Revista clinica espanola最新文献

{"title":"Impacto clínico y económico de la Unidad del Paciente Pluripatológico","authors":"F. Martínez García ,&nbsp;L.M. Cantero Nieto ,&nbsp;T. Bruno Pérez ,&nbsp;A.J. Trujillo Santos","doi":"10.1016/j.rce.2026.502521","DOIUrl":"10.1016/j.rce.2026.502521","url":null,"abstract":"<div><h3>Introduction</h3><div>Managing patients with a high burden of chronic conditions and multiple pathologies poses a challenge to the sustainability of the healthcare system. We evaluated the impact of establishing a Multimorbidity Patient Unit (MUP) on reducing emergency department visits and hospital admissions.</div></div><div><h3>Methods</h3><div>This was a pre-post observational study that included patients enrolled in the MUP between November 2022 and December 2023. Demographic and clinical variables were analyzed, as well as the number of emergency department visits and hospital admissions before and after enrollment. The savings resulting from the implementation of the unit were estimated.</div></div><div><h3>Results</h3><div>Eighty-six patients were included (mean age 81.2 years; 52.3% male), with the most prevalent diagnoses being heart failure (97.7%), hypertension (95.3%), and chronic kidney disease (91.9%). Avoidable emergency room visits decreased by 64.18% and avoidable hospital admissions decreased by 64.47%. The estimated savings during the study period was €541,723.20.</div></div><div><h3>Conclusions</h3><div>The MUP proved to be a highly cost-effective intervention, significantly reducing avoidable healthcare utilization and improving continuity of care.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502521"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploración de los patrones espaciales de la mortalidad por sarcoidosis en España entre 2009 y 2023","authors":"L. Cayuela ,&nbsp;A.M. Gaeta ,&nbsp;V. Achaval Rodríguez ,&nbsp;J. Librero ,&nbsp;A. Cayuela","doi":"10.1016/j.rce.2026.502516","DOIUrl":"10.1016/j.rce.2026.502516","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe temporal trends and spatial distribution of sarcoidosis-related mortality in mainland Spain between 2009 and 2023, with a focus on sex-specific differences and high-risk clusters.</div></div><div><h3>Methods</h3><div>An ecological study was conducted using mortality data from the Spanish National Statistics Institute (INE) for deaths coded as ICD-10 D86. Age-adjusted mortality rates were calculated using direct standardization to the European Standard Population 2013. Temporal trends were assessed with joinpoint regression, and spatial patterns were analyzed at the provincial level using standardized mortality ratios (SMRs), Bayesian-smoothed relative risks (RRs), and posterior probabilities via the Besag–York–Mollié model. Global and local clustering was evaluated with spatial scan statistics, Moran's I, and Local Indicators of Spatial Association (LISA).</div></div><div><h3>Results</h3><div>Between 2009 and 2023, 709 sarcoidosis-related deaths were recorded (417 women, 292 men). Mortality increased significantly in men (average annual percentage change (AAPC) 4.5%, 95% CI 1.6–7.4%) but not in women (AAPC 1.0%, 95% CI –1.3–3.5%). Geographic analysis revealed persistent high-risk clusters in northwestern provinces, particularly Galicia and Castilla y León, whereas central and Mediterranean provinces exhibited lower-than-expected mortality. Sex-specific clustering patterns were evident, with women showing more widespread high-risk regions. Bayesian-smoothed relative risks and posterior probabilities corroborated these findings, indicating true excess risk rather than random variation.</div></div><div><h3>Conclusions</h3><div>Sarcoidosis mortality in mainland Spain demonstrates marked geographic heterogeneity and sex-specific patterns, with persistent high-risk clusters in the northwest. These results are suggestive of the interplay of genetic, environmental, and healthcare-related factors, providing a foundation for targeted surveillance, preventive strategies, and resource allocation.</div><div>.