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We develop a predictive prognosis model to support medical experts in their clinical decision-making process in Intensive Care Units (ICUs) (a) to enhance early mortality prediction, (b) to make more efficient medical decisions about patients at higher risk, and (c) to evaluate the effectiveness of new treatments or detect changes in clinical practice. It is a machine learning hierarchical model based on Bayesian classifiers built from some recorded features of a real-world ICU cohort, to bring about the assessment of the risk of mortality, also predicting destination at ICU discharge if the patient survives, or the cause of death otherwise, constructed as an ensemble of five base Bayesian classifiers by using the average ensemble criterion with weights, and we name it the Ensemble Weighted Average (EWA). We compare EWA against other state-of-the-art machine learning predictive models. Our results show that EWA outperforms its competitors, presenting in addition the advantage over the ensemble using the majority vote criterion of allowing to associate a confidence level to the provided predictions. We also prove the convenience of locally recalibrate from data the standard model used to predict the mortality risk based on the APACHE II score, although as a predictive model it is weaker than the other.
Rosario Delgado; J. David Núñez-González; J. Carlos Yébenes; Ángel Lavado. Survival in the Intensive Care Unit: A prognosis model based on Bayesian classifiers. Artificial Intelligence in Medicine 2021, 115, 102054 .
AMA StyleRosario Delgado, J. David Núñez-González, J. Carlos Yébenes, Ángel Lavado. Survival in the Intensive Care Unit: A prognosis model based on Bayesian classifiers. Artificial Intelligence in Medicine. 2021; 115 ():102054.
Chicago/Turabian StyleRosario Delgado; J. David Núñez-González; J. Carlos Yébenes; Ángel Lavado. 2021. "Survival in the Intensive Care Unit: A prognosis model based on Bayesian classifiers." Artificial Intelligence in Medicine 115, no. : 102054.
Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia. La sepsis es una entidad sindrómica de elevada prevalencia y mortalidad. Su manejo está estandarizado y tiene una eficacia dependiente del tiempo. Sin embargo, el manejo de los pacientes con sepsis es complejo. La heterogeneidad de las formas de presentación puede dificultar su detección y manejo, así como las diferencias en formación, competencias o disponibilidad de recursos sanitarios. La Comisión Asesora para la Atención al PAciente con Sepsis (CAAPAS), formada por 7 sociedades científicas, el Sistema de Emergencias Médicas y el Servei Català de la Salut, han desarrollado en Catalunya el Código Sepsis Interhospitalario (CSI). El objetivo general del CSI es facilitar la detección precoz, la atención inicial y la coordinación interhospitalaria para optimizar el tratamiento de los pacientes con sepsis o shock séptico en formato código de riesgo vital, de forma homogénea a lo largo de todo el territorio catalán.
J.C. Yébenes; C. Lorencio; E. Esteban; L. Espinosa; J.M. Badia; J.A. Capdevila; B. Cisteró; S. Moreno; E. Calbo; X. Jiménez-Fábrega; M. Clèries; M.T. Faixedas; R. Ferrer; E. Vela; C. Medina; A. Rodríguez; C. Netto; E. Armero; M. Solsona; R. Lopez; A. Granes; V. Perez-Claveria; A. Artigas; J Estany. Interhospital sepsis code in Catalonia (Spain): territorial model for initial care of patients with sepsis. Medicina Intensiva (English Edition) 2019, 44, 36 -45.
AMA StyleJ.C. Yébenes, C. Lorencio, E. Esteban, L. Espinosa, J.M. Badia, J.A. Capdevila, B. Cisteró, S. Moreno, E. Calbo, X. Jiménez-Fábrega, M. Clèries, M.T. Faixedas, R. Ferrer, E. Vela, C. Medina, A. Rodríguez, C. Netto, E. Armero, M. Solsona, R. Lopez, A. Granes, V. Perez-Claveria, A. Artigas, J Estany. Interhospital sepsis code in Catalonia (Spain): territorial model for initial care of patients with sepsis. Medicina Intensiva (English Edition). 2019; 44 (1):36-45.
Chicago/Turabian StyleJ.C. Yébenes; C. Lorencio; E. Esteban; L. Espinosa; J.M. Badia; J.A. Capdevila; B. Cisteró; S. Moreno; E. Calbo; X. Jiménez-Fábrega; M. Clèries; M.T. Faixedas; R. Ferrer; E. Vela; C. Medina; A. Rodríguez; C. Netto; E. Armero; M. Solsona; R. Lopez; A. Granes; V. Perez-Claveria; A. Artigas; J Estany. 2019. "Interhospital sepsis code in Catalonia (Spain): territorial model for initial care of patients with sepsis." Medicina Intensiva (English Edition) 44, no. 1: 36-45.
La sepsis es una entidad sindrómica de elevada prevalencia y mortalidad. Su manejo está estandarizado y tiene una eficacia dependiente del tiempo. Sin embargo, el manejo de los pacientes con sepsis es complejo. La heterogeneidad de las formas de presentación puede dificultar su detección y manejo, así como las diferencias en formación, competencias o disponibilidad de recursos sanitarios. La Comisión Asesora para la Atención al PAciente con Sepsis (CAAPAS), formada por 7 sociedades científicas, el Sistema de Emergencias Médicas (SEM) y el Servei Català de la Salut (CatSalut), han desarrollado en Catalunya el Código Sepsis Interhospitalario (CSI). El objetivo general del CSI es facilitar la detección precoz, la atención inicial y la coordinación interhospitalaria para optimizar el tratamiento de los pacientes con sepsis o shock séptico en formato código de riesgo vital, de forma homogénea a lo largo de todo el territorio catalán. Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia.
J.C. Yébenes; C. Lorencio; E. Esteban; L. Espinosa; J.M. Badia; J.A. Capdevila; B. Cisteró; S. Moreno; E. Calbo; X. Jiménez-Fábrega; M. Clèries; M.T. Faixedas; R. Ferrer; E. Vela; C. Medina; A. Rodríguez; C. Netto; E. Armero; M. Solsona; R. Lopez; A. Granes; V. Perez-Claveria; A. Artigas; J. Estany. Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis. Medicina Intensiva 2019, 44, 36 -45.
AMA StyleJ.C. Yébenes, C. Lorencio, E. Esteban, L. Espinosa, J.M. Badia, J.A. Capdevila, B. Cisteró, S. Moreno, E. Calbo, X. Jiménez-Fábrega, M. Clèries, M.T. Faixedas, R. Ferrer, E. Vela, C. Medina, A. Rodríguez, C. Netto, E. Armero, M. Solsona, R. Lopez, A. Granes, V. Perez-Claveria, A. Artigas, J. Estany. Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis. Medicina Intensiva. 2019; 44 (1):36-45.
Chicago/Turabian StyleJ.C. Yébenes; C. Lorencio; E. Esteban; L. Espinosa; J.M. Badia; J.A. Capdevila; B. Cisteró; S. Moreno; E. Calbo; X. Jiménez-Fábrega; M. Clèries; M.T. Faixedas; R. Ferrer; E. Vela; C. Medina; A. Rodríguez; C. Netto; E. Armero; M. Solsona; R. Lopez; A. Granes; V. Perez-Claveria; A. Artigas; J. Estany. 2019. "Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis." Medicina Intensiva 44, no. 1: 36-45.
Water, the main component of the body, is distributed in the extracellular and intracellular compartments. Water exchange between these compartments is mainly governed by osmotic pressure. Extracellular water osmolarity must remain within very narrow limits to be compatible with life. Older adults lose the thirst sensation and the ability to concentrate urine, and this favours increased extracellular osmolarity (hyperosmotic stress). This situation, in turn, leads to cell dehydration, which has severe consequences for the intracellular protein structure and function and, ultimately, results in cell damage. Moreover, the fact that water determines cell volume may act as a metabolic signal, with cell swelling acting as an anabolic signal and cell shrinkage acting as a catabolic signal. Ageing also leads to a progressive loss in muscle mass and strength. Muscle strength is the main determinant of functional capacity, and, in elderly people, depends more on muscle quality than on muscle quantity (or muscle mass). Intracellular water content in lean mass has been related to muscle strength, functional capacity, and frailty risk, and has been proposed as an indicator of muscle quality and cell hydration. This review aims to assess the role of hyperosmotic stress and cell dehydration on muscle function and frailty.
Isabel Lorenzo; Mateu Serra-Prat; Juan Carlos Yébenes. The Role of Water Homeostasis in Muscle Function and Frailty: A Review. Nutrients 2019, 11, 1857 .
AMA StyleIsabel Lorenzo, Mateu Serra-Prat, Juan Carlos Yébenes. The Role of Water Homeostasis in Muscle Function and Frailty: A Review. Nutrients. 2019; 11 (8):1857.
Chicago/Turabian StyleIsabel Lorenzo; Mateu Serra-Prat; Juan Carlos Yébenes. 2019. "The Role of Water Homeostasis in Muscle Function and Frailty: A Review." Nutrients 11, no. 8: 1857.
Critically ill patients often require life support measures such as mechanical ventilation or haemodialysis. Despite the essential role of nutrition in patients’ recovery, the inappropriate use of medical nutrition therapy can have deleterious effects, as is the case with the use of respiratory, circulatory, or renal support. To increase awareness and to monitor the effects of inappropriate medical nutrition therapy, we propose to introduce the concept of nutritrauma in clinical practice, defined as metabolic adverse events related to the inappropriate administration of medical nutrition therapy or inadequate nutritional monitoring.
Juan Carlos Yébenes; Lluis Campins; Itziar Martínez De Lagran; Lluisa Bordeje; Carol Lorencio; Teodoro Grau; Juan Carlos Montejo; Maria Bodí; Mateu Serra-Prat; Working Group on Nutrition and Metabolism of the Spanish Society of Critical Care. Nutritrauma: A Key Concept for Minimising the Harmful Effects of the Administration of Medical Nutrition Therapy. Nutrients 2019, 11, 1775 .
AMA StyleJuan Carlos Yébenes, Lluis Campins, Itziar Martínez De Lagran, Lluisa Bordeje, Carol Lorencio, Teodoro Grau, Juan Carlos Montejo, Maria Bodí, Mateu Serra-Prat, Working Group on Nutrition and Metabolism of the Spanish Society of Critical Care. Nutritrauma: A Key Concept for Minimising the Harmful Effects of the Administration of Medical Nutrition Therapy. Nutrients. 2019; 11 (8):1775.
Chicago/Turabian StyleJuan Carlos Yébenes; Lluis Campins; Itziar Martínez De Lagran; Lluisa Bordeje; Carol Lorencio; Teodoro Grau; Juan Carlos Montejo; Maria Bodí; Mateu Serra-Prat; Working Group on Nutrition and Metabolism of the Spanish Society of Critical Care. 2019. "Nutritrauma: A Key Concept for Minimising the Harmful Effects of the Administration of Medical Nutrition Therapy." Nutrients 11, no. 8: 1775.
High intracellular water (ICW) content has been associated with better functional performance and a lower frailty risk in elderly people. However, it is not clear if the protective effect of high ICW is due to greater muscle mass or better muscle quality and cell hydration. We aimed to assess the relationship between ICW content in lean mass (LM) and muscle strength, functional performance, frailty, and other clinical characteristics in elderly people. In an observational cross-sectional study of community-dwelling subjects aged ≥75 years, ICW and LM were estimated by bioelectrical impedance, and the ICW/LM ratio (mL/kg) calculated. Muscle strength was measured as hand grip, frailty status was assessed according to Fried criteria, and functional status was assessed by Barthel score. For 324 recruited subjects (mean age 80 years), mean (SD) ICW/LM ratio was 408 (29.3) mL/kg. The ICW/LM ratio was negatively correlated with age (rs = −0.249; p < 0.001). A higher ICW/LM ratio was associated with greater muscle strength, better functional capacity, and a lower frailty risk, even when adjusted by age, sex, nº of co-morbidities, and LM. ICW content in LM (including the muscle) may influence muscle strength, functional capacity and frailty. However, further studies are needed to confirm this hypothesis.
Mateu Serra-Prat; Isabel Lorenzo; Elisabet Palomera; Juan Carlos Yébenes; Lluís Campins; Mateu Cabré. Intracellular Water Content in Lean Mass is Associated with Muscle Strength, Functional Capacity, and Frailty in Community-Dwelling Elderly Individuals. A Cross-Sectional Study. Nutrients 2019, 11, 661 .
AMA StyleMateu Serra-Prat, Isabel Lorenzo, Elisabet Palomera, Juan Carlos Yébenes, Lluís Campins, Mateu Cabré. Intracellular Water Content in Lean Mass is Associated with Muscle Strength, Functional Capacity, and Frailty in Community-Dwelling Elderly Individuals. A Cross-Sectional Study. Nutrients. 2019; 11 (3):661.
Chicago/Turabian StyleMateu Serra-Prat; Isabel Lorenzo; Elisabet Palomera; Juan Carlos Yébenes; Lluís Campins; Mateu Cabré. 2019. "Intracellular Water Content in Lean Mass is Associated with Muscle Strength, Functional Capacity, and Frailty in Community-Dwelling Elderly Individuals. A Cross-Sectional Study." Nutrients 11, no. 3: 661.
Background: Sepsis diagnosis can be incorrectly associated with the presence of hypotension during an infection, so the detection and management of non-hypotensive sepsis can be delayed. We aimed to evaluate how the presence or absence of hypotension, on admission at the emergency department, affects the initial management and outcomes of patients with community-onset severe sepsis. Methods: Demographic, clinical, laboratory, process of care, and outcome variables were recorded for all patients, at the emergency department of our university hospital, who presented with community-onset severe sepsis, between 1 March and 31 August in three consecutive years. Patient management consisted of standardized bundled care with five measures: Detection, blood cultures and empirical antibiotics, oxygen supplementation and fluid resuscitation (if needed), clinical monitoring, and noradrenalin administration (if needed). We compared all variables between patients who had hypotension (mean arterial pressure <65 mmHg), on admission to the emergency department, and those who did not. Results: We identified 153 episodes (84 (54.5%) men; mean age 73.6 ± 1.2; mean Sequential Organ Failure Assessment (SOFA) score 4.9 ± 2.7, and 41.2% hospital mortality). Hypotension was present on admission to the emergency department in 57 patients (37.2%). Hemodynamic treatment was applied earlier in patients who presented hypotension initially. Antibiotics were administered 48 min later in non-hypotensive sepsis (p = 0.08). A higher proportion of patients without initial hypotension required admission to the intensive care unit (ICU) (43.1% for patients initially hypotensive vs. 56.9% in those initially non-hypotensive, p < 0.05). Initial hypotension was not associated with mortality. A delay in door-to-antibiotic administration time was associated with mortality [OR 1.150, 95%CI: 1.043–1.268). Conclusions: Initial management of patients with community-onset severe sepsis differed according to their clinical presentation. Initial hypotension was associated with early hemodynamic management and less ICU requirement. A non-significant delay was observed in the administration of antibiotics to initially non-hypotensive patients. The time of door-to-antibiotic administration was related to mortality.
Leonor Ballester; Rafael Martínez; Juan Méndez; Gloria Miró; Manel Solsona; Elisabeth Palomera; Josep Anton Capdevila; Alejandro Rodriguez; Juan Carlos Yébenes. Differences in Hypotensive vs. Non-Hypotensive Sepsis Management in the Emergency Department: Door-to-Antibiotic Time Impact on Sepsis Survival. Medical Sciences 2018, 6, 91 .
AMA StyleLeonor Ballester, Rafael Martínez, Juan Méndez, Gloria Miró, Manel Solsona, Elisabeth Palomera, Josep Anton Capdevila, Alejandro Rodriguez, Juan Carlos Yébenes. Differences in Hypotensive vs. Non-Hypotensive Sepsis Management in the Emergency Department: Door-to-Antibiotic Time Impact on Sepsis Survival. Medical Sciences. 2018; 6 (4):91.
Chicago/Turabian StyleLeonor Ballester; Rafael Martínez; Juan Méndez; Gloria Miró; Manel Solsona; Elisabeth Palomera; Josep Anton Capdevila; Alejandro Rodriguez; Juan Carlos Yébenes. 2018. "Differences in Hypotensive vs. Non-Hypotensive Sepsis Management in the Emergency Department: Door-to-Antibiotic Time Impact on Sepsis Survival." Medical Sciences 6, no. 4: 91.
Juan Carlos Yébenes. Detección precoz de la sepsis: adaptarse o morir. Medicina Clínica 2017, 149, 209 -210.
AMA StyleJuan Carlos Yébenes. Detección precoz de la sepsis: adaptarse o morir. Medicina Clínica. 2017; 149 (5):209-210.
Chicago/Turabian StyleJuan Carlos Yébenes. 2017. "Detección precoz de la sepsis: adaptarse o morir." Medicina Clínica 149, no. 5: 209-210.
Up-to-date identification of local trends in sepsis incidence and outcomes is of considerable public health importance. The aim of our study was to estimate annual incidence rates and in-hospital mortality trends for hospitalized patients with sepsis in a European setting, while avoiding selection bias in relation to different complexity hospitals. A large retrospective analysis of a 5-year period (2008–2012) was conducted of hospital discharge records obtained from the Catalan Health System (CatSalut) Minimum Basic Data Set for Acute-Care Hospitals (a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia). Patients hospitalized with sepsis were detected on the basis of ICD-9-CM codes used to identify acute organ dysfunction and infectious processes. Of 4,761,726 discharges from all acute-care hospitals in Catalonia, 82,300 cases (1.72%) had sepsis diagnoses. Annual incidence was 212.7 per 100,000 inhabitants/year, rising from 167.2 in 2008 to 261.8 in 2012. Length of hospital stay fell from 18.4 to 15.3 days (p < .00001), representing a relative reduction of 17%. Hospital mortality fell from 23.7 to 19.7% (p < .0001), representing a relative reduction of 16.9%. These differences were confirmed in the multivariate analysis (adjusted for age group, sex, comorbidities, ICU admission, emergency admission, organ dysfunction, number of organ failures, sepsis source and bacteraemia). Sepsis incidence has risen in recent years, whereas mortality has fallen. Our findings confirm reports for other parts of the world, in the context of scarce administrative data on sepsis in Europe.
Juan Carlos Yébenes; SOCMIC (Catalonian Critical Care Society) Sepsis Working Group; Juan Carlos Ruiz-Rodriguez; Ricard Ferrer; Montserrat Clèries; Anna Bosch; Carol Lorencio; Alejandro Rodriguez; Xavier Nuvials; Ignacio Martin-Loeches; Antoni Artigas. Epidemiology of sepsis in Catalonia: analysis of incidence and outcomes in a European setting. Annals of Intensive Care 2017, 7, 1 -10.
AMA StyleJuan Carlos Yébenes, SOCMIC (Catalonian Critical Care Society) Sepsis Working Group, Juan Carlos Ruiz-Rodriguez, Ricard Ferrer, Montserrat Clèries, Anna Bosch, Carol Lorencio, Alejandro Rodriguez, Xavier Nuvials, Ignacio Martin-Loeches, Antoni Artigas. Epidemiology of sepsis in Catalonia: analysis of incidence and outcomes in a European setting. Annals of Intensive Care. 2017; 7 (1):1-10.
Chicago/Turabian StyleJuan Carlos Yébenes; SOCMIC (Catalonian Critical Care Society) Sepsis Working Group; Juan Carlos Ruiz-Rodriguez; Ricard Ferrer; Montserrat Clèries; Anna Bosch; Carol Lorencio; Alejandro Rodriguez; Xavier Nuvials; Ignacio Martin-Loeches; Antoni Artigas. 2017. "Epidemiology of sepsis in Catalonia: analysis of incidence and outcomes in a European setting." Annals of Intensive Care 7, no. 1: 1-10.
