelló, Raquel Iglesia, Rafael Mañéz, J. Ballús, Rosa Mª Granada, Jordi Vallés, Marta Ortíz, C. Guía, Joaquim Páez, Jordi Almirall, Xavier Balanzo, Estel Güell, Juan Carlos Yebenes, Jordi Rello, Elena Arnau, Marcos Pérez, César Laborda, Jesica Souto, Leonel Lagunes, Iñaki Catalán, Josep Mª Sirvent, Nerea López de Arbina, Anna Baró Serra, Adriana Sánchez, Silvia M. Cuenca, Mariona Badía, Begonia Baseda-Garrido, Montserrat Valverdú-Vidal, Fernando Barcenilla, Mercedes Palomar, Xavier Nuvials, Pedro Garrido Benedicto, Ferran Roche Campo, M.F. Esteban, José Luna, Gaspar Masdeu Eixarch, Angels Pascual Diago, Juan Mª Nava, J. González de Molina, Josep Trenado, Ricard Ferrer, Zoran Josic, Montserrat Casanovas, Francisco Gurri, Paula Rodríguez, Alejandro Rodríguez, Laura Claverias, Sandra Trefler, María Bodí, Mónica Magret, Cristina Ferri, Rosa María Díaz, Eduard Mesalles, Fernando Arméstar, Diego de Mendoza, Carmen Lomas Fernández, José Julián Berrade, Alfonso Bonet Saris, Marina Pechkova, Cristina Mora Jiménez, Santiago Picos Gil, José Juliá-Narváez, Manuel Robles Marcos, Vanessa Farje Mallqui, Mª. Angeles Santiago Triviño, Pablo Martínez García, Alberto Fernández-Zapata, Teresa Recio, Abilio Arrascaeta, Mª José García-Ramos, Elena Gallego, Esther Saiz Rodrigo, Fernándo Bueno, Mercedes Díaz, Noemí Gil Pérez, David López Hormigo, Juan Diego Jiménez Delgado, Pérez Frutos, M.J. Rivera Pinna, Mª Lourdes Cordero, José A. Pastor, Luis Álvarez-Rocha, Alexandra Ceniceros Barros, Alejandra Virgós Pedreira, Dolores Vila, Carmen Fernández González, Javier Blanco Pérez, M. Ortiz Piquer, Eleuterio Merayo, Victor Jose López-Ciudad, Juan Cortes Cañones, Eva Vilaboy, José Villar Chao, Francisco Savira Cid López, Pablo Vidal Cortés, Marcos A. Pérez Veloso, Eva Maria Saborido, Enrique Alemparte Pardavila, Ana Ortega Montes, Raul José González, Santiago Freita, Enrique Alemparte, Ana Ortega, Ana María López, Julio Canabal, Enrique Ferres, Santiago Freitas Ramos, Lucas Lage Cendón, Vanesa Gómez Casal, Sabela Vara Adrio, Eva Menor Fernández, Susana González Prado, Antonio Varela Franco, José Luis Monzón, Félix Goñi, Frutos Del Nogal Sáez, M. Blasco Navalpotro, Ricardo Díaz Abad, José Luis Flordelis Lasierra, Mª Carmen García-Torrejón, César Pérez–Calvo, Diego López, Luis Arnaiz, S. Sánchez-Alonso, Carlos Velayos, Francisco del Río, Miguel Ángel González, Mercedes Nieto, Carmen Sánchez Cesteros, María Cruz Martín, José Mª Molina, Juan Carlos Montejo, Mercedes Catalán, Patricia Albert, Ana de Pablo, José Eugenio Guerrero, María Zurita, Jaime Benitez Peyrat, Miriam Díaz Cámara, Enrique Cerdá, Manuel Alvarez, Carlos Pey, Eva Manteiga Riestra, Concepción Martinez-Fidalgo, Montse Rodríguez, Eduardo Palencia, Rafael Caballero, Concepción Vaquero, Francisco Mariscal, S. García, Rico Cepeda, Nieves Carrasco, Isidro Prieto, A. Liétor, R. Ramos, Rosario Cuadra Casas, Cruz Soriano Cuesta, Susana Sánchez Alonso, Beatriz Galván, Juan C. Figueira, M. Cruz Soriano, Bélen Civantos Martín, Alejgandro Robles Caballero, P. Galdós, Bárbara Balandin Moreno, Sara Alcántara Carmona, Fernández del Cabo, Cecilia Hermosa, Federico Gordo, Alejandro Algora, Amparo Paredes, Teodoro Grau Carmona, J.A. Cambroner, Esther López Ramos, Yaiza Ortiz de Zárate, Sonia Gómez-Rosado, Margarita