The prevalence, relationships and outcomes of sarcopenia and frailty in polypathological patients remain unknown. We performed a multicenter prospective observational study in six hospitals in order to assess prevalence, clinical features, outcome and associated risk factors of sarcopenia and frailty in a hospital-based population of polypathological patients. The cohort was recruited by performing prevalence surveys every 14 days during the inclusion period (March 2012–June 2016). Sarcopenia was assessed by means of EWGSOP criteria and frailty by means of Fried’s criteria. Skeletal muscle mass was measured by tetrapolar bioimpedanciometry. All patients were followed for 12 months. Factors associated with sarcopenia, frailty and mortality were analyzed by multivariate logistic regression, and Kaplan–Meier curves. A total of 444 patients (77.3 ± 8.4 years, 55% males) were included. Sarcopenia was present in 97 patients (21.8%), this being moderate in 54 (12.2%), and severe in 43 (9.6%); frailty was present in 278 patients (62.6%), and 140 (31.6%) were pre-frail; combined sarcopenia and frailty were present in the same patient in 80 (18%) patients. Factors independently associated to the presence of both, sarcopenia and frailty were female gender, older age, different chronic conditions, poor functional status, low body mass index, asthenia and depressive disorders, and low leucocytes and lymphocytes count. Mortality in the 12-months follow-up period was 40%. Patients with sarcopenia, frailty or both survived significantly less than those without these conditions. Sarcopenia and frailty are frequent and interrelated conditions in polypathological patients, shadowing their survival. Their early recognition and management could improve health-related outcomes in this population.

El espectro clínico de la COVID-19 varía entre sintomatología leve o ausente hasta neumonías con complicaciones mortales. El objetivo del estudio fue determinar los factores predictivos de mortalidad e ingreso en cuidados intensivos (UCI) en pacientes hospitalizados por COVID-19. Estudio retrospectivo de una cohorte de pacientes ingresados por COVID-19 entre marzo de 2020 y febrero de 2021. Se describieron las variables demográficas, clínicas, radiológicas y analíticas al ingreso. Los predictores independientes de mortalidad e ingreso en UCI se identificaron mediante regresión logística por pasos hacia atrás y se describieron como odds ratio (OR) e intervalo de confianza al 95% (IC95%). Se incluyeron 883 pacientes, 51,8% varones y edad media 68 años; el 1,8% reingresó. Fallecieron 154 pacientes (17,6%); los predictores independientes de mortalidad fueron: edad (OR=1,071; IC95%: 1,046-1,095), porcentaje de saturación de oxígeno (SatO2) (OR=0,938; IC95%: 0,903-0,974), tensión arterial diastólica (PAD, OR=0,972; IC95%: 0,955-0,989), creatinina (OR=1,516; IC95%: 1,088-2,113), INR (OR=1,199; IC95%: 1,012-1,419) y sodio (OR=1,082; IC95%: 1,037-1,128). El 8% de los pacientes ingresaron en UCI; las variables predictoras independientes fueron: sexo masculino (OR=2,079; IC95%: 1,099-3,935), edad (OR=0,960; IC95%: 0,942-0,979), SatO2 (OR=0,925; IC95%: 0,889-0,962), creatinina (OR=1,551; IC95%: 1,118-2,152) y proteína C reactiva (PCR, OR=1,003; IC95%: 1,000-1,007). La identificación de predictores independientes de mortalidad (edad, SatO2, PAD, creatinina, INR, sodio) y de ingreso en UCI (sexo, edad, SatO2, creatinina y PCR) permite estratificar a los pacientes y adaptar los protocolos de atención clínica a estos hallazgos, mejorando las decisiones médicas.

Background: Community-acquired pneumonia (CAP) remains one of the leading causes of infectious mortality worldwide. Variability in diagnosis and management can significantly influence outcomes. Objective: To assess the association between the implementation of a standardized hospital protocol and clinical outcomes in patients hospitalized for bacterial CAP and to identify factors associated with in-hospital and 30-day mortality. Methods: An ambispective before–after study was conducted at Hospital San Juan de Dios del Aljarafe (Seville, Spain), including a retrospective phase (2019) and a prospective intervention period (2022–2023). The intervention consisted of a standardized clinical protocol supported by training sessions and a 9-item checklist. Adults (≥18 years) with clinically and radiologically confirmed bacterial CAP were included. Mortality, length of stay, and empirical and targeted antibiotic adequacy were compared between periods. In the prospective cohort (n = 169), mortality-associated factors were analyzed using multivariate logistic regression. Results: A total of 1610 patients were analyzed: 634 in the pre-intervention period and 976 during the intervention period. Hospital mortality was lower during the intervention (11.3% [95% CI 9.3–13.2] vs. 16.6%; [95% CI 13.7–19.5] p = 0.002) with an absolute risk difference of 5.3%, corresponding to an approximate number needed to treat (NNT) of 19. Median length of stay decreased slightly (8.1 vs. 7.9 days; p < 0.001). In the prospective cohort, in-hospital mortality was 7.7% and 30-day mortality 16.6%. The therapeutic effort limitation (aOR 9.10, 95% CI 1.36–121.57; p = 0.021) and lower SaO₂/FiO₂ (aOR per unit 0.98, 95% CI 0.97–0.99; p < 0.001) were independently associated with in-hospital mortality. The ARDS (aOR 4.29, 95% CI 1.05–19.93; p = 0.043), lower SaO₂/FiO₂ (aOR 0.99 per unit, 95% CI 0.98–1.00; p = 0.005), older age (aOR 1.06 per year, 95% CI 1.02–1.12; p = 0.005), and lower Barthel Index (aOR 0.97 per point, 95% CI 0.94–0.99; p < 0.001) were associated with higher 30-day mortality. Conclusions: Implementation of a standardized CAP protocol was associated with lower mortality and high antibiotic adequacy in the intervention cohort. While causal inference is limited by the non-contemporaneous before–after design, these findings support the integration of structured, multidisciplinary, protocol-driven strategies—together with periodic audit and feedback cycles—to strengthen CAP management in community hospital settings.