A. Rodríguez; I. Martín-Loeches; Juan Carlos Yébenes. New definition of sepsis and septic shock: What does it give us? Medicina Intensiva 2017, 41, 38 -40.
AMA StyleA. Rodríguez, I. Martín-Loeches, Juan Carlos Yébenes. New definition of sepsis and septic shock: What does it give us? Medicina Intensiva. 2017; 41 (1):38-40.
Chicago/Turabian StyleA. Rodríguez; I. Martín-Loeches; Juan Carlos Yébenes. 2017. "New definition of sepsis and septic shock: What does it give us?" Medicina Intensiva 41, no. 1: 38-40.
Sarcopenia is a geriatric syndrome characterized by progressive and generalized loss of skeletal muscle mass and function. Reported prevalence of this geriatric syndrome, differs depending on the definition, the population and the method used to identify sarcopenia. The causes of sarcopenia are multifactorial, and can include genetic influence, immobility or disuse, endocrine factors, inflammation and nutritional deficiencies. These disorders involve an imbalance between anabolic and catabolic pathways that rules muscle mass. Many drugs taken regularly for common conditions may interact with some mechanisms that can alter the balance between protein synthesis and degradation. This may lead to a harmful or a beneficial effect on muscle mass and strength. Widely prescribed drugs could play an important role during the time of onset and development of sarcopenia. In this paper, we reviewed the current understanding of how can drugs contribute positively or negatively on sarcopenia and muscle wasting. We decided to focus this review on oral common drugs, which are usually prescribed in older adults, leaving aside other drugs as hormone therapy.
Lluis Campins; Marcella Camps; Ariadna Riera; Eulogio Pleguezuelos; Juan Carlos Yébenes; Mateu Serra-Prat. Oral Drugs Related with Muscle Wasting and Sarcopenia. A Review. Pharmacology 2016, 99, 1 -8.
AMA StyleLluis Campins, Marcella Camps, Ariadna Riera, Eulogio Pleguezuelos, Juan Carlos Yébenes, Mateu Serra-Prat. Oral Drugs Related with Muscle Wasting and Sarcopenia. A Review. Pharmacology. 2016; 99 (1-2):1-8.
Chicago/Turabian StyleLluis Campins; Marcella Camps; Ariadna Riera; Eulogio Pleguezuelos; Juan Carlos Yébenes; Mateu Serra-Prat. 2016. "Oral Drugs Related with Muscle Wasting and Sarcopenia. A Review." Pharmacology 99, no. 1-2: 1-8.
Most studies aimed at getting to know the incidence of severe sepsis have methodological limitations which condition results that are difficult to compare and are inapplicable when it comes to estimating the necessary resources. Our objective is to evaluate the incidence and epidemiological aspects of community-acquired severe sepsis which require intensive care unit admission. Prospective observational population-based study in a population of 180,000 adults over 15 years old and a general hospital with 350 beds and 14 ICU beds. All episodes of community-acquired infection requiring admission to ICU due to severe sepsis were registered over a period of 9 years. The variables analyzed were: age, sex, SAPS II score, length of stay in ICU, type of infection, isolated microorganism, and deaths during their ICU admission. A statistical bivariate analysis and a multiple logistic regression were performed. Nine hundred and seventeen episodes with an average age of 65.2 years. The most frequent infectious focus was pulmonary (55.2%). The average SAPS II severity score index was 37.87 and mortality 19.7%. The annual incidence was 51.54 episodes per 100,000 adult inhabitants, meaning 1.97 ICU beds per day. In the multivariate analysis, the SAPS II score and a known aetiology were demonstrated as mortality risk factors. This study brings us some epidemiological data from a population-based perspective which help us to care for patients better in our geographical area. The average annual incidence is 51.5 cases per 100,000 adult inhabitants which means that 2 ICU beds per day to attend this population.
Jordi Almirall; Estel Güell; Josep A. Capdevila; Lluís Campins; Elisabet Palomera; Rafael Martinez; Gloria Miró; Mari C. de la Torre; Manel Solsona; Juan Carlos Yébenes. Epidemiología de la sepsis grave adquirida en la comunidad. Estudio de base poblacional. Medicina Clínica 2016, 147, 139 -143.
AMA StyleJordi Almirall, Estel Güell, Josep A. Capdevila, Lluís Campins, Elisabet Palomera, Rafael Martinez, Gloria Miró, Mari C. de la Torre, Manel Solsona, Juan Carlos Yébenes. Epidemiología de la sepsis grave adquirida en la comunidad. Estudio de base poblacional. Medicina Clínica. 2016; 147 (4):139-143.
Chicago/Turabian StyleJordi Almirall; Estel Güell; Josep A. Capdevila; Lluís Campins; Elisabet Palomera; Rafael Martinez; Gloria Miró; Mari C. de la Torre; Manel Solsona; Juan Carlos Yébenes. 2016. "Epidemiología de la sepsis grave adquirida en la comunidad. Estudio de base poblacional." Medicina Clínica 147, no. 4: 139-143.
