Medicina

The Role of Neutrophil-to-Lymphocyte Ratio in Patients with Diabetes and Atrial Fibrillation. Insights from Sumamos-Fa-Semi Registry

2026-03-05T01:04:16Z

The Role of Neutrophil-to-Lymphocyte Ratio in Patients with Diabetes and Atrial Fibrillation. Insights from Sumamos-Fa-Semi Registry Arévalo Lorido, José Carlos; Carretero Gómez, Juana; Muela Molinero, Alberto; Montero Hernández, Esther; López Sáez, José Juan Bosco; González Anglada, Maria Isabel; Vazquez Ronda, Miguel Angel; Castiella-Herrero, Jesús; Miramontes González, José Pablo; García Alonso, Rocío Aim: To analyse the importance of inflammation in the disease burden and prognosis of patients with type 2 diabetes (T2DM) and atrial fibrillation (AF). We assessed these patients according to their neutrophil-to-lymphocyte ratio (NLR) values, examining their baseline characteristics and their prognosis at one year of follow-up based on a prospective AF registry in Spain (Sumamos-FA-SEMI). Methods: A prospective, multicentre, observational study of patients with AF (Sumamos-FA-SEMI) was conducted. We categorised the patients into four groups according to the presence of T2DM and NLR levels with a reference cut-off point of three. We compared the characteristics of the four groups and evaluated the prognosis using the mean values of all-cause mortality and all-cause mortality plus readmissions during a year of follow-up. Results: We analysed 1071 patients, 482 of whom had T2DM. This group had significantly higher rates of obesity and comorbidities. Groups with an NLR greater than three points had a higher prevalence of cancer, lower HDL cholesterol levels, and more albuminuria. Other inflammatory markers, such as C-reactive protein, were also higher in these groups. Regarding prognosis, groups (both with and without T2DM) with an NLR greater than three had significantly higher mortality, with a higher probability in those without T2DM (HR 3.58, 95% CI: 1.99–6.43, p < 0.00). In terms of mortality and readmissions, only the group without T2DM and with an NLR greater than three had significantly higher mortality (HR 2.19, 95% CI: 1.51–3.19, p < 0.00). Conclusions: Among atrial fibrillation patients, the combination of T2DM and high inflammation (NLR) was linked to higher comorbidity, worse metabolic and kidney disease, and the poorest prognosis. Surprisingly, the highest risk of readmission or death was in non-T2DM patients with higher NLR levels, suggesting that T2DM treatments may mitigate risk.

Baseline Hemoglobin Values and Clinical Outcomes in Acute Venous Thromboembolism: Insights From the RIETE Registry

2026-03-05T01:05:19Z

Baseline Hemoglobin Values and Clinical Outcomes in Acute Venous Thromboembolism: Insights From the RIETE Registry Siniscalchi, Carmine; Di Micco, Pierpaolo; Tufano, Antonella; Peris, María Luisