Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia最新文献

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Effectiveness and safety of dual therapy with co-packaged dolutegravir and lamivudine compared to triple therapy as switching strategy in clinical practice. 在临床实践中,与三联治疗作为转换策略相比,多替格拉韦和拉米夫定复合治疗的有效性和安全性。
Diego Cecchini, Edgardo Bottaro, Brenda Bacelar, Ángeles Tisné, Claudia Migazzi, Macarena Roel, Maximiliano Bergman, Isabel Cassetti
{"title":"Effectiveness and safety of dual therapy with co-packaged dolutegravir and lamivudine compared to triple therapy as switching strategy in clinical practice.","authors":"Diego Cecchini, Edgardo Bottaro, Brenda Bacelar, Ángeles Tisné, Claudia Migazzi, Macarena Roel, Maximiliano Bergman, Isabel Cassetti","doi":"10.37201/req/030.2025","DOIUrl":"https://doi.org/10.37201/req/030.2025","url":null,"abstract":"<p><strong>Introduction: </strong>Dolutegravir plus lamivudine (DTG/3TC) dual therapy has demonstrated efficacy in HIV treatment, but access remains challenging in Latin America. Argentina approved a generic co-packaged DTG+3TC presentation to improve accessibility. This study evaluated the effectiveness and safety of co-packed DTG/3TC compared to DTG-based triple therapy in clinical practice.</p><p><strong>Materials and methods: </strong>A retrospective observational cohort study conducted between October 2019 and November 2023 at a reference HIV center in Argentina. Treatment-experienced people living with HIV (PLWH) with viral suppression who switched to either co-packaged DTG/3TC or DTG-based triple therapy were included. Primary outcomes included persistence, virologic suppression rates (VSR), and safety at 6, 12, and 18 months.</p><p><strong>Results: </strong>Of 599 PLWH, 245 (41%) switched to dual therapy and 354 (59%) to triple therapy. Persistence rates for dual therapy at 6, 12, and 18 months were 99%, 100% and 98%; for triple therapy: 99%, 97% and 97%, respectively. VSR for dual therapy were 99%, 98% and 99%; for triple therapy: 99%, 97% and 98% at the same timepoints. Adverse event rates were low in both groups: dual therapy (0.5%, 0%, 0.8% at 6, 12, 18 months) and triple therapy (1.2%, 0.7%, 0.4% at 6, 12, 18 months).</p><p><strong>Conclusion: </strong>Co-packaged DTG/3TC demonstrated high persistence and virologic suppression rates with a favorable safety profile in clinical practice. Its effectiveness and safety were comparable to DTG-based triple therapy, supporting its use as a cost-effective alternative for treatment-experienced PLWH in resource-limited settings.</p>","PeriodicalId":94198,"journal":{"name":"Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Recommendations on prevention and treatment of respiratory infections in institutionalised older people]. [关于机构老年人呼吸道感染预防和治疗的建议]。
Rubén Lovatti-González, Javier Gómez-Pavón, Rafael Bielza, Clara Hernando, Javier Martínez-Peromingo, Jesús Mateos-Nozal, Cristina Bermejo-Boixareu
{"title":"[Recommendations on prevention and treatment of respiratory infections in institutionalised older people].","authors":"Rubén Lovatti-González, Javier Gómez-Pavón, Rafael Bielza, Clara Hernando, Javier Martínez-Peromingo, Jesús Mateos-Nozal, Cristina Bermejo-Boixareu","doi":"10.37201/req/054.2025","DOIUrl":"https://doi.org/10.37201/req/054.2025","url":null,"abstract":"<p><p>Acute respiratory infections (ARIs) are one of the main causes of morbidity, functional impairment, and mortality in institutionalised older adults. This group is highly vulnerable due to factors such as advanced age, multimorbidity, frailty, and structural barriers to infection prevention and control. This article reviews, in a question-and-answer format, the most recent evidence on the epidemiology, prevention and treatment of the most relevant respiratory infections in nursing homes: influenza, SARS-CoV-2, respiratory syncytial virus, and <i>Streptococcus pneumoniae</i>. Epidemiological changes after the COVID-19 pandemic, current vaccination strategies, the efficacy and characteristics of newly vaccines available, as well as the updated therapeutic approach according to resistance profiles and the availability of antivirals, are analysed. In addition, the clinical and functional impact that these infections can have on residents is addressed, as well as the need to find a balance between preventive measures and the quality of life of this population group. The importance of effective coordination between health and social care professionals, and the implementation of protocols adapted to the residential context is highlighted. The article provides practical, evidence-based recommendations to improve the prevention and treatment of these infections in a particularly vulnerable environment.