Smoking can play a key role in SARS-CoV-2 infection and in the course of the disease. Previous studies have conflicting or inconclusive results on the prevalence of smoking and the severity of the ...coronavirus disease (COVID-19).
Observational, multicenter, retrospective cohort study of 14,260 patients admitted for COVID-19 in Spanish hospitals between February and September 2020. Their clinical characteristics were recorded and the patients were classified into a smoking group (active or former smokers) or a non-smoking group (never smokers). The patients were followed up to one month after discharge. Differences between groups were analyzed. A multivariate logistic regression and Kapplan Meier curves analyzed the relationship between smoking and in-hospital mortality.
The median age was 68.6 (55.8-79.1) years, with 57.7% of males. Smoking patients were older (69.9 59.6-78.0 years), more frequently male (80.3%) and with higher Charlson index (4 2-6) than non-smoking patients. Smoking patients presented a worse evolution, with a higher rate of admission to the intensive care unit (ICU) (10.4 vs 8.1%), higher in-hospital mortality (22.5 vs. 16.4%) and readmission at one month (5.8 vs. 4.0%) than in non-smoking patients. After multivariate analysis, smoking remained associated with these events.
Active or past smoking is an independent predictor of poor prognosis in patients with COVID-19. It is associated with higher ICU admissions and in-hospital mortality.
Community Acquired Pneumonia (CAP) is common disease that can be treated in Hospital At Home (HAH). In this paper we evaluate the room of improvement in the use of antibiotics in CAP in HH.
Patients ...with CAP were retrospectively recruited in two Spanish hospitals from 1/1/18 to 10/30/19. Demographic, clinical and quality of antibiotic prescription variables were recorded. Subsequently, we created a new variable that collected six quality of care indicator, categorizing and comparing patients into two groups: good quality of care (4 or more indicators performed) or poor quality of care (3 or less indicators performed).
We recruited 260 patients. The request for diagnostic tests and the adequacy to Clinical Practice Guidelines were 85.4% and 85.8% respectively. Percentages of de-escalation (53.7%) and sequential therapy (57.7%) when indicated were low. The average length of treatment was 7.3 days for intravenous and 9.5 days for total. Quality of prescription was good in 134 (63.2%) patients, being more frequent in those who were admitted directly to HAD from the emergency room. It was also associated with less readmission at 30 days.
There is a wide room for improvement in some fields of antimicrobials use in HAH that could stimulate the implementation of Antimicrobial Stewardship Programs.
La Neumonía Adquirida en la Comunidad (NAC) es una enfermedad frecuente que puede ser abordada en Hospitalización a Domicilio (HAD). En el presente trabajo evaluamos el margen de mejora en el uso de antibióticos en la NAC en HAD.
Se reclutaron retrospectivamente todos los pacientes con NAC en dos hospitales españoles desde el 01 de enero de 2018 al 30 de octubre de 2019. Se registraron variables demográficas, clínicas y sobre calidad de prescripción antibiótica. Posteriormente se construyó una variable que recogía seis indicadores de calidad asistencial, categorizando y comparando a los pacientes en dos grupos: buena calidad asistencial (cuatro o más indicadores realizados) o mala calidad asistencial (tres o menos indicadores realizados).
Obtuvimos una muestra de 260 pacientes. La solicitud de pruebas diagnósticas y la adecuación a las guías de práctica clínica fue del 85,4 y 85,8%, respectivamente. Los porcentajes de realización de desescalada (53,7%) y terapia secuencial (57,7%) cuando estaban indicadas fueron bajos. La duración media del tratamiento fue de 7,3 días para el intravenoso y 9,5 días para el total. La calidad de prescripción fue buena en 134 (63,2%) pacientes, siendo más frecuente en aquellos que ingresaron directamente en HAD desde urgencias. También se asoció a menor reingreso a 30 días.
Existe un amplio margen de mejora en algunos aspectos con el uso de antimicrobianos en HAD, que podría motivar la implementación de programas de optimización del uso de antibióticos.
Smoking can play a key role in SARS-CoV-2 infection and in the course of the disease. Previous studies have conflicting or inconclusive results on the prevalence of smoking and the severity of the ...coronavirus disease (COVID-19).
Observational, multicenter, retrospective cohort study of 14,260 patients admitted for COVID-19 in Spanish hospitals between February and September 2020. Their clinical characteristics were recorded and the patients were classified into a smoking group (active or former smokers) or a non-smoking group (never smokers). The patients were followed up to one month after discharge. Differences between groups were analysed. A multivariate logistic regression and Kapplan Meier curves analysed the relationship between smoking and in-hospital mortality.
The median age was 68.6 (55.8−79.1) years, with 57.7% of males. Smoking patients were older (69.9 (59.6−78.0 years)), more frequently male (80.3%) and with higher Charlson index (4 (2−6)) than non-smoking patients. Smoking patients presented a worse evolution, with a higher rate of admission to the intensive care unit (ICU) (10.4 vs. 8.1%), higher in-hospital mortality (22.5 vs. 16.4%) and readmission at one month (5.8 vs. 4.0%) than in non-smoking patients. After multivariate analysis, smoking remained associated with these events.
Active or past smoking is an independent predictor of poor prognosis in patients with COVID-19. It is associated with higher ICU admissions and in-hospital mortality.
El tabaquismo puede tener un papel importante en la infección por SARS-CoV-2 y en el curso de la enfermedad. Los estudios previos muestran resultados contradictorios o no concluyentes sobre la prevalencia de fumar y la severidad en la enfermedad por coronavirus (COVID-19).
Estudio de cohortes observacional, multicéntrico y retrospectivo de 14.260 pacientes que ingresaron por COVID-19 en hospitales españoles desde febrero a septiembre de 2020. Se registraron sus características clínicas y se clasificaron en el grupo con tabaquismo si tabaquismo activo o previo o en el grupo sin tabaquismo si nunca habían fumado. Se realizó un seguimiento hasta un mes después del alta. Se analizaron las diferencias entre grupos. La relación entre tabaquismo y mortalidad intrahospitalaria se valoró mediante una regresión logística multivariante y curvas de Kapplan Meier.
La mediana de edad fue 68,6 (55,8–79,1) años, con un 57,7% de varones. El grupo con tabaquismo presentó mayor edad (69,9 (59,6–78,0 años)), predominio masculino (80,3%) y mayor índice de Charlson (4 (2−6)). La evolución fue peor en estos pacientes, con una mayor tasa de ingreso en UCI (10,4 vs 8,1%), mayor mortalidad intrahospitalaria (22,5 vs 16,4%) y reingreso al mes (5,8 vs 4,0%) que el grupo sin tabaquismo. Tras el análisis multivariante, el tabaquismo permanecía asociado a estos eventos.
El tabaquismo de forma activa o pasada es un factor predictor independiente de mal pronóstico en los pacientes con COVID-19, estando asociada a mayor probabilidad de ingreso en UCI y a mayor mortalidad intrahospitalaria.
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