Mortality in patients with community-acquired pneumonia (CAP) remains high despite improvements in treatment. To determine immunoglobulin levels in patients with CAP and impact on disease severity and mortality. Observational study. Hospitalized patients with CAP were followed up for 30 days. Levels of immunoglobulin G (IgG) and subclasses, immunoglobulin A (IgA) and immunoglobulin M (IgM) were measured in serum within 24 hours of CAP diagnosis. Three hundred sixty-two patients with CAP were enrolled -172 ward-treated and 190 intensive care unit-treated. Intensive care unit-treated patients had significantly lower values of IgG1, IgG2, IgG3 subclasses, and IgA than ward-treated patients. Thirty-eight patients died before 30 days. Levels of IgG2 were significantly lower in non-survivors than survivors (P=.004) and IgG2 <301 mg/dL was associated with poorer survival according to both the bivariate (hazard ratio 4.47; P<.001) and multivariate (HR 3.48; P=.003) analyses. Patients with CAP with IgG2 levels <301 mg/dL had a poorer prognosis and a higher risk of death. Our study suggests the usefulness of IgG2 to predict CAP evolution and to provide support measures or additional treatment.
Mari C. De La Torre; Elisabet Palomera; Mateu Serra-Prat; Estel Güell; Joan Carles Yébenes; Jesús F. Bermejo-Martín; Jordi Almirall. IgG2 as an independent risk factor for mortality in patients with community-acquired pneumonia. Journal of Critical Care 2016, 35, 115 -119.
AMA StyleMari C. De La Torre, Elisabet Palomera, Mateu Serra-Prat, Estel Güell, Joan Carles Yébenes, Jesús F. Bermejo-Martín, Jordi Almirall. IgG2 as an independent risk factor for mortality in patients with community-acquired pneumonia. Journal of Critical Care. 2016; 35 ():115-119.
Chicago/Turabian StyleMari C. De La Torre; Elisabet Palomera; Mateu Serra-Prat; Estel Güell; Joan Carles Yébenes; Jesús F. Bermejo-Martín; Jordi Almirall. 2016. "IgG2 as an independent risk factor for mortality in patients with community-acquired pneumonia." Journal of Critical Care 35, no. : 115-119.
Community-acquired pneumonia (CAP) mortality exceeds 20 % in critical care patients despite appropriate antibiotic therapy. Regional tissue oxygen saturation index (rSO2) measured with near-infrared spectroscopy (NIRS) might facilitate early detection for patients at risk of serious complications. Our objectives were to determine the relationship between early determination of rSO2 and mortality and to compare discrimination power for mortality of rSO2 and other resuscitation variables in critically ill CAP patients. This is a prospective observational study. Patients with CAP were enrolled within 6 h to intensive care admission. Demographics and clinical variables were recorded. rSO2 was determined using NIRS in brachioradialis muscle. All variables were determined at baseline and 24 h after admission. Forty patients were enrolled. Fourteen patients (35 %) had a baseline rSO2 < 60 % and 7 of them died (50 %). Only 1 of 26 (3.8 %) patients with rSO2 ≥ 60 % died (p = 0.007). The area under ROC curve (AUROC) showed consistent mortality discrimination at baseline (0.84, p = 0.03) and at 24 h (0.86, p = 0.006) for rSO2 values. Cox regression analysis showed that "low" rSO2 at ICU admission (hazard ratio (HR) = 8.99; 95 % confidence interval (CI) 1.05-76.8; p = 0.045) and "low" rSO2 at 24 h (HR = 13.18; 95 % CI 1.52-113.6; p = 0.019) were variables independently associated with mortality. In contrast, other variables such as Acute Physiology and Chronic Health Evaluation (APACHE II) score (HR = 1.09; 95 % CI 0.99-1.19; p = 0.052) were not associated with mortality. Our findings suggest that forearm skeletal muscle rSO2 differs in patients with severe CAP according to outcome and might be an early prognosis tool.
Laura Claverias; Michael Marí; Judith Marin-Corral; Mónica Magret; Sandra Trefler; María Bodí; Antonio Garcia-España; Juan Carlos Yébenes; Sergi Pascual; Joaquim Gea; Alejandro Rodríguez. The prognostic value of muscle regional oxygen saturation index in severe community-acquired pneumonia: a prospective observational study. Journal of Intensive Care 2016, 4, 7 .
AMA StyleLaura Claverias, Michael Marí, Judith Marin-Corral, Mónica Magret, Sandra Trefler, María Bodí, Antonio Garcia-España, Juan Carlos Yébenes, Sergi Pascual, Joaquim Gea, Alejandro Rodríguez. The prognostic value of muscle regional oxygen saturation index in severe community-acquired pneumonia: a prospective observational study. Journal of Intensive Care. 2016; 4 (1):7.
Chicago/Turabian StyleLaura Claverias; Michael Marí; Judith Marin-Corral; Mónica Magret; Sandra Trefler; María Bodí; Antonio Garcia-España; Juan Carlos Yébenes; Sergi Pascual; Joaquim Gea; Alejandro Rodríguez. 2016. "The prognostic value of muscle regional oxygen saturation index in severe community-acquired pneumonia: a prospective observational study." Journal of Intensive Care 4, no. 1: 7.