</p>","PeriodicalId":94198,"journal":{"name":"Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Características epidemiológicas de pacientes con aislamientos de Enterobacterales productores de carbapenemasas-NDM en un hospital de alta complejidad]. [在高度复杂的医院中分离出产生碳青霉烯酶-NDM的肠杆菌患者的流行病学特征]。
Cristina María Artiles-León, Sarita Rodríguez-Restrepo, Ivonne Andrea Torres-Jiménez, María de Las Delicias Quintana-Estellés, Esther Viedma-Moreno, Pilar Arrazola-Martínez, Felisa Jaén-Herreros, Inmaculada Sanz-Gallardo, Esther Suárez-García, Ana Craviotto-Vallejo, Sara de Miguel-García
{"title":"[Características epidemiológicas de pacientes con aislamientos de Enterobacterales productores de carbapenemasas-NDM en un hospital de alta complejidad].","authors":"Cristina María Artiles-León, Sarita Rodríguez-Restrepo, Ivonne Andrea Torres-Jiménez, María de Las Delicias Quintana-Estellés, Esther Viedma-Moreno, Pilar Arrazola-Martínez, Felisa Jaén-Herreros, Inmaculada Sanz-Gallardo, Esther Suárez-García, Ana Craviotto-Vallejo, Sara de Miguel-García","doi":"10.37201/req/015.2025","DOIUrl":"https://doi.org/10.37201/req/015.2025","url":null,"abstract":"<p><strong>Introduction: </strong>Carbapenemase-producing Enterobacteriaceae (CPE) of the New Delhi metallo-β-lactamase (NDM) type are a growing public health concern due to their rapid dissemination, widespread antimicrobial resistance and associated increase in morbidity and mortality. The aim of this study was to describe the epidemiological characteristics of patients with NDM-type CPE (NDM-CPE) isolates.</p><p><strong>Methods: </strong>A descriptive study of patients with at least one CPE-NDM isolate between December 1, 2022, and December 31, 2023. Demographic and clinical evolution data were collected from electronic medical records.</p><p><strong>Results: </strong>NDM-CPE were identified in 77 patients, 87% of whom were adults and 75.3% were male. Thirty-two-point five percent were immunosuppressed. A total of 84.4% required hospital admission (60% in ICU) and 66.2% underwent surgery. The median time between admission and the first microbiological isolation of NDM-CPE was 18 days (RIC: 4-32 days). The most frequent microorganism was Klebsiella pneumoniae (92.2%), followed by Escherichia coli (4.2%), and Citrobacter freundii (4.2%). A total of 58.4% carried genes coding for NDM and OXA-48 carbapenemases, 40.3% for only NDM, and 1.3% for NDM and VIM. A total of 45.5% were patients with positive colonization samples for NDM-CPE, of whom 31.4% developed infection. Overall mortality at study end was 24.7 %.</p><p><strong>Conclusions: </strong>Early identification of carriers, strengthening epidemiological and molecular surveillance, and prompt implementation of control measures are essential to interrupt transmission chains and protect the most vulnerable patients.</p>","PeriodicalId":94198,"journal":{"name":"Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of perceived versus actual care complexity in HIV-positive patients receiving antiretroviral treatment: The STRATPATIENT study. 接受抗逆转录病毒治疗的hiv阳性患者感知与实际护理复杂性的比较:STRATPATIENT研究。
Cristina Galindo García, Enrique Contreras-Macías, Gema Araceli Naranjo-Pérez, Ramón Morillo-Verdugo
{"title":"Comparison of perceived versus actual care complexity in HIV-positive patients receiving antiretroviral treatment: The STRATPATIENT study.","authors":"Cristina Galindo García, Enrique Contreras-Macías, Gema Araceli Naranjo-Pérez, Ramón Morillo-Verdugo","doi":"10.37201/req/014.2025","DOIUrl":"https://doi.org/10.37201/req/014.2025","url":null,"abstract":"<p><strong>Introduction: </strong>HIV is now considered a chronic disease due to advances in antiretroviral therapy (ART), which have improved survival but have also increased both comorbidities and polypharmacy. This underscores the need for personalized care strategies such as the Capacity-Motivation-Opportunity (CMO) model and patient stratification tools. This study aimed to identify the discrepancy between patient-perceived and actual care complexity in HIV-positive patients on ART, as assessed by a stratification tool.</p><p><strong>Methods: </strong>A retrospective, observational study at Valme Hospital (April-June 2024) included HIV-positive patients aged over 18 years on stable ART, excluding clinical trial participants. Data collected included age, sex, route of HIV acquisition, viral load, CD4 count, AIDS stage, comorbidities, polypharmacy and the Medication Regimen Complexity Index (MRCI). Perceived complexity was assessed using a visual analogue scale, whereas complexity according to the stratification tool was calculated with the variables of the CMO model.</p><p><strong>Results: </strong>A total of 411 participants with a median age of 55 years were included, of whom 72.5 % had comorbidities, primarily cardiovascular. The median MRCI score was 8, with 85.4 % of patients were classified at stratification level 3, while 74.9 % reported low perceived healthcare complexity. Concordance between stratification and perceived complexity was weak. Significant associations were observed between perceived complexity and AIDS stage, extensive polypharmacy, and stratification levels.</p><p><strong>Conclusion: </strong>This study emphasises integrating objective assessments and patient perspectives to improve healthcare evaluation and patient-centered care.</p>","PeriodicalId":94198,"journal":{"name":"Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Conjunctival and cutaneous Kaposi's Sarcoma as the first manifestation of HIV infection. 结膜和皮肤卡波西肉瘤是HIV感染的第一表现。
Raúl Parra-Fariñas, Carlota Insua, Lucía Buznego, Paula Runza, Carlos Armiñanzas, Manuel Gutierrez-Cuadra, Sara Marcos-González, Francisco Arnaiz de Las Revillas
{"title":"Conjunctival and cutaneous Kaposi's Sarcoma as the first manifestation of HIV infection.","authors":"Raúl Parra-Fariñas, Carlota Insua, Lucía Buznego, Paula Runza, Carlos Armiñanzas, Manuel Gutierrez-Cuadra, Sara Marcos-González, Francisco Arnaiz de Las Revillas","doi":"10.37201/req/013.2025","DOIUrl":"https://doi.org/10.37201/req/013.2025","url":null,"abstract":"","PeriodicalId":94198,"journal":{"name":"Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evolution of postsurgical mediastinis after major heart surgery (mhs) in the last 12 years: are we improving? 大心脏手术(mhs)术后纵隔在过去12年的演变:我们正在改善吗?
María Jesús Pérez-Granda, Emilio Bouza, José María Barrio-Gutiérrez, Marina Machado, Agustín Estevez, Gregorio Cuerpo, Javier Hortal, Patricia Muñoz, Ángel González-Pinto, Maricela Valerio
{"title":"Evolution of postsurgical mediastinis after major heart surgery (mhs) in the last 12 years: are we improving?","authors":"María Jesús Pérez-Granda, Emilio Bouza, José María Barrio-Gutiérrez, Marina Machado, Agustín Estevez, Gregorio Cuerpo, Javier Hortal, Patricia Muñoz, Ángel González-Pinto, Maricela Valerio","doi":"10.37201/req/041.2025","DOIUrl":"https://doi.org/10.37201/req/041.2025","url":null,"abstract":"<p><strong>Background: </strong>Postsurgical mediastinitis (PSM) is a serious and potentially life-threatening complication of Major Heart Surgery (MHS). Data on the evolution of the incidence of PSM after MHS in large series of operated patients in recent years are scarce. The aim of our study was to evaluate the trend of incidence, microbial etiology, and associated mortality of PSM at a referral MHS unit in the last 12 years.</p><p><strong>Material and methods: </strong>The study was conducted at a tertiary hospital in Madrid, Spain. We carried out a retrospective and cross-sectional study that included all patients who underwent CCM and developed MPQ between January 2012 and December 2023 at our institution. It was conducted at a tertiary hospital in Madrid, Spain. We carried out a retrospective and cross-sectional study that included all patients who underwent CCM and developed MPQ between January 2012 and December 2023 at our institution.