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502516"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estándares de atención en diabetes de la Asociación Americana de Diabetes de 2026: aspectos clave para la práctica del internista","authors":"Luis M. Pérez-Belmonte ,&nbsp;Nuria Prieto-Laín ,&nbsp;Alicia Trenas-Calero ,&nbsp;Ricardo Gómez-Huelgas","doi":"10.1016/j.rce.2026.502491","DOIUrl":"10.1016/j.rce.2026.502491","url":null,"abstract":"<div><div>Diabetes mellitus is a complex, chronic condition that has become a growing epidemic in recent years. It requires personalized medical care with strategies focused on reducing adverse outcomes beyond glycemic management. Internists play a key role in comprehensive diabetes management due to its multisystemic nature, cardio-reno-metabolic implications and associated comorbidities. The American Diabetes Association's Standards of Care in Diabetes are landmark international clinical guidelines in diabetes management. This review aims to provide a practical overview of some important points of interest for internists from the recently published Standards of Care in Diabetes-2026. Several topics are highlighted, such as the glycemic goals and hypoglycemia, assessment of diabetes-related comorbidities, management of older adults, and diabetes care in the hospital. Through coordination of multidisciplinary care and integration of preventive and therapeutic strategies, internists are essential in ensuring high-quality, patient-centered diabetes mellitus care.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502491"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalencia de desnutrición y su impacto en la mortalidad en los pacientes de medicina interna en España: un análisis a partir del conjunto mínimo básico de datos 2018-2022","authors":"J.A. Rueda-Camino ,&nbsp;J. San Roman ,&nbsp;A. Zapatero Gaviria ,&nbsp;A. Asenjo Mota ,&nbsp;J. Canora Lebrato ,&nbsp;P. de Peralta García ,&nbsp;R. Barba Martín","doi":"10.1016/j.rce.2026.502508","DOIUrl":"10.1016/j.rce.2026.502508","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Although it is known that malnourished patients have a higher risk of death during hospitalization, the diagnosis is not always reflected in discharge reports, and underreporting is common. The aim of this study is to analyze the notification of malnutrition in internal medicine departments and to assess whether the presence of this diagnosis correlates with a higher risk of death.</div></div><div><h3>Material and methods</h3><div>Data from the Minimum Basic Data Set (MBDS) of patients discharged from internal medicine departments in Spain between 2018 and 2022 were analyzed. Patients with a diagnosis of malnutrition (ICD-10-ES: moderate or mild malnutrition E44.x, E46, severe malnutrition E40.x, E41.x, E42.x, E43.x, R64) were identified, and their demographic and clinical characteristics were analyzed.</div></div><div><h3>Results</h3><div>The 3.8% of discharges from internal medicine services have a recorded diagnosis of malnutrition, being more frequent in men (54.4%) and in older patients (81 vs. 80 years). The registration rate has increased over the years of the study (from 3.5% in 2018 to 4.5% in 2022; <em>P</em>&lt;.001 for trend). The unadjusted mortality rate was 19.7% for patients with mild malnutrition and 32.5% for those with severe malnutrition codes, compared to 11.45% for patients without malnutrition. After adjusting for comorbidities, patients with severe malnutrition have 3.8 times higher odds of dying.</div></div><div><h3>Conclusions</h3><div>Malnutrition notification in internal medicine is low and is associated with increased morbidity, mortality, and costs.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502508"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Díez N, et al. «Comparación de pacientes reales y estandarizados en el Grado de Medicina: un estudio de intervención aleatorizado y controlado»","authors":"C. Elendu ,&nbsp;D.C. Amaechi ,&nbsp;T.C. Elendu ,&nbsp;I.D. Elendu","doi":"10.1016/j.rce.2026.502515","DOIUrl":"10.1016/j.rce.2026.502515","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502515"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identificación de la dinapenia mediante parámetros ventilatorios en pacientes con insuficiencia cardiaca con fracción de eyección preservada: análisis transversal del estudio FUNNEL+","authors":"C. García-Conejo ,&nbsp;C. Roldán-Jiménez ,&nbsp;M.A. Pérez-Velasco ,&nbsp;R. Gómez-Huelgas ,&nbsp;L.M. Pérez-Belmonte ,&nbsp;A.I. Cuesta-Vargas","doi":"10.1016/j.rce.2026.502494","DOIUrl":"10.1016/j.rce.2026.502494","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>We aimed to evaluate: (a) the discriminatory capacity of ventilatory parameters to differentiate between patients with heart failure with preserved ejection fraction (HFpEF) with or without dynapenia, (b) the relationship between maximal grip strength (MGS) and ventilatory parameters, and (c) the differences between groups of HFpEF patients with and without dynapenia.