Martinez-Urbistondo, D. (Diego)
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- Mortality Prediction in Patients Undergoing Non-Invasive Ventilation in Intermediate Care(San Francisco CA: Public Library of Science, 2015) Landecho, M.F. (Manuel F.); Garcia-Mouriz, A. (Alberto); Lucena-Ramírez, J.F. (Juan Felipe); Huerta, A. (Ana); Alegre, F. (Félix); Fernandez-Ros, N. (Nerea); Martinez-Urbistondo, D. (Diego); Carmona-Torre, F. (Francisco de A.); Garcia, N. (Nicolás); Quiroga, J. (Jorge); Nuñez-Cordoba, J.M. (Jorge M.)Background Intermediate Care Units (ImCU) have become an alternative scenario to perform Non-Inva- sive Ventilation (NIV). The limited number of prognostic studies in this population support the need of mortality prediction evaluation in this context. Objective The objective of this study is to analyze the performance of Simplified Acute Physiology Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for new variables that could be useful to customize these scores, in order to improve mortality prediction. Design Cohort study with prospectively collected data from all patients admitted to a single center ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality rates were calculated. Discrimination and calibration were evaluated by calculating the area under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow goodness of fit test for the models, respectively. Binary logistic regression was used to iden- tify new variables to customize the scores for mortality prediction in this setting. Patients The study included 241 patients consecutively admitted to an ImCU staffed by hospitalists from April 2006 to December 2013. Key Results The observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio (SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppres- sion, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic acid, pCO2 and haemoglobin levels showed better discrimination than old scores with simi- lar calibration power. Conclusions These results suggest that SAPS II and 3 should be customized with additional patient-risk factors to improve mortality prediction in patients undergoing NIV in intermediate care.
- El índice neutrófilo/linfocito como marcador de disfunción sistémica endotelial en sujetos asintomáticos(Sociedad Española de Nefrología, 2016) Huerta, A. (Ana); Beloqui, O. (Óscar); Martinez-Urbistondo, D. (Diego); Beltrán, A. (Almudena)Fundamento y objetivo: El índice neutrófilo/linfocito es un marcador inflamatorio de valor pronóstico en enfermedades cardiovasculares. El objetivo del presente trabajo es valorar la asociación entre el índice neutrófilo/linfocito y la alteración del cociente albú- mina/creatinina urinario como marcador precoz de disfunción endotelial sistémica asociada a enfermedad microvascular y riesgo cardiovascular, en sujetos asintomáticos. Materiales y métodos: Se realizó un estudio transversal en 1.816 sujetos asintomáticos. Se excluyó del a estudio aquellos pacientes que presentaron antecedentes de enfermedad car- diovascular, los que recibían tratamiento con fármacos antiproteinúricos (inhibidores de la enzima conversora de angiotensina y antagonistas de los receptores de la angiotensina II) y aquellos que presentaron un cociente albúmina/creatinina superior a 300mg/dL. La variable desenlace del estudio fue la alteración del cociente albúmina/creatinina urinario. Resultados: El índice neutrófilo/linfocito resultó significativamente asociado a la alteración del cociente albúmina/creatinina urinario, tanto en el estudio univariante como en el mul- tivariante, independientemente de otros cofactores como la edad, la hipertensión arterial, la diabetes, la dislipidemia o el filtrado glomerular patológico. El análisis de la sensibilidad y la especificidad de distintos niveles del índice neutrófilo/linfocito permitió generar 3 grupos de riesgo de alteración del cociente albúmina/creatina urinario: riesgo bajo con un cociente neutrófilo/linfocito < 1,5, riesgo intermedio con cociente neutrófilo/linfocito entre 1,5y3y riesgo alto con un cociente neutrófilo/linfocito > 3. La proporción relativa de alteración del cociente albúmina/creatinina urinario, en los 3 grupos de riesgo, aumentaba en razón del valor del índice neutrófilo/linfocito de forma independiente al resto de cofactores. Conclusiones: El índice neutrófilo/linfocito surge como un potencial marcador de disfun- ción endotelial sistémica económico, rápido, no invasivo e independiente de otros factores conocidos, en sujetos asintomáticos.
