Objective To describe mortality of in-hospital patients with COVID-19 and compare risk factors between survivors and non-survivors. Design Prospective cohort of adult inpatients. Setting Tertiary healthcare teaching hospital in Guadalajara, Mexico. Participants All patients with confirmed COVID-19 hospitalised from 25 March to 7 September 2020 were included. End of study: 7 November 2020. Primary outcome measures Patient survival analysed by the Kaplan-Meier method and comparison of factors by the log-rank test. Mortality risk factors analysed by multivariate Cox’s proportional-hazard model. Results One thousand ten patients included: 386 (38%) died, 618 (61%) alive at discharge and six (0.6%) remained hospitalised. There was predominance of men (63%) and high frequency of overweight–obesity (71%); hypertension (54%); diabetes (40%); and lung (9%), cardiovascular (8%) and kidney diseases (11%); all of them significantly more frequent in non-survivors. Overweight–obesity was not different between groups, but severity of disease (Manchester Triage System and quick Sequential Organ Failure Assessment) was significantly worse in non-survivors, who were also significantly older (65 vs 45 years, respectively) and had haematological, biochemical, coagulation and inflammatory biomarkers more altered than survivors. Mortality predictors were invasive mechanical ventilation (IMV; OR 3.31, p<0.0001), admission to intensive care unit (ICU; OR 2.18, p<0.0001), age (OR 1.02, p<0.0001), Manchester Triage System (urgent OR 1.44, p=0.02; immediate/very urgent OR 2.02, p=0.004), baseline C reactive protein (CRP; OR 1.002, p=0.009) and antecedent of kidney disease (OR 1.58, p=0.04) Conclusions Mortality in hospitalised patients with COVID-19 in this emerging country centre seemed to be higher than in developed countries. Patients displayed a high frequency of risk factors for poor outcome, but the need for IMV, ICU admission, older age, more severe disease at admission, antecedent of kidney disease and higher CRP levels significantly predicted mortality.

Adipokines, especially chemerin, can interact with cytokines and other molecules in inflammation. To date, there is insufficient information regarding a possible correlation between functional disability and chemerin and other pro-inflammatory molecules in rheumatoid arthritis (RA). To identify the association of functional disability with serum chemerin and other pro-inflammatory molecules, including other adipokines, cytokines and E-selectin, in patients with RA. Cross-sectional study. Assessment: disease activity (DAS28-ESR) and functional disability (HAQ-DI). We compared the adipokines (chemerin, leptin, adiponectin, resistin, and visfatin), cytokines (TNF-α, IL-6, IL-1β, and IL-18) and E-selectin levels between RA with functional disability and RA non-disabled patients. Of 82 patients with RA, 43 (52%) had functional disability. The RA with functional disability group had higher chemerin (140 vs. 112 ng/mL, p = 0.007) than the non-disabled RA group. Chemerin correlated with the HAQ-DI (rho = 0.27, p = 0.02) and DAS28-ESR (rho = 0.21, p = 0.05). Severe activity correlated with IL-6 (rho = 0.33, p = 0.003) and E-selectin (rho = 0.23, p = 0.03) but not with disability. No other pro-inflammatory molecules correlated with HAQ-DI. High chemerin levels were associated with functional disability in RA, whereas no other molecules correlated with loss of function. These results encourage further studies assessing new roles of chemerin as a marker of impairment in RA.

Resumen Introducción: el trastorno del control de impulsos sugiere una disfunción frontoestriatal que deteriora las habilidades metacognitivas ejecutivas como resultado de la activación de los receptores de dopamina, siendo los agonistas dopaminérgicos una terapia adyuvante en adenomas hipofisarios. Objetivo: analizar la frecuencia del trastorno del control de impulsos en pacientes con adenomas hipofisarios tratados con agonistas dopaminérgicos. Material y métodos: estudio transversal analítico en pacientes ≥ 18 años con diagnóstico de adenoma hipofisario y tratamiento con agonistas dopaminérgicos. Se utilizó la Escala de Impulsividad de Barratt (BIS-11). Se compararon proporciones con Chi cuadrada y medias con la prueba t de Student; se empleó la correlación de Pearson para evaluar la fuerza de asociación entre cada subescala. Para el cálculo de riesgos se estimaron razones de momios ajustadas. La significación estadística se estableció en p ≤ 0.05. Resultados: se estudiaron 40 pacientes; el 50% eran mujeres, con una edad promedio de 42.32 años. De acuerdo con la BIS-11, el 40% resultó positivo para alteración cognitiva, el 27.5% para impulsividad motora y el 7.5% para impulsividad no planificada; en la suma total, el 12.5% de la población obtuvo resultado positivo. El 75% presentó una dosis acumulada menor de 500 mg, con una media de 248.4 mg, y el 60% tenía más de dos años de tratamiento. Conclusiones: se presentó un 12.5% de impulsividad según el puntaje total positivo de la BIS-11, con un riesgo 19 veces mayor en mujeres y tendencia a presentarse en pacientes con microprolactinoma.