Mas Lodo, Nieves Franco Garrobo, Silvia Álvarez Hernández, Teresa Honrubia, Luis Miguel Prado López, A. Esteban, J.A. Lorente, N. Nin, Carlos Jaramillo Sotomayor, Esperanza Molero Silvero, Eduardo Morales Fdez. de la Reguera, Rosa Mª de la Casa Monje, Fátima Martín Serrano, Mª Victoria Trasmonte Martínez, M. Cruz Martín Delgado, Sofía Martínez, F. Felices Abad, Isabel Cremades Navalon, Martín Vigil Velis, Mariano Martínez, Domingo Martínez Baño, Enriqueta Andreu, Sergio Manuel Butí, Bernardo Gil Rueda, Francisco García, Noemí Llamas Fernández, Luis Herrera Para, Alejandro Ortín Freire, Mª Rosa Nvarro Ruiz, C.R. Hernández Romero, Enrique Maraví-Poma, I. Jimenez Urra, Laura Macaya Redin, A. Tellería, Josu Insansti, Noelia Artesero Garcia, Laura Macaya, Joaquín Lobo Palanco, Nagore González, Pilar Marco, Estibaliz Salas, Ruth Salaberría Udabe, B. Santamaría, Tomás Rodríguez, Juan Carlos Vergara, Jose Ramon Iruretagoyena Amiano, Iratí Garrido Santos, Alberto Manzano, Carlos Castillo Arenal, Pedro María Olaechea, Alejandro Martín López, Fernando Fonseca San Miguel, José Blanquer, Nieves Carbonell, José Ferreres Franco, Roberto Reig Valero, A. Belenger, Susana Altaba, Bernabé Álvarez–Sánchez, José Canovas Robles, Jaime Sánchez Francisco, Mar Ruiz Sánchez, Santiago Alberto Picos, Abilio Arrascaeta Llanes, Eugenio Herrero Gutiérrez, Alberto Fernández Zapata, Ángel Sánchez-Miralles, José Luis Antón Pascual, M. Palamo, Javier Cebrian, José Cuñat, Mónica Gordón Sahuquillo, Belén Romero, Santiago Borrás Pallé, Javier de León Belmar, Constantino Tormo, Susana Sancho Chinesta, Virgilio Paricio, Asunción Marques, S. Sánchez-Morcillo, S. Tormo, J. Latour, M. Ángel García, Manuel Palomo, Francisco Tarín Royo, Pedro Manzano Hinojosa, Mª Salomé Sánchez Pino, Concha Maragues Ribes, Rubén González Luis, Antoli Ribas, and Universitat de Barcelona

Subjects
Male, Procalcitonin, 0302 clinical medicine, Community-acquired pneumonia, Septic shock, Prospective Studies, 030212 general & internal medicine, Coinfection, Bacterial Infections, Middle Aged, Prognosis, Intensive Care Units, Infectious Diseases, Female, Pèptids, Adult, Calcitonin, Microbiology (medical), medicine.medical_specialty, Icu patients, Calcitonin Gene-Related Peptide, CHAID analysis, Respiratory coinfection, Sensitivity and Specificity, Influenzavirus, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Influenza, Human, parasitic diseases, medicine, Humans, Influenza viruses, Protein Precursors, Intensive care medicine, Influenza A(H1N1)pmd, business.industry, Decision Trees, 030208 emergency & critical care medicine, Influenza a, medicine.disease, CHAID, Observational study, business, Peptides, Biomarkers
Abstract

Objectives: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods: A secondary analysis from a prospective, multicentre, observational study (2009 -2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the bi-nominal distributions of the true (+) and true (-) results. Results: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT < 0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT < 0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock. (C) 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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