We aimed to describe changes in characteristics and treatment strategies of hospitalised patients with COVID-19 and detail the mortality trend over time.
Observational cohort study of all consecutive ...patients admitted ≥ 48 h to Hospital Clinic of Barcelona for COVID-19 (1 March–30 September 2020).
A total of 1645 consecutive patients with COVID-19 were assessed over a 7-month period. Overall mortality (≤30 days) was 9.7% (159 patients), 7.7% in patients hospitalised in regular wards and 16.7 % in patients requiring ICU admission. Overall mortality decreased from 11.6% in the first month to 1.4% in the last month, reflecting a progressive, significant downward trend (p for trend <0.001). Patients’ age changed over time, peaking in June. Most changes in the use of antivirals and anti-inflammatory treatments were documented. Age (OR 1.1, CI 1.1–1.12), chronic heart disease, (OR 1.7, CI 1.1–2.9), D-dimer>700 ng/mL (OR 2.3, CI 1.3–4.1), ferritin>489 ng/mL (OR 1.9; CI 1.5–3.2), C-RP>7 mg/dL (OR 2.6; CI 1.5–4.6), and shorter duration from symptom onset to hospital admission (OR 1.11; CI 1.04–1.17) were factors associated with 30-day mortality at hospital admission. Conversely, hospital admission in the last months (OR 0.80; CI 0.65–0.98) was significantly associated with lower mortality.
In-hospital mortality has decreased in patients with COVID-19 over the last, few months, even though main patient characteristics remain similar. Several changes made when managing patients may explain this decreasing trend. Our study provides current data on mortality of patients hospitalised with COVID-19 that might be useful in establishing quality of standard of care.
EIT Health, European Union´s Horizon 2020 Research and Innovation Programme), EDRD. PPA CM18/00132, NGP FI19/00133, and CGV FIS PI18/01061, have received grants from Ministerio de Sanidad y Consumo, ISCIII.
Nuestro objetivo es describir los cambios en las características y las estrategias de tratamiento de los pacientes hospitalizados por COVID-19, y detallar la tendencia de la mortalidad en el tiempo.
Estudio observacional de cohortes de todos los pacientes consecutivos, ingresados por COVID-19 durante más de 48 horas, en el Hospital Clínic de Barcelona (del 1 de marzo al 30 de septiembre de 2020).
Un total de 1645 pacientes consecutivos fueron evaluados durante un período de 7 meses. La mortalidad global (≤30 días) fue del 9.7% (159 pacientes): 7.7% en pacientes hospitalizados en salas convencionales, y 16.7% en pacientes que requirieron ingreso en UCI. La mortalidad global disminuyó del 11.6% en el primer mes al 1.4% en el último mes evaluado, reflejando una progresiva y significativa tendencia a la baja (p para la tendencia <0.001). La edad de los pacientes ha cambiado con el tiempo, habiendo alcanzado su pico en junio. La mayoría de cambios en el uso de antivirales y antiinflamatorios se han documentado. La edad (OR 1.1; CI 1.1–1.12), cardiopatía crónica (OR 1.7; CI 1.1–2.9), dímero-D>700 ng/mL (OR 2.3; CI 1.3–4.1), ferritina>489 ng/mL (OR 1.9; CI 1.5–3.2), PCR>7 mg/dL (OR 2.6; CI 1.5–4.6), y una menor duración desde el inicio de síntomas a la hospitalización (OR 1.11; CI 1.04–1.17) fueron factores asociados a la mortalidad intrahospitalaria a 30 días. Por el contrario, el ingreso hospitalario previo en los últimos meses (OR 0.80; CI 0.65–0.98) se asoció significativamente a una menor mortalidad.
La mortalidad intrahospitalaria ha disminuido en los pacientes con COVID-19 durante los últimos meses, incluso siendo similares las características de los pacientes. Algunos cambios realizados en el manejo de estos pacientes podrían explicar esta tendencia decreciente. Nuestro estudio aporta datos actualizados en la mortalidad de los pacientes hospitalizados con COVID-19, que podrían ser útiles de cara a establecer unos cuidados estándar de calidad.
