Background/Purpose
We investigated the incidence, risk factors, clinical characteristics and outcomes of acute pancreatitis (AP) in patients with COVID‐19 attending the emergency department (ED), ...before hospitalization.
Methods
We retrospectively reviewed all COVID patients diagnosed with AP in 62 Spanish EDs (20% of Spanish EDs, COVID‐AP) during the COVID outbreak. We formed two control groups: COVID patients without AP (COVID‐non‐AP) and non‐COVID patients with AP (non‐COVID‐AP). Unadjusted comparisons between cases and controls were performed regarding 59 baseline and clinical characteristics and four outcomes.
Results
We identified 54 AP in 74 814 patients with COVID‐19 attending the ED (frequency = 0.72‰, 95% CI = 0.54‐0.94‰). This frequency was lower than in non‐COVID patients (2231/1 388 879, 1.61‰, 95% CI = 1.54‐1.67; OR = 0.44, 95% CI = 0.34‐0.58). Etiology of AP was similar in both groups, being biliary origin in about 50%. Twenty‐six clinical characteristics of COVID patients were associated with a higher risk of developing AP: abdominal pain (OR = 59.4, 95% CI = 23.7‐149), raised blood amylase (OR = 31.8; 95% CI = 1.60‐632) and vomiting (OR = 15.8, 95% CI = 6.69‐37.2) being the strongest, and some inflammatory markers (C‐reactive protein, procalcitonin, platelets, D‐dimer) were more increased. Compared to non‐COVID‐AP, COVID‐AP patients differed in 23 variables; the strongest ones related to COVID symptoms, but less abdominal pain was reported, pancreatic enzymes raise was lower, and severity (estimated by BISAP and SOFA score at ED arrival) was higher. The in‐hospital mortality (adjusted for age and sex) of COVID‐AP did not differ from COVID‐non‐AP (OR = 1.12, 95% CI = 0.45‐245) but was higher than non‐COVID‐AP (OR = 2.46, 95% CI = 1.35‐4.48).
Conclusions
Acute pancreatitis as presenting form of COVID‐19 in the ED is unusual (<1‰ cases). Some clinically distinctive characteristics are present compared to the remaining COVID patients and can help to identify this unusual manifestation. In‐hospital mortality of COVID‐AP does not differ from COVID‐non‐AP but is higher than non‐COVID‐AP, and the higher severity of AP in COVID patients could partially contribute to this increment.
Highlight
Miró and colleagues found that acute pancreatitis was less frequent in COVID patients than in non‐COVID patients attending the emergency department, suggesting the absence of a direct relationship with SARS‐CoV‐2. This report is the first to present the distinctive characteristics of COVID patients at increased risk of presenting acute pancreatitis.
Objective
We investigated the incidence, predictor variables, clinical characteristics, and stroke outcomes in patients with COVID‐19 seen in emergency departments (EDs) before hospitalization.
...Methods
We retrospectively reviewed all COVID‐19 patients diagnosed with stroke during the COVID‐19 outbreak in 62 Spanish EDs. We formed two control groups: COVID‐19 patients without stroke (control A) and non–COVID‐19 patients with stroke (control B). We compared disease characteristics and four outcomes between cases and controls.
Results
We identified 147 strokes in 74,814 patients with COVID‐19 seen in EDs (1.96‰, 95% confidence interval CI = 1.66‰ to 2.31‰), being lower than in non–COVID‐19 patients (6,541/1,388,879, 4.71‰, 95% CI = 4.60‰ to 4.83‰; odds ratio OR = 0.42, 95% CI = 0.35 to 0.49). The estimated that standardized incidences of stroke per 100,000 individuals per year were 124 and 133 for COVID‐19 and non–COVID‐19 individuals, respectively (OR = 0.93 for COVID patients, 95% CI = 0.87 to 0.99). Baseline characteristics associated with a higher risk of stroke in COVID‐19 patients were hypertension, diabetes mellitus, and previous cerebrovascular and coronary diseases. Clinically, these patients more frequently presented with confusion, decreased consciousness, and syncope and higher D‐dimer concentrations and leukocyte count at ED arrival. After adjustment for age and sex, the case group had higher hospitalization and intensive care unit (ICU) admission rates (but not mortality) than COVID‐19 controls without stroke (OR = 3.41, 95% CI = 1.27 to 9.16; and OR = 3.79, 95% CI = 1.69 to 8.50, respectively) and longer hospitalization and greater in‐hospital mortality than stroke controls without COVID‐19 (OR = 1.55, 95% CI = 1.24 to 1.94; and OR = 1.77, 95% CI = 1.37 to 2.30, respectively).
Conclusions
The incidence of stroke in COVID‐19 patients presenting to EDs was lower than that in the non–COVID‐19 reference sample. COVID‐19 patients with stroke had greater need for hospitalization and ICU admission than those without stroke and longer hospitalization and greater in‐hospital mortality than non–COVID‐19 patients with stroke.
Aims
Benzodiazepines have been used as safe anxiolytic drugs for decades and some authors have suggested they could be an alternative for morphine for treating acute cardiogenic pulmonary oedema ...(ACPE). We compared the efficacy and safety of midazolam and morphine in patients with ACPE.
Methods and results
A randomized, multicentre, open‐label, blinded endpoint clinical trial was performed in seven Spanish emergency departments (EDs). Patients >18 years old clinically diagnosed with ACPE and with dyspnoea and anxiety were randomized (1:1) at ED arrival to receive either intravenous midazolam or morphine. Efficacy was assessed by in‐hospital all‐cause mortality (primary endpoint). Safety was assessed through serious adverse event (SAE) reporting, and the composite endpoint included 30‐day mortality and SAE. Analyses were made on an intention‐to‐treat basis. The trial was stopped early after a planned interim analysis by the safety monitoring committee. At that time, 111 patients had been randomized: 55 to midazolam and 56 to morphine. There were no significant differences in the primary endpoint (in‐hospital mortality for midazolam vs. morphine 12.7% vs. 17.9%; risk ratioRR 0.71, 95% confidence interval CI 0.29–1.74; p = 0.60). SAE were less common with midazolam versus morphine (18.2% vs. 42.9%; RR 0.42, 95% CI 0.22–0.80; p = 0.007), as were the composite endpoint (23.6% vs. 44.6%; RR 0.53, 95% CI 0.30–0.92; p = 0.03).
Conclusion
Although the number of patients was too small to draw final conclusions and there were no significant differences in mortality between midazolam and morphine, a significantly higher rate of SAEs was found in the morphine group.
There were no significant differences in mortality between morphine and midazolam but the rate of serious adverse events was significantly higher in the morphine group, although the number of patients was too small to draw final conclusions.
Introduction
Social vulnerability is a known determinant of health in respiratory diseases. Our aim was to identify whether there are socio-demographic factors among COVID-19 patients hospitalized in ...Spain and their potential impact on health outcomes during the hospitalization.
Methods
A multicentric retrospective case series study based on administrative databases that included all COVID-19 cases admitted in 19 Spanish hospitals from 1 March to 15 April 2020. Socio-demographic data were collected. Outcomes were critical care admission and in-hospital mortality.
Results
We included 10,110 COVID-19 patients admitted to 18 Spanish hospitals (median age 68 (IQR 54–80) years old; 44.5% female; 14.8% were not born in Spain). Among these, 779 (7.7%) cases were admitted to critical care units and 1678 (16.6%) patients died during the hospitalization. Age, male gender, being immigrant, and low hospital saturation were independently associated with being admitted to an intensive care unit. Age, male gender, being immigrant, percentile of average per capita income, and hospital experience were independently associated with in-hospital mortality.
Conclusions
Social determinants such as residence in low-income areas and being born in Latin American countries were associated with increased odds of being admitted to an intensive care unit and of in-hospital mortality. There was considerable variation in outcomes between different Spanish centers.
BACKGROUND // Mental health problems are increasing in Spain, and those related to drug use are a preventable aspect of public health. In
Spain there are few studies on the incidence and ...characteristics of acute psychosis due to illegal drug use, especially at national and multicenter
level, reason that motivated this paper.
METHODS // A prospective multicentre study was carried out in eleven hospital Emergency Departments in Spain, lasting twenty-four months
(REDUrHE Registry). Patients with acute psychosis were compared with those with organic pathology, analysing demographic aspects, drugs involved,
associated clinical manifestations and evolution Quantitative variables were compared using Student’s t-test and qualitative variables were
compared using the chi-squared test (or Fisher’s exact test as appropriate) and the magnitude of the association with the presence of psychosis
using logistic regression. A p-value of less than 0.05 was considered statistically significant or if the 95%CI of the OR excluded the value 1.
RESULTS // Of the 4,487 patients in the registry, 9.5% presented acute psychosis, with a median age of thirty-two years and 79% male. The
main clinical features were agitation (53%, p=0.001), hallucinations (43.2%, p=0.001) and anxiety (40%, p=0.00). Psychosis was more frequent
with cannabis (57.7%), cocaine (42%) and amphetamines and derivatives (26.4%), although in the analysis adjusted for co-drug use (39.5%), or
in association with ethyl alcohol (57.7%), it was only statistically significant for cannabis (p=0.0). Patients with psychosis required more hospital
admissions (38.1% vs. 10%, p=0.001), mainly in psychiatric units (34.1% vs. 4.2%, p=0.001), with hardly any intensive care unit admissions (0.4%
vs. 2.1%, p=0.01). ED stay was high (29.3±73.8 hours vs 10.5±58.8 hours, p=0.001).