</div></div><div><h3>Materials and methods</h3><div>A cross-sectional study using MGS and ventilatory parameters from volunteers in the FUNNEL+ study was conducted. Patients with HFpEF were categorised using the MGS into two groups: dynapenia and no dynapenia. Data analysis included the Chi-square test, the Wilcoxon signed-rank test, Spearman's correlation coefficient, the ROC curve analysis, and the area under the ROC curve.</div></div><div><h3>Results</h3><div>77 measurements of HFpEF patients were grouped based on the presence (n<!--> <!-->=<!--> <!-->29) or no (n<!--> <!-->=<!--> <!-->48) of dynapenia. The discriminatory capacity of forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and peak expiratory flow (PEF) was acceptable for identifying dynapenia. Significant correlations were found between ventilatory parameters and MGS. Furthermore, significant differences were observed in grouped patients in terms of demographic, clinical and ventilatory variables.</div></div><div><h3>Conclusions</h3><div>These preliminary results suggest that ventilatory parameters may have potential for the early detection of dynapenia in HFpEF, although further studies are required to confirm these findings.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502494"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precisión diagnóstica del NT-proBNP sérico en derrames pleurales por insuficiencia cardiaca: una revisión sistemática y metaanálisis actualizado","authors":"Jian-Ying Cui ,&nbsp;Wen-Qi Zheng ,&nbsp;José M. Porcel ,&nbsp;Zhi-De Hu ,&nbsp;Yan Niu ,&nbsp;Li Yan","doi":"10.1016/j.rce.2026.502498","DOIUrl":"10.1016/j.rce.2026.502498","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Several studies have investigated the diagnostic value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) for congestive heart failure (CHF) in patients with undiagnosed pleural effusion, but results remain inconsistent. This systematic review aimed to determine the diagnostic accuracy of serum NT-proBNP levels in CHF-related effusions.</div></div><div><h3>Methods</h3><div>PubMed and Web of Science databases were searched for eligible studies investigating the accuracy of serum NT-proBNP in diagnosing CHF-related pleural effusions until March 1, 2025. We used a bivariate model to summarize the pooled sensitivity and specificity. The overall diagnostic accuracy was evaluated using a summary receiver operating characteristic (sROC) curve. We compared the accuracy of serum and pleural fluid NT-proBNP levels in studies evaluating both. Study quality was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).</div></div><div><h3>Results</h3><div>Seven studies, including 1098 patients with and 1114 without CHF-related pleural effusion, were included. Serum NT-proBNP's pooled sensitivity and specificity for diagnosing CHF-related pleural effusion were 0.83 (95% CI: 0.75–0.88) and 0.84 (95% CI: 0.75–0.91). The positive likelihood ratio was 5.3 (95% CI: 3.2–8.8), negative likelihood ratio 0.20 (95% CI: 0.14–0.31), diagnostic odds ratio 26 (95% CI: 12–56), and area under the sROC curve 0.90 (95% CI: 0.87–0.92). No publication bias was detected. A head-to-head comparison of five studies showed that the area under the curve (AUC) of serum and pleural NT-proBNP for labeling CHF was similar.</div></div><div><h3>Conclusions</h3><div>Serum NT-proBNP level shows good diagnostic accuracy for CHF-related pleural effusions, with diagnostic performance comparable to that of pleural fluid NT-proBNP level.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502498"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capnografía en el diagnóstico de cetoacidosis diabética (CAD): una revisión sistemática y un metaanálisis","authors":"M. Torabi ,&nbsp;M. Mirzaee","doi":"10.1016/j.rce.2026.502496","DOIUrl":"10.1016/j.rce.2026.502496","url":null,"abstract":"<div><h3>Objective</h3><div>The study investigates the role of capnography as an auxiliary diagnostic tool for diagnosing diabetic ketoacidosis (DKA) in order to reduce treatment delays and associated morbidities.