Introduction The use of non-invasive mechanical ventilation (NIV) in patients with influenza A (H1N1)pdm09 admitted to intensive care units (ICU) has been controversial.
C Ferri; J Marin-Corral; M Magret; M Bodi; S Trefler; E Diaz; I Martín-Loeches; Jc Yébenes; C Cillóniz; J Masclans; F Gordo-Vidal; L Cordero; A Rodriguez. Impact of non-invasive mechanical ventilation (niv) in critical patients with influenza (H1N1) PDM09. Intensive Care Medicine Experimental 2015, 3, A702 .
AMA StyleC Ferri, J Marin-Corral, M Magret, M Bodi, S Trefler, E Diaz, I Martín-Loeches, Jc Yébenes, C Cillóniz, J Masclans, F Gordo-Vidal, L Cordero, A Rodriguez. Impact of non-invasive mechanical ventilation (niv) in critical patients with influenza (H1N1) PDM09. Intensive Care Medicine Experimental. 2015; 3 (1):A702.
Chicago/Turabian StyleC Ferri; J Marin-Corral; M Magret; M Bodi; S Trefler; E Diaz; I Martín-Loeches; Jc Yébenes; C Cillóniz; J Masclans; F Gordo-Vidal; L Cordero; A Rodriguez. 2015. "Impact of non-invasive mechanical ventilation (niv) in critical patients with influenza (H1N1) PDM09." Intensive Care Medicine Experimental 3, no. 1: A702.
L. Canadell; I. Martín-Loeches; E. Diaz; S. Trefler; S. Grau; Juan Carlos Yébenes; Jordi Almirall; M. Olona; Francesc X. Sureda; J. Blanquer; A. Rodriguez. Grado de adherencia al tratamiento antivírico recomendado durante la pandemia y periodo pospandémico de gripe A (H1N1)pdm09 en 148 unidades de cuidados intensivos españolas. Medicina Intensiva 2015, 39, 222 -233.
AMA StyleL. Canadell, I. Martín-Loeches, E. Diaz, S. Trefler, S. Grau, Juan Carlos Yébenes, Jordi Almirall, M. Olona, Francesc X. Sureda, J. Blanquer, A. Rodriguez. Grado de adherencia al tratamiento antivírico recomendado durante la pandemia y periodo pospandémico de gripe A (H1N1)pdm09 en 148 unidades de cuidados intensivos españolas. Medicina Intensiva. 2015; 39 (4):222-233.
Chicago/Turabian StyleL. Canadell; I. Martín-Loeches; E. Diaz; S. Trefler; S. Grau; Juan Carlos Yébenes; Jordi Almirall; M. Olona; Francesc X. Sureda; J. Blanquer; A. Rodriguez. 2015. "Grado de adherencia al tratamiento antivírico recomendado durante la pandemia y periodo pospandémico de gripe A (H1N1)pdm09 en 148 unidades de cuidados intensivos españolas." Medicina Intensiva 39, no. 4: 222-233.
Susceptibility to invasive pneumococcal disease (IPD) correlates with age, younger children being the group with the highest burden of disease. The relevance of the innate immune response and particularly the role of mannose-binding lectin (MBL) in combating IPD is not well known. This is a 2-year prospective study (February 2011 to March 2013) including patients with IPD who attended two hospitals from Catalonia, Spain. Variables including attack rate of pneumococcal serotype (high or low invasive potential serotypes) and genotypes associated with low serum MBL levels were recorded. One hundred and forty-seven patients were included in the study. One hundred and two (69.4%) patients were children or adolescents p = 0.031). Further sub-analysis revealed a higher proportion of low-MBL genotypes in children p = 0.02). However, no statistically significant differences between the two groups were observed when including patients infected with invasive or high-attack-rate serotypes (18.8% vs. 10.0%; p = 0.59). Our data suggest that young children with a genetically determined low-MBL production are at a higher risk of developing IPD, particularly that caused by opportunistic or low-attack-rate pneumococcal serotypes.
Carmen Muñoz-Almagro; C. Bautista; M.T. Arias; Ramon Boixeda; E. del Amo; C. Borrás; N. Armiger; L. Garcia; G. Sauca; L. Selva; M.F. de Sevilla; P. Ciruela; Juan Carlos Yébenes; Roman Pallares; Francisco Lozano. High prevalence of genetically-determined mannose binding lectin deficiency in young children with invasive pneumococcal disease. Clinical Microbiology and Infection 2014, 20, O745 -O752.
AMA StyleCarmen Muñoz-Almagro, C. Bautista, M.T. Arias, Ramon Boixeda, E. del Amo, C. Borrás, N. Armiger, L. Garcia, G. Sauca, L. Selva, M.F. de Sevilla, P. Ciruela, Juan Carlos Yébenes, Roman Pallares, Francisco Lozano. High prevalence of genetically-determined mannose binding lectin deficiency in young children with invasive pneumococcal disease. Clinical Microbiology and Infection. 2014; 20 (10):O745-O752.
Chicago/Turabian StyleCarmen Muñoz-Almagro; C. Bautista; M.T. Arias; Ramon Boixeda; E. del Amo; C. Borrás; N. Armiger; L. Garcia; G. Sauca; L. Selva; M.F. de Sevilla; P. Ciruela; Juan Carlos Yébenes; Roman Pallares; Francisco Lozano. 2014. "High prevalence of genetically-determined mannose binding lectin deficiency in young children with invasive pneumococcal disease." Clinical Microbiology and Infection 20, no. 10: O745-O752.
SummaryBackgroundA population-based case-control study was designed to assess changes of serum levels of immunoglobulins and IgG subclasses between infected and convalescent phase in community-acquired pneumonia (CAP).MethodsOver a 2-year period, all subjects who were >14 years of age living in the Maresme region (Barcelona, Spain) diagnosed of CAP were registered. Controls were healthy subjects selected from the municipal census. Prognostic factors were assessed and serum levels of total IgG, IgA, IgM, and IgG subclasses were measured at diagnosis and 1 month later (cases).ResultsWe studied 171 patients with CAP and 90 controls. All immunoglobulins were significantly lower in cases than in controls. At diagnosis, 42.7% of cases showed low levels of some immunologic parameter, mainly total IgG and IgG2. Low immunoglobulin levels at diagnosis were more frequent in patients requiring in-patient care and in those with pneumonia of other etiology than Streptococcus pneumoniae. In the convalescent phase, 26 (23.6%) patients normalized immunological levels. In 27 (24.5%) cases, some parameter with low levels persisted especially in patients with etiology of CAP other than S. pneumoniae.ConclusionsLow serum levels of immunoglobulins particularly total IgG and IgG2 were a common finding in patients with CAP compared to healthy controls. Low immunoglobulin levels may be related to CAP prognosis and persisted in the convalescent phase in one-fourth of cases
Mari C. de la Torre; Ignasi Bolíbar; Montse Vendrell; Javier De Gracia; Ester Vendrell; M. José Rodrigo; Xavier Boquet; Pablo Torrebadella; Juan Carlos Yébenes; Mateu Serra-Prat; Jordi Rello; Antoni Torres; Jordi Almirall. Serum immunoglobulins in the infected and convalescent phases in community-acquired pneumonia. Respiratory Medicine 2013, 107, 2038 -2045.
AMA StyleMari C. de la Torre, Ignasi Bolíbar, Montse Vendrell, Javier De Gracia, Ester Vendrell, M. José Rodrigo, Xavier Boquet, Pablo Torrebadella, Juan Carlos Yébenes, Mateu Serra-Prat, Jordi Rello, Antoni Torres, Jordi Almirall. Serum immunoglobulins in the infected and convalescent phases in community-acquired pneumonia. Respiratory Medicine. 2013; 107 (12):2038-2045.
Chicago/Turabian StyleMari C. de la Torre; Ignasi Bolíbar; Montse Vendrell; Javier De Gracia; Ester Vendrell; M. José Rodrigo; Xavier Boquet; Pablo Torrebadella; Juan Carlos Yébenes; Mateu Serra-Prat; Jordi Rello; Antoni Torres; Jordi Almirall. 2013. "Serum immunoglobulins in the infected and convalescent phases in community-acquired pneumonia." Respiratory Medicine 107, no. 12: 2038-2045.
Maria Delgado-Capel; Alessandra Gabillo; Lorena Elías; Juan Carlos Yébenes; Goretti Sauca; Josep Anton Capdevila. [Peripheral venous catheter-related bacteremia in a general hospital]. Revista Española de Quimioterapia 2012, 25, 1 .
AMA StyleMaria Delgado-Capel, Alessandra Gabillo, Lorena Elías, Juan Carlos Yébenes, Goretti Sauca, Josep Anton Capdevila. [Peripheral venous catheter-related bacteremia in a general hospital]. Revista Española de Quimioterapia. 2012; 25 (2):1.
Chicago/Turabian StyleMaria Delgado-Capel; Alessandra Gabillo; Lorena Elías; Juan Carlos Yébenes; Goretti Sauca; Josep Anton Capdevila. 2012. "[Peripheral venous catheter-related bacteremia in a general hospital]." Revista Española de Quimioterapia 25, no. 2: 1.
F. Álvarez Lerma; Juan Carlos Yébenes; M.P. Martínez. «Hay que evitar la cateterización de las venas femorales siempre que sea posible». Medicina Intensiva 2010, 34, 219 -221.
AMA StyleF. Álvarez Lerma, Juan Carlos Yébenes, M.P. Martínez. «Hay que evitar la cateterización de las venas femorales siempre que sea posible». Medicina Intensiva. 2010; 34 (3):219-221.
Chicago/Turabian StyleF. Álvarez Lerma; Juan Carlos Yébenes; M.P. Martínez. 2010. "«Hay que evitar la cateterización de las venas femorales siempre que sea posible»." Medicina Intensiva 34, no. 3: 219-221.