</p><p><strong>Results: </strong>During the 12-year study period, a total of 5,584 patients underwent MHS at our institution. The incidence rate of PSM varied yearly between 1.16 and 2.34 episodes/100 surgical procedures. Overall, the 89 patients with PSM were analyzed (92 different episodes). Their median age was 67 years (IQR 56-75) and most of them were male (63%). Their median Euroscore was 7 (IQR 5-9.5). Main type of heart surgery in patients with PSM was: coronary artery bypass graft in 37% and valve replacement in 32.6%. The more frequent causative microorganisms were: Gram-positive bacteria (59.0%), Gram-negative bacteria (32.4%), fungi (7.6%) and others (1%). Overall, 22 patients died (24.7%).</p><p><strong>Conclusion: </strong>The incidence of PSM has remained stable and below 2.5% in the last 12 years in our institution, but it continues to be an entity associated with high morbidity and mortality and long hospital stays.</p>","PeriodicalId":94198,"journal":{"name":"Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Impact of increasing the frequency of meetings in which the Antimicrobial Stewardship Programme team conducted prospective audit and feedback on antimicrobial consumption]. [增加抗菌素管理规划团队对抗菌素消耗进行前瞻性审核和反馈的会议频率的影响]。
María Inmaculada Zas-García, José Manuel Fernández-Carreira, Jorge Rodríguez-Prida, Ana Blanco-Suárez, Marcos Álvarez-Pérez, Jesús Rubio-Sanz, Elsa Castelo-Alvárez, Daniel González-Fernández, Tania Rubio-Alfonso
{"title":"[Impact of increasing the frequency of meetings in which the Antimicrobial Stewardship Programme team conducted prospective audit and feedback on antimicrobial consumption].","authors":"María Inmaculada Zas-García, José Manuel Fernández-Carreira, Jorge Rodríguez-Prida, Ana Blanco-Suárez, Marcos Álvarez-Pérez, Jesús Rubio-Sanz, Elsa Castelo-Alvárez, Daniel González-Fernández, Tania Rubio-Alfonso","doi":"10.37201/req/022.2025","DOIUrl":"https://doi.org/10.37201/req/022.2025","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate how antimicrobial consumption was influenced by increasing the frequency of meetings in which the Antimicrobial Stewardship Program (ASP) team conducted prospective audit and feedback (PAF).</p><p><strong>Materials and methods: </strong>Retrospective cohort study comparing consumption in DDD per 1000 beds-day and DDD per 1000 admissions across groups of anti-infectives, antibacterial groups, agents against methicillin-susceptible <i>Staphylococcus aureus</i> (anti-MSSA agents)/agents against methicillin-resistant <i>Staphylococcus aureus</i> (anti-MRSA agents), antibiotics targeting sensitive Gram-negative bacteria/antibiotics targeting resistant Gram-negative bacteria and antimicrobial agents, during two comparative periods of ASP activity (2 weekly meetings in 2023 versus 1 weekly meeting in 2022).</p><p><strong>Results: </strong>Comparing 2023 to 2022: antibacterials for systemic use consumption increased in DDD per 1000 beds-day (+0.13%) and decreased in DDD per 1000 admissions (-3.55 %); consumption in DDD per 1000 beds-day and DDD per 1000 admissions increased for penicillins, glycopeptides and aminoglycosides while it decreased for cephalosporins and carbapenems, quinolones use increased per beds-days but decreased per admissions; regarding anti-MSSA and anti-MRSA agents, consumption of cefazolin, cloxacillin, vancomycin and daptomycin increased in DDD per 1000 beds-day and DDD per 1000 admissions, linezolid consumption increased per beds-day but decreased per admissions; for antibiotics targeting sensitive Gram-negative bacteria and antibiotics targeting resistant Gram-negative bacteria, consumption of amoxicillin-clavulanate, piperacillin-tazobactam, aminoglycosides, ceftazidime, cefepime and polymyxins increased per DDD/1000 bed-days and DDD per 1000 admissions, carbapenems consumption decreased per bed-days and admissions.</p><p><strong>Conclusion: </strong>The increase in the frequency of meetings seems to be related to better use of antimicrobials in our center.</p>","PeriodicalId":94198,"journal":{"name":"Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Early diagnosis of a case of septic arthritis thanks to the BioFire® joint infection panel]. 【利用BioFire®关节感染面板进行脓毒性关节炎的早期诊断】。
José Carlos De Gracia-Díaz, Ana Madueño, Sara Díaz-Martín, María Lecuona-Fernández