</div></div><div><h3>Methods</h3><div>A registered protocol followed PRISMA guidelines and included all diabetic patients undergoing capnography, excluding those with metabolic disturbances unrelated to DKA. A comprehensive review of electronic medical resources was performed, with quality assessment conducted using the Newcastle-Ottawa Scale (NOS). Heterogeneity was expressed using Cochran's Q statistic, along with I² and tau-squared (τ²) statistics. Potential publication bias was evaluated through the Egger test and funnel plots, utilizing Comprehensive Meta-Analysis (CMA) and Stata/MP 17 for the analyses.</div></div><div><h3>Results</h3><div>Seven studies, including two cohort and five cross-sectional, were analyzed. Among the participants, 322 (28.67%) were diagnosed with DKA, while 801 (71.33%) were not. The main outcome assessed was DKA diagnosis using capnography. The analysis of studies has revealed a statistically significant difference in EtCO₂ levels (standardized mean difference: −1.80, 95% CI: −2.33 – −-1.28, p<!--> <!-->&lt;<!--> <!-->0.001), the pooled EtCO₂ odds ratio (OR: 0.03, 95% CI: 0.01–0.09, p<!--> <!-->&lt;<!--> <!-->0.001), and a pooled standardized mean difference (SMD) (–1.80, 95% CI: −2.33 – −1.28, p<!--> <!-->&lt;<!--> <!-->0.001) between DKA and non-DKA patients. The pooled sensitivity of EtCO₂ for DKA was 0.91 (95%CI: 0.87, 0.94), and the pooled specificity was 0.90 (95%CI: 0.81, 0.94).</div></div><div><h3>Conclusion</h3><div>The measurement of EtCO₂ by capnography, a non-invasive and readily available tool, may facilitate the expedited diagnosis of DKA in diabetic patients, pending further validation in RCTs and diverse settings.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502496"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalización domiciliaria por infecciones agudas: no olvidemos el COVID-19","authors":"J. Jacob ,&nbsp;M. Arranz","doi":"10.1016/j.rce.2026.502514","DOIUrl":"10.1016/j.rce.2026.502514","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502514"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importancia de la hipocloremia en pacientes con insuficiencia cardíaca aguda: ¿debería la terapia descongestiva modificarse según esta condición?","authors":"S. Crespo-Aznarez ,&nbsp;L.K. Esterellas-Sánchez ,&nbsp;A. Campos-Sáenz de Santamaría ,&nbsp;A. Venegas-Robles ,&nbsp;M. Gómez-Godos ,&nbsp;R. García-Muñio ,&nbsp;M.A. Julian-Anson ,&nbsp;M. Sánchez-Marteles ,&nbsp;V. Garcés-Horna ,&nbsp;J. Rubio-Gracia","doi":"10.1016/j.rce.2026.502495","DOIUrl":"10.1016/j.rce.2026.502495","url":null,"abstract":"<div><h3>Introduction</h3><div>Serum chloride has recently emerged as a potential prognostic biomarker in heart failure, with hypochloremia linked to poor outcomes and diuretic resistance. We aimed to evaluate the prevalence, predictors, and prognostic significance of hypochloremia at admission in acute decompensated heart failure patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including 638 patients admitted with acute decompensated heart failure between 2016 and 2025 at a tertiary hospital. Baseline clinical, laboratory, and ultrasound data were collected within the first 48<!--> <!-->h. Hypochloremia was defined as serum chloride<!--> <!-->&lt;<!--> <!-->96<!--> <!-->mmol/l at admission. The primary endpoint was a composite of all-cause mortality and/or heart failure rehospitalization at 180 days. Cox regression analyses were performed to identify independent predictors.</div></div><div><h3>Results</h3><div>Hypochloremia was present in 15.7% of patients. This group had higher rates of chronic heart failure, greater outpatient loop diuretic use and doses, lower sodium and diastolic blood pressure, and higher bicarbonate levels. Independent predictors of hypochloremia included lower sodium levels, inferior vena cava enlargement, and lower creatinine. At 180 days, the primary endpoint occurred more frequently in the hypochloremic group. Admission hypochloremia independently predicted the composite outcome (HR 2.68; 95% CI 1.27-5.67; p<!--> <!-->=<!--> <!-->0.010), along with higher outpatient loop diuretic doses and lower admission sodium.</div></div><div><h3>Conclusion</h3><div>Hypochloremia on admission is independently associated with worse outcomes in patients hospitalized for acute decompensated heart failure. Serum chloride is an accessible, low-cost marker that may help identify high-risk patients and provide additional insight into congestion status. Further prospective studies are needed to confirm its prognostic role and determine whether chloride-guided approaches can improve clinical outcomes.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502495"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}