Background: Various authors have validated scales to measure comorbidity. However, the prognosis capacity variation according to the comorbidity measurement index used needs to be determined in order to identify which is the best predictor. Aims: To quantify the differences between the Charlson (CCI), Elixhauser (ECI) and van Walraven (WCI) comorbidity indices as prognostic factors for in-hospital mortality and to identify the best comorbidity measure predictor. Methods: A retrospective observational study that included all hospitalizations of patients over 18 years of age, discharged between 2017 and 2021 in the hospital, using the Minimum Basic Data Set (MBDS). We calculated CCI, ECI, WCI according to ICD-10 coding algorithms. The correlation and concordance between the three indices were evaluated by Spearman’s rho and Intraclass Correlation Coefficient (ICC), respectively. The logistic regression model for each index was built for predicting in-hospital mortality. Finally, we used the receiver operating characteristic (ROC) curve for comparing the performance of each index in predicting in-hospital mortality, and the Delong method was employed to test the statistical significance of differences. Results: We studied 79,425 admission episodes. The 54.29% were men. The median age was 72 years (interquartile range [IQR]: 56–80) and in-hospital mortality rate was 4.47%. The median of ECI was = 2 (IQR: 1–4), ICW was 4 (IQR: 0–12) and ICC was 1 (IQR: 0–3). The correlation was moderate: ECI vs. WCI rho = 0.645, p < 0.001; ECI vs. CCI rho = 0.721, p < 0.001; and CCI vs. WCI rho = 0.704, p < 0.001; and the concordance was fair to good: ECI vs. WCI Intraclass Correlation Coefficient type A (ICC_A) = 0.675 (CI 95% 0.665–0.684) p < 0.001; ECI vs. CCI ICC_A = 0.797 (CI 95% 0.780–0.812), p < 0.001; and CCI vs. WCI ICC_A = 0.731 (CI 95% 0.667–0.779), p < 0.001. The multivariate regression analysis demonstrated that comorbidity increased the risk of in-hospital mortality, with differences depending on the comorbidity measurement scale: odds ratio [OR] = 2.10 (95% confidence interval [95% CI] 2.00–2.20) p > |z| < 0 using ECI; OR = 2.31 (CI 95% 2.21–2.41) p > |z| < 0 for WCI; and OR = 2.53 (CI 95% 2.40–2.67) p > |z| < 0 employing CCI. The area under the curve [AUC] = 0.714 (CI 95% 0.706–0.721) using as a predictor of in-hospital mortality CCI, AUC = 0.729 (CI 95% 0.721–0.737) for ECI and AUC = 0.750 (CI 95% 0.743–0.758) using WCI, with statistical significance (p < 0.001). Conclusion: Comorbidity plays an important role as a predictor of in-hospital mortality, with differences depending on the measurement scale used, the van Walraven comorbidity index being the best predictor of in-hospital mortality.

Background: Invasive aspergillosis (IA) is an opportunistic infection that affects immunocompromised patients. While voriconazole is commonly used for IA treatment, it presents the risk of drug interactions, particularly in patients on polytherapy. Isavuconazole may serve as a safer alternative with fewer interactions. However, the use of isavuconazole is typically limited to the parenteral route for patients without access to the enteral route, due to recommendations against tablet handling for enteral administration. The objective of this study was to evaluate the suitability of isavuconazole administration via an enteral tube, by therapeutic drug monitoring of isavuconazole plasma concentrations. Methods: This case study examines a patient with diffuse large B-cell lymphoma who was diagnosed with IA and treated with isavuconazole via an enteral tube. Therapeutic pharmacokinetic monitoring of isavuconazole plasma concentrations was performed to assess the feasibility and safety of enteral administration. Results: The results show that isavuconazole concentrations were maintained within the therapeutic range when administered via an enteral tube. No significant deviations in plasma concentration were noted during the monitoring period. Conclusions: Administering isavuconazole through an enteral tube is a safe and viable alternative for patients that are unable to receive the drug via the oral route. Therapeutic monitoring of plasma concentrations is recommended to ensure proper dosing and efficacy.

Invasive aspergillosis (IA) is an opportunistic infection affecting immunocompromised patients. Current clinical guidelines support the use of voriconazole for the treatment of IA, although this treatment is not free of interactions in this group of patients who are often treated with polytherapy; in these cases, isavuconazole may be a safe alternative with a lower risk of interactions. The oral route is commonly preferred to the parenteral route, but in patients who do not have access to the enteral route, the use of isavuconazole is limited to the parenteral route only, since the technical information sheet does not recommend the handling of tablets for enteral administration, stating that the capsules should not be chewed, crushed, dissolved or opened. This paper presents the case of a patient with diffuse large B-cell lymphoma with confirmed AI on treatment with isavuconazole by enteral tube. It is detailed here that isavuconazole concentrations are maintained when administered by enteral tube, as measured by therapeutic pharmacokinetic monitoring of its plasma concentrations. Administering isavuconazole by enteral tube was found to be a safe practice with monitoring of its plasma concentrations.