{"title":"[Early diagnosis of a case of septic arthritis thanks to the BioFire<sup>®</sup> joint infection panel].","authors":"José Carlos De Gracia-Díaz, Ana Madueño, Sara Díaz-Martín, María Lecuona-Fernández","doi":"10.37201/req/023.2025","DOIUrl":"https://doi.org/10.37201/req/023.2025","url":null,"abstract":"","PeriodicalId":94198,"journal":{"name":"Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Ability of midregional proadrenomedullin (MR-proADM) to predict poor clinical outcome and stratify prognosis in adult patients seen for suspected infection in the Emergency Department]. [中区域肾上腺髓质素原(MR-proADM)对急诊科疑似感染成人患者不良临床结局和分层预后的预测能力]。
Elena de Rafael-González, Javier Cabañas-Morafraile, Laura Serrano-Martín, Agustín Julián-Jiménez, María Torres-Fernández, Elia Chaves-Prieto, Laura Morell-Jurado, William Esneider López-Forero, María Francisca Calafell-Mas, Álvaro Thomas-Balaguer Cordero, María Remedios Asensio-Nieto, Isabel Nieto-Rojas, Rafael Rubio-Díaz, Eva Heredero-Gálvez, María Carmen Lorenzo-Lozano, Raúl Canabal-Berlanga
{"title":"[Ability of midregional proadrenomedullin (MR-proADM) to predict poor clinical outcome and stratify prognosis in adult patients seen for suspected infection in the Emergency Department].","authors":"Elena de Rafael-González, Javier Cabañas-Morafraile, Laura Serrano-Martín, Agustín Julián-Jiménez, María Torres-Fernández, Elia Chaves-Prieto, Laura Morell-Jurado, William Esneider López-Forero, María Francisca Calafell-Mas, Álvaro Thomas-Balaguer Cordero, María Remedios Asensio-Nieto, Isabel Nieto-Rojas, Rafael Rubio-Díaz, Eva Heredero-Gálvez, María Carmen Lorenzo-Lozano, Raúl Canabal-Berlanga","doi":"10.37201/req/031.2025","DOIUrl":"https://doi.org/10.37201/req/031.2025","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze and compare the accuracy of midregional proadrenomedullin (MR-proADM) to predict poor clinical outcome (understood as progression to septic shock or admission to the Critical Care Unit -CCU-) and 30-day mortality in adult patients seen for suspected infection in the Emergency Department (ED). We also compared their performance with other biomarkers (C-reactive protein -CRP-, procalcitonin -PCT-, lactate and leukocyte count) and clinical scales widely used in routine practice (qSOFA, SRIS, NEWS-2).</p><p><strong>Methods: </strong>A prospective, observational and analytical study was carried out on adult patients who were treated in an ED with the clinical diagnosis of an infectious process. Follow-up was carried out for 30 days. The main outcome was a composite measure that included progression to septic shock or admission to the CCU and 30-day mortality. The predictive ability was analyzed with the area under the curve (AUC) of the receiver operating characteristic (ROC) and the values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of MR-proADM, PCR, PCT, lactate, leukocyte count and the clinical scales.</p><p><strong>Results: </strong>214 patients were included, of whom 31 (14.5%) fulfilled the combined variable. The mean age was 68.6 (SD 20.75) years, 55.1% (118) were men. The MR-proADM concentration achieved the best AUC-ROC of 0.920 (95% CI: 0.850-0.989) compared to the other biomarkers and clinical scales. With a cut-off point (Cp) according to the Youden index > 2.105 nmol/L, a Se: 68%, Es: 98% and NPV: 97% were obtained. The NEWS-2 scale ≥ 5 achieves an AUC-ROC of 0.733 (95% CI: 0.630-0.835) with a Se: 87%, Es: 55% and NPV: 96%. The mixed model (MR-proADM ≥2.1 nmol/l + NEWS-2 ≥5) improved the AUC-ROC to 0.849 (95% CI: 0.782-0.915) and Se: 68%, Es: 98%, PPV: 74% and NPV: 88%.</p><p><strong>Conclusion: </strong>In adult patients attended with clinical suspicion of infection in the ED, MR-proADM presents a high ability to predict poor clinical evolution (progression to septic shock or ICU admission) and 30-day mortality and performs better than PCT, lactate, CRP, leukocyte count and the clinical scales qSOFA, SRIS, NEWS-2. The combined model (MR-proADM ≥2.1 nmol/L + NEWS-2 ≥5) improves prediction of both MR-proADM and clinical scales.</p>","PeriodicalId":94198,"journal":{"name":"Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Impact of a dedicated multidisciplinary committee (endocarditis team) on the management and outcome of infective endocarditis in a reference center]. [一个专门的多学科委员会(心内膜炎小组)对参考中心感染性心内膜炎的管理和结果的影响]。
Javier Iglesias-Varea, Mario Fernández-Ruiz, Laura Domínguez, Jorge Boán, Eduardo Aparicio-Minguijón, Antonio Terrón, María Asunción Pérez-Jacoiste Asín, José María Aguado, Francisco López-Medrano
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