- Design and Performance of a New Severity Score for Intermediate Care(San Francisco CA: Public Library of Science, 2015) Landecho, M.F. (Manuel F.); Lucena-Ramírez, J.F. (Juan Felipe); Huerta, A. (Ana); Alegre, F. (Félix); Fernandez-Ros, N. (Nerea); Martinez-Urbistondo, D. (Diego); Garcia, N. (Nicolás)Background Application of illness-severity scores in Intermediate Care Units (ImCU) shows conflicting results. The aim of the study is to design a severity-of-illness score for patients admitted to an ImCU. Methods We performed a retrospective observational study in a single academic medical centre in Pamplona, Spain. Demographics, past medical history, reasons for admission, physiologi- cal parameters at admission and during the first 24 hours of ImCU stay, laboratory variables and survival to hospital discharge were recorded. Logistic regression analysis was per- formed to identify variables for mortality prediction. Results A total of 743 patients were included. The final multivariable model (derivation cohort = 554 patients) contained only 9 variables obtained at admission to the ImCU: previous length of stay 7 days (6 points), health-care related infection (11), metastatic cancer (9), immunosup- pressive therapy (6), Glasgow comma scale 12 (10), need of non-invasive ventilation (14), platelets 50000/mcL (9), urea 0.6 g/L (10) and bilirubin 4 mg/dL (9). The ImCU severity score (ImCUSS) is generated by summing the individual point values, and the formula for determining the expected in-hospital mortality risk is: eImCUSS points*0.099 – 4,111 / (1 + eImCUSS points*0.099 – 4,111). The model showed adequate calibration and discrimination. Performance of ImCUSS (validation cohort = 189 patients) was comparable to that of SAPS II and 3. Hos- mer-Lemeshow goodness-of-fit C test was χ2 8.078 (p=0.326) and the area under receiver operating curve 0.802. Conclusions ImCUSS, specially designed for intermediate care, is based on easy to obtain variables at admission to ImCU. Additionally, it shows a notable performance in terms of calibration and mortality discrimination.
- Performance of SAPS II and SAPS 3 in Intermediate Care(Public Library of Science, 2013) Landecho, M.F. (Manuel F.); Garcia-Mouriz, A. (Alberto); Lucena-Ramírez, J.F. (Juan Felipe); Huerta, A. (Ana); Alegre, F. (Félix); Martinez-Urbistondo, D. (Diego); Garcia, N. (Nicolás); Quiroga, J. (Jorge)Objective: The efficacy and reliability of prognostic scores has been described extensively for intensive care, but their role for predicting mortality in intermediate care patients is uncertain. To provide more information in this field, we have analyzed the performance of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 in a single center intermediate care unit (ImCU). Materials and Methods: Cohort study with prospectively collected data from all patients admitted to a single center ImCU in Pamplona, Spain, from April 2006 to April 2012. The SAPS II and SAPS 3 scores with respective predicted mortality rates were calculated according to standard coefficients. Discrimination was evaluated by calculating the area under receiver operating characteristic curve (AUROC) and calibration with the Hosmer-Lemeshow goodness of fit test. Standardized mortality ratios (SMR) with 95% confidence interval (95% CI) were calculated for each model. Results: The study included 607 patients. The observed in-hospital mortality was 20.1% resulting in a SMR of 0.87 (95% CI 0.73-1.04) for SAPS II and 0.56 (95% CI 0.47-0.67) for SAPS 3. Both scores showed acceptable discrimination, with an AUROC of 0.76 (95% CI 0.71-0.80) for SAPS II and 0.75 (95% CI 0.71- 0.80) for SAPS 3. Calibration curves showed similar performance based on Hosmer-Lemeshow goodness of fit C-test: (X2=12.9, p=0.113) for SAPS II and (X2=4.07, p=0.851) for SAPS 3. Conclusions: Although both scores overpredicted mortality, SAPS II showed better discrimination for patients admitted to ImCU in terms of SMR.
- Antioxidant lifestyle, co-morbidities and quality of life empowerment concerning liver fibrosis(MDPI, 2020) Martinez, J.A. (José Alfredo); Suárez-del-Villar, R. (Rafael); Daimiel, L. (Lidia); San-Cristobal, R. (Rodrigo); Villares, P. (Paula); Martinez-Urbistondo, D. (Diego); Ramos-López, O. (Omar); Argemí, J. (Josepmaria)The assessment of liver fibrosis has gained importance since the progression of non-alcoholic fatty liver disease (NAFLD). Indeed, the description of the association between undetected liver fibrosis and lifestyle in terms of antioxidant habits, comorbidity and quality of life (QoL) domains may help in the characterization of subjects with NAFLD. A cross-sectional evaluation of (n = 116) consecutive patients from an Internal Medicine ambulatory evaluation was performed. Demographic data, lifestyle, co-morbidity, QoL (according to the SF-36 index) and analytical values to calculate the oxidative related Fibrosis-4 (FIB-4) index were recorded. The association between FIB-4 and co-morbidity, antioxidant habits in QoL was assessed in univariate analysis (p < 0.05) and confirmed in multivariable analysis for 4 of the 8 SF-36 categories: Physical QoL, Physical role, Social QoL and General QoL, as well as in the Physical summary of SF-36 (p < 0.05). Finally, interactions were assessed between co-morbidity, FIB-4 and antioxidant habits showed in the prediction of mean SF-36 (p < 0.01). Liver fibrosis assessed by the oxidative surrogate index FIB-4 is associated with the interaction between antioxidant lifestyle, co-morbidity and physical, social and general aspects of QoL in apparent liver disease-free individuals, generating a proof of concept for health empowerment and personalized medicine.