EIT Health, European Union´s Horizon 2020 Research and Innovation Programme, EDRD. PPA CM18/00132, NGP FI19/00133 y CGV FIS PI18/01061, han recibido becas del Ministerio de Sanidad y Consumo, ISCIII.
The present paper describes the effects of maturation on the physicochemical, biochemical and color components of Napoleon and Dominga grape varieties, and on any differences between them. Climatic ...conditions were taken into account to explain the results obtained. Protein levels increased during ripening and were correlated with pH. Polyphenoloxidase activity was affected by climatic conditions (rainfall) and increased to a greater degree in Dominga than in Napoleon. Taste tests were conducted to determine the contribution of physicochemical and biochemical parameters to the sensorial properties of the grapes. Principal components analysis showed that parameters were correlated in different ways during the ripening period in Napoleon and Dominga varieties. In Dominga AE were correlated to the b parameter and in Napoleon to the L parameter.
We propose a classification method suitable for high-resolution synthetic aperture radar (SAR) images over urban areas. When processing SAR images, there is a strong need for statistical models of ...scattering to take into account multiplicative noise and high dynamics. For instance, the classification process needs to be based on the use of statistics. Our main contribution is the choice of an accurate model for high-resolution SAR images over urban areas and its use in a Markovian classification algorithm. Clutter in SAR images becomes non-Gaussian when the resolution is high or when the area is man-made. Many models have been proposed to fit with non-Gaussian scattering statistics (K, Weibull, Log-normal, Nakagami-Rice, etc.), but none of them is flexible enough to model all kinds of surfaces in our context. As a consequence, we use a mathematical model that relies on the Fisher distribution and the log-moment estimation and which is relevant for one-look data. This estimation method is based on the second-kind statistics, which are detailed in the paper. We also prove its accuracy for urban areas at high resolution. The quality of the classification that is obtained by mixing this model and a Markovian segmentation is high and enables us to distinguish between ground, buildings, and vegetation.
Respiratory failure after extubation and reintubation is associated with increased morbidity and mortality.
To assess the efficacy of noninvasive ventilation in averting respiratory failure after ...extubation in patients at increased risk.
A prospective randomized controlled trial was conducted in 162 mechanically ventilated patients who tolerated a spontaneous breathing trial after recovery from the acute episode but had increased risk for respiratory failure after extubation. Patients were randomly allocated after extubation to receive noninvasive ventilation for 24 h (n = 79), or conventional management with oxygen therapy (control group, n = 83).
The primary end-point variable was the decrease in respiratory failure after extubation. In the noninvasive ventilation group, respiratory failure after extubation was less frequent (13, 16 vs. 27, 33%; p = 0.029) and the intensive care unit mortality was lower (2, 3 versus 12, 14%; p = 0.015). However, 90-d survival did not change significantly between groups. Separate analyses of patients without and with hypercapnia (arterial CO(2) tension greater than 45 mm Hg) during the spontaneous breathing trial showed that noninvasive ventilation improved intensive care unit mortality (0 vs. 4, 18%; p = 0.035) and 90-d survival (p = 0.006) in hypercapnic patients only; of them, 98% had chronic respiratory disorders.
The early use of noninvasive ventilation averted respiratory failure after extubation and decreased intensive care unit mortality among patients at increased risk. The beneficial effect of noninvasive ventilation in improving survival of hypercapnic patients with chronic respiratory disorders warrants a new prospective clinical trial.
The renin-angiotensin system plays an important role in hepatic fibrogenesis. In other organs, myofibroblasts accumulated in damaged tissues generate angiotensin II, which promotes inflammation and ...extracellular matrix synthesis. It is unknown whether myofibroblastic hepatic stellate cells, the main hepatic fibrogenic cell type, express the renin-angiotensin system and synthesize angiotensin II. The aim of this study was to investigate whether quiescent and activated human hepatic stellate cells contain the components of the renin–angiotensin system and synthesize angiotensin II.
Hepatic stellate cells were freshly isolated from normal human livers (quiescent hepatic stellate cells) and from human cirrhotic livers (in vivo activated hepatic stellate cells). Culture-activated hepatic stellate cells were used after a second passage of quiescent hepatic stellate cells. Angiotensinogen, renin, and angiotensin-converting enzyme were assessed by quantitative polymerase chain reaction. Angiotensin II production was assessed by enzyme-linked immunosorbent assay and immunohistochemistry.