CONCLUSIONS // In Spain, cannabis is the drug most associated with psychosis. This clinical condition produces more hospital admissions,
although with a low risk at an organic level.
FUNDAMENTOS // Los problemas de salud mental van en aumento en España, siendo los relacionados con el consumo de drogas una faceta
prevenible en el ámbito de la Salud Pública. En España existen pocos estudios sobre la incidencia y características de la psicosis aguda por
consumo de drogas ilegales, sobre todo de ámbito nacional y multicéntrico, razón que motivó este trabajo.
MÉTODOS // Se realizó un estudio multicéntrico prospectivo, de veinticuatro meses de duración, en once servicios de Urgencias hospitalarias
de España (Registro REDUrHE). Se compararon los pacientes con psicosis aguda respecto a los que presentaban patología orgánica, analizando
aspectos demográficos, drogas involucradas, clínica asociada y evolución. Las variables cuantitativas se compararon mediante la t de Student y
cualitativas con la prueba ji al cuadrado (o el test exacto de Fisher según procediera) y la magnitud de la asociación con la presencia de psicosis
mediante regresión logística. Se consideró estadísticamente significativo un valor de p menor de 0,05 o si el IC95% de la OR excluía el valor 1.
RESULTADOS // De los 4.487 pacientes del registro, el 9,5% presentó psicosis aguda, con una mediana de edad de treinta y dos años y un 79%
de varones. La clínica principal consistió en agitación (53%, p=0,001), alucinaciones (43,2%, p=0,001) y ansiedad (40%, p=0,00). La psicosis fue
más frecuente con el consumo de cannabis (57,7%), de cocaína (42%) y de anfetaminas y derivados (26,4%), aunque en el análisis ajustado por
coingesta de varias drogas (39,5%), o asociado a alcohol etílico (57,7%), sólo resultó estadísticamente significativo para el cannabis (p=0,0). Los
pacientes con psicosis precisaron más ingreso hospitalario (38,1% frente a 10%, p=0,001), fundamentalmente en Unidades de psiquiatría (34,1%
frente a 4,2%, p=0,001), sin apenas ingresar en unidades de cuidados intensivos (0,4% frente a 2,1%, p=0,01). La estancia en Urgencias fue más
elevada (29,3±73,8 horas frente a 10,5±58,8 horas, p=0,001).
CONCLUSIONES // En España, el cannabis es la droga que se relaciona en mayor medida con los casos de psicosis atendidas en Urgencias
hospitalarias. Ésta clínica produce más ingresos hospitalarios, aunque con bajo riesgo a nivel orgánico.
Two recent publications in this journal regarding cannabinoid hyperemesis syndrome (CHS) reflect a common fact in the clinical practice. Although the syndrome is increasingly well-known, patients ...still receive a late diagnosis, sometimes after years of delay. This entails multiple visits to the ER, as well multiple outpatient visits and diagnostic tests in gastroenterology departments. Furthermore, there are many unnecessary hospital admissions that are often accompanied by an uncertain discharge diagnosis (psychogenic vomiting, etc.).
We investigated the incidence, clinical characteristics, risk factors, and outcome of meningoencephalitis (ME) in patients with COVID-19 attending emergency departments (ED), before hospitalization. ...We retrospectively reviewed all COVID patients diagnosed with ME in 61 Spanish EDs (20% of Spanish EDs, COVID-ME) during the COVID pandemic. We formed two control groups: non-COVID patients with ME (non-COVID-ME) and COVID patients without ME (COVID-non-ME). Unadjusted comparisons between cases and controls were performed regarding 57 baseline and clinical characteristics and 4 outcomes. Cerebrospinal fluid (CSF) biochemical and serologic findings of COVID-ME and non-COVID-ME were also investigated. We identified 29 ME in 71,904 patients with COVID-19 attending EDs (0.40‰, 95%CI=0.27–0.58). This incidence was higher than that observed in non-COVID patients (150/1,358,134, 0.11‰, 95%CI=0.09–0.13; OR=3.65, 95%CI=2.45–5.44). With respect to non-COVID-ME, COVID-ME more frequently had dyspnea and chest X-ray abnormalities, and neck stiffness was less frequent (OR=0.3, 95%CI=0.1–0.9). In 69.0% of COVID-ME, CSF cells were predominantly lymphocytes, and SARS-CoV-2 antigen was detected by RT-PCR in 1 patient. The clinical characteristics associated with a higher risk of presenting ME in COVID patients were vomiting (OR=3.7, 95%CI=1.4–10.2), headache (OR=24.7, 95%CI=10.2–60.1), and altered mental status (OR=12.9, 95%CI=6.6–25.0). COVID-ME patients had a higher in-hospital mortality than non-COVID-ME patients (OR=2.26; 95%CI=1.04–4.48), and a higher need for hospitalization (OR=8.02; 95%CI=1.19–66.7) and intensive care admission (OR=5.89; 95%CI=3.12–11.14) than COVID-non-ME patients. ME is an unusual form of COVID presentation (<0.5‰ cases), but is more than 4-fold more frequent than in non-COVID patients attending the ED. As the majority of these MEs had lymphocytic predominance and in one patient SARS-CoV-2 antigen was detected in CSF, SARS-CoV-2 could be the cause of most of the cases observed. COVID-ME patients had a higher unadjusted in-hospital mortality than non-COVID-ME patients.