- Estimation of fatty liver disease clinical role on glucose metabolic remodelling phenotypes and T2DM onset(Wiley, 2023) Landecho, M.F. (Manuel F.); Martinez, J.A. (José Alfredo); Navarro-Gonzalez, D. (David); Huerta, A. (Ana); Martinez-Urbistondo, D. (Diego); Sanchez-Iñigo, L. (Laura); Fernandez-Montero, A. (Alejandro); Pastrana-Delgado, J. (Juan)Introduction: Metabolic syndrome (MetS), prediabetes (PreDM) and Fatty Liver Disease (FLD) share pathophysiological pathways concerning type 2 diabetes mellitus (T2DM) onset. The non-invasive assessment of fatty liver combined with PreDM and MetS features screening might provide further accuracy in predicting hyperglycemic status in the clinical setting with the putative description of singu- lar phenotypes. The objective of the study is to evaluate and describe the links of a widely available FLD surrogate -the non-invasive serological biomarker Hepatic Steatosis Index (HSI)- with previously described T2DM risk predictors, such as preDM and MetS in forecasting T2DM onset. Patients and methods: A retrospective ancillary cohort study was performed on 2799 patients recruited in the Vascular-Metabolic CUN cohort. The main out- come was the incidence of T2DM according to ADA criteria. MetS and PreDM were defined according to ATP III and ADA criteria, respectively. Hepatic stea- tosis index (HSI) with standardized thresholds was used to discriminate patients with FLD, which was referred as estimated FLD (eFLD). Results: MetS and PreDM were more common in patients with eFLD as com- pared to those with an HSI < 36 points (35% vs 8% and 34% vs. 18%, respectively). Interestingly, eFLD showed clinical effect modification with MetS and PreDM in the prediction of T2DM [eFLD-MetS interaction HR = 4.48 (3.37-5.97) and eFLD-PreDM interaction HR = 6.34 (4.67-8.62)]. These findings supported thedescription of 5 different liver status-linked phenotypes with increasing risk of T2DM: Control group (1,5% of T2DM incidence), eFLD patients (4,4% of T2DM incidence), eFLD and MetS patients (10,6% of T2DM incidence), PreDM patients (11,1% of T2DM incidence) and eFLD and PreDM patients (28,2% of T2DM inci- dence). These phenotypes provided independent capacity of prediction of T2DM incidence after adjustment for age, sex, tobacco and alcohol consumption, obesity and number of SMet features with a c-Harrell=0.84. Conclusion: Estimated Fatty Liver Disease using HSI criteria (eFLD) interplay with MetS features and PreDM might help to discriminate patient risk of T2DM in the clinical setting through the description of independent metabolic risk phenotypes. [Correction added on 15 June 2023, after first online publication: The abstract section was updated in this current version.]
- Exploring host genetic polymorphisms involved in SARS-CoV infection autcomes: implications for personalized medicine in COVID-19(Hindawi, 2020) Martinez, J.A. (José Alfredo); Daimiel, L. (Lidia); Vargas, J.A. (Juan A.); Martinez-Urbistondo, D. (Diego); Ramirez-de-Molina, A. (Ana); Ramos-López, O. (Omar)Objective. To systematically explore genetic polymorphisms associated with the clinical outcomes in SARS-CoV infection in humans. Methods. This comprehensive literature search comprised available English papers published in PubMed/Medline and SCOPUS databases following the PRISMA-P guidelines and PICO/AXIS criteria. Results. Twenty-nine polymorphisms located in 21 genes were identified as associated with SARS-CoV susceptibility/resistance, disease severity, and clinical outcomes predominantly in Asian populations. Thus, genes implicated in key pathophysiological processes such as the mechanisms related to the entry of the virus into the cell and the antiviral immune/inflammatory responses were identified. Conclusions. Although caution must be taken, the results of this systematic review suggest that multiple genetic polymorphisms are associated with SARS-CoV infection features by affecting virus pathogenesis and host immune response, which could have important applications for the study and understanding of genetics in SARS-CoV-2/COVID-19 and for personalized translational clinical practice depending on the population studied and associated environments.