Sanz, E. (Eva)
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- Permanent postoperative hypoparathyroidism: an analysis of prevalence and predictive factors for adequacy of control in a cohort of 260 patients(AME Publishing Company, 2020) Fernandez-Garcia, J.C. (José C.); Baena-Nieto, G. (Gloria); Bandrés, O. (Orosia); Zafón, C. (Carles); Anda, E. (Emma); Sánchez-Ragnarsson, C. (Cecilia); Megía, A. (Ana); Romero-Lluch, A.R. (Ana Reyes); Sambo, M. (Marcel); Picallo, M. (María); Donnay, S. (Sergio); Iglesias, P. (Pedro); Manjón, L. (Laura); Lecumberri, B. (Beatriz); Sahún-de-la-Vega, M. (Manel); Fernández, P.S. (Piedad Santiago); Pérez-Corral, B. (Begoña); Sanz, E. (Eva); Navarro, E. (Elena); Díez, J.J. (Juan J.); Paja, M. (Miguel); Blanco-Carrera, C. (Concepción); Galofre, J.C. (Juan Carlos); Sastre, J. (Julia); Álvarez-Escolá, C. (Cristina); Oleaga, A. (A.)Background: Recent guidelines for the treatment of hypoparathyroidism emphasize the need for long-term disease control, avoiding symptoms and hypocalcaemia. Our aim has been to analyze the prevalence of poor disease control in a national cohort of patients with hypoparathyroidism, as well as to evaluate predictive variables of inadequate disease control. Methods: From a nation-wide observational study including a cohort of 1792 patients undergoing total thyroidectomy, we selected 260 subjects [207 women and 53 men, aged (mean ± SD) 47.2±14.8 years] diagnosed with permanent hypoparathyroidism. In every patient demographic data and details on surgical procedure, histopathology, calcium (Ca) metabolism, and therapy with Ca and calcitriol were retrospectively collected. A patient was considered not adequately controlled (NAC) if presented symptoms of hypocalcemia or biochemical data showing low serum Ca levels or high urinary Ca excretion. Results: Two hundred and twenty-one (85.0%) patients were adequately controlled (AC) and 39 (15.0%) were NAC. Comparison between AC and NAC patients did not show any significant difference in demographic, surgical, and pathological features. Rate of hospitalization during follow-up was significantly higher among NAC patients in comparison with AC patients (35.9% vs. 10.9%, P<0.001). Dose of oral Ca and calcitriol were also significantly higher in NAC subjects. In a subgroup of 129 patients with serum parathyroid hormone (PTH) levels available, we found that NAC patients exhibited significantly lower postoperative PTH concentrations than AC patients [median (interquartile range) 3 (1.9-7.8) vs. 6.9 (3.0-11) pg/mL; P=0.009]. Conclusions: In a nation-wide cohort of 260 subjects with definitive hypoparathyroidism, 15% of them had poor disease control. These patients required higher doses of oral Ca and calcitriol, had higher rate of hospitalization during follow-up and showed lower PTH concentrations in the postoperative period.
- Long-term outcome of critically III advanced cancer patients managed in an intermediate care unit(2022) Landecho, M.F. (Manuel F.); Sunsundegui-Seviné, P. (Patricia); Lucena-Ramírez, J.F. (Juan Felipe); Alegre, F. (Félix); Fernandez-Ros, N. (Nerea); Gurpide, A. (Alfonso); Sanz, E. (Eva); Lecumberri, R. (Ramón); Garcia-Gonzalez, N. (Nicolás); Quiroga, J. (Jorge); Rodríguez-Rodríguez, J. (Javier)Background: To analyze the long-term outcomes for advanced cancer patients admitted to an intermediate care unit (ImCU), an analysis of a do not resuscitate orders (DNR) subgroup was made. Methods: A retrospective observational study was conducted from 2006 to January 2019 in a single academic medical center of cancer patients with stage IV disease who suffered acute severe complications. The Simplified Acute Physiology Score 3 (SAPS 3) was used as a prognostic and severity score. In-hospital mortality, 30-day mortality and survival after hospital discharge were calculated. Results: Two hundred and forty patients with stage IV cancer who attended at an ImCU were included. In total, 47.5% of the cohort had DNR orders. The two most frequent reasons for admission were sepsis (32.1%) and acute respiratory failure (excluding sepsis) (38.7%). Mortality in the ImCU was 10.8%. The mean predicted in-hospital mortality according to SAPS 3 was 51.9%. The observed in-hospital mortality was 37.5% (standard mortality ratio of 0.72). Patients discharged from hospital had a median survival of 81 (30.75-391.25) days (patients with DNR orders 46 days (19.5-92.25), patients without DNR orders 162 days (39.5-632)). The observed mortality was higher in patients with DNR orders: 52.6% vs. 23.8%, p 0 < 0.001. By multivariate logistic regression, a worse ECOG performance status (3-4 vs. 0-2), a higher SAPS 3 Score and DNR orders were associated with a higher in-hospital mortality. By multivariate analysis, non-invasive mechanical ventilation, higher bilirubin levels and DNR orders were significantly associated with 30-day mortality. Conclusion: For patients with advanced cancer disease, even those with DNR orders, who suffer from acute complications or require continuous monitoring, an ImCU-centered multidisciplinary management shows encouraging results in terms of observed-to-expected mortality ratios.