We investigated the incidence, risk factors, clinical characteristics and outcomes of acute pancreatitis (AP) in patients with COVID-19 attending the emergency department (ED), before ...hospitalization.
We retrospectively reviewed all COVID patients diagnosed with AP in 62 Spanish EDs (20% of Spanish EDs, COVID-AP) during the COVID outbreak. We formed two control groups: COVID patients without AP (COVID-non-AP) and non-COVID patients with AP (non-COVID-AP). Unadjusted comparisons between cases and controls were performed regarding 59 baseline and clinical characteristics and four outcomes.
We identified 54 AP in 74 814 patients with COVID-19 attending the ED (frequency = 0.72‰, 95% CI = 0.54-0.94‰). This frequency was lower than in non-COVID patients (2231/1 388 879, 1.61‰, 95% CI = 1.54-1.67; OR = 0.44, 95% CI = 0.34-0.58). Etiology of AP was similar in both groups, being biliary origin in about 50%. Twenty-six clinical characteristics of COVID patients were associated with a higher risk of developing AP: abdominal pain (OR = 59.4, 95% CI = 23.7-149), raised blood amylase (OR = 31.8; 95% CI = 1.60-632) and vomiting (OR = 15.8, 95% CI = 6.69-37.2) being the strongest, and some inflammatory markers (C-reactive protein, procalcitonin, platelets, D-dimer) were more increased. Compared to non-COVID-AP, COVID-AP patients differed in 23 variables; the strongest ones related to COVID symptoms, but less abdominal pain was reported, pancreatic enzymes raise was lower, and severity (estimated by BISAP and SOFA score at ED arrival) was higher. The in-hospital mortality (adjusted for age and sex) of COVID-AP did not differ from COVID-non-AP (OR = 1.12, 95% CI = 0.45-245) but was higher than non-COVID-AP (OR = 2.46, 95% CI = 1.35-4.48).
Acute pancreatitis as presenting form of COVID-19 in the ED is unusual (<1‰ cases). Some clinically distinctive characteristics are present compared to the remaining COVID patients and can help to identify this unusual manifestation. In-hospital mortality of COVID-AP does not differ from COVID-non-AP but is higher than non-COVID-AP, and the higher severity of AP in COVID patients could partially contribute to this increment.
Recently, desert dust in Europe has been recognized as a cardiovascular health problem. In Spain, desert dust inflows in recent years have been associated with worsening air quality. The present ...study examines whether desert dust events are related to the incidence of acute coronary syndrome (ACS) in patients under 55 years of age.
Data from 2416 consecutive patients admitted to a tertiary hospital due to ACS were prospectively analyzed. A case-crossover time-stratified design using Poisson conditional regression models was applied to estimate the impact of desert dust events involving particulate matter concentrations of an aerodynamic diameter <10 μm (PM
) on the incidence of ACS in patients under 55 years of age.
Desert dust intrusion on days 0 to 5 before ACS onset showed no significant association with the incidence of ACS in patients under 55 years of age. The incidence rate ratios of PM
concentrations 1, 2, 3, 3, 4, and 5 days before ACS onset (for changes of 10 µg/m
) were 1.02 (95% CI 0.97-1.1;
= 0.41), 1.01 (95% CI 0.96-1.07;
= 0.66), 0.99 (95% CI 0.94-1.05;
= 0.78), 0.96 (95% CI 0.9-1.02;
= 0.18), and 0.97 (95% CI 0.91-1.04;
= 0.41).
Our findings suggest that desert dust is unlikely to be related to the incidence of ACS in patients under 55 years of age.
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