Quiescent hepatic stellate cells barely express the renin-angiotensin system components—angiotensinogen, renin, and angiotensin-converting enzyme—and do not secrete angiotensin II. In contrast, both in vivo activated hepatic stellate cells and culture-activated hepatic stellate cells highly express active renin and angiotensin-converting enzyme and secrete angiotensin II to the culture media. Mature angiotensin II protein is also detected in the cytoplasm of in vivo activated and culture-activated hepatic stellate cells. Growth factors (platelet-derived growth factor and epidermal growth factor) and vasoconstrictor substances (endothelin-1 and thrombin) stimulate angiotensin II synthesis, whereas transforming growth factor-β and proinflammatory cytokines have no effect. Vasodilator substances markedly attenuate the effect of endothelin-1.
After activation, human hepatic stellate cells express the components of the renin-angiotensin system and synthesize angiotensin II. These results suggest that locally generated angiotensin II could participate in tissue remodeling in the human liver.
Risk factors for nosocomial pneumonia, such as gastro-oesophageal reflux and subsequent aspiration, can be reduced by semirecumbent body position in intensive-care patients. The objective of this ...study was to assess whether the incidence of nosocomial pneumonia can also be reduced by this measure.
This trial was stopped after the planned interim analysis. 86 intubated and mechanically ventilated patients of one medical and one respiratory intensive-care unit at a tertiary-care university hospital were randomly assigned to semirecumbent (n=39) or supine (n=47) body position. The frequency of clinically suspected and microbiologically confirmed nosocomial pneumonia (clinical plus quantitative bacteriological criteria) was assessed in both groups. Body position was analysed together with known risk factors for nosocomial pneumonia.
The frequency of clinically suspected nosocomial pneumonia was lower in the semirecumbent group than in the supine group (three of 39 8%
vs 16 of 47 34%; 95% CI for difference 10·0–42.0, p=0·003). This was also true for microbiologically confirmed pneumonia (semirecumbent 2/39 5%
vs supine 11/47 23%; 4.2–31.8, p=0·018). Supine body position (odds ratio 6.8 1.7–26.7, p=0·006) and enteral nutrition (5.7 1.5–22.8, p=0·013) were independent risk factors for nosocomial pneumonia and the frequency was highest for patients receiving enteral nutrition in the supine body position (14/28, 50%). Mechanical ventilation for 7 days or more (10·9 3.0–40·4, p=0·001) and a Glasgow coma scale score of less than 9 were additional risk factors.
The semirecumbent body position reduces frequency and risk of nosocomial pneumonia, especially in patients who receive enteral nutrition. The risk of nosocomial pneumonia is increased by long-duration mechanical ventilation and decreased consciousness.
Background & Aims: Circulating levels of angiotensin II (ANGII), a powerful vasoconstrictor factor, are frequently increased in chronic liver diseases. In these conditions, hepatic stellate cells ...(HSCs) proliferate and acquire contractile properties. This study investigated the presence of receptors for ANGII and the effects of ANGII in human HSCs activated in culture.
Methods: The presence of ANGII receptors was assessed by binding studies. The effects of ANGII on intracellular calcium concentration (Ca
2+
i), cell contraction, and cell proliferation were also assessed.
Results: Binding studies showed the presence of ANGII receptors of the AT1 subtype. ANGII elicited a marked dose-dependent increase in Ca
2+
i and cell contraction. Moreover, ANGII stimulated DNA synthesis and increased cell number. All these effects were totally blocked by losartan and reduced by nitric oxide donors or prostaglandin E
2. The effects of ANGII were barely detectable in quiescent cells (2 days in culture), suggesting that phenotypic transformation of HSCs is associated with a marked increase in the effects of ANGII.
Conclusions: ANGII induces contraction and is mitogenic for human-activated HSCs by acting through AT1 receptors. These results suggest that activated HSCs are targets of the vasoconstrictor action of ANGII in the intrahepatic circulation.
GASTROENTEROLOGY 2000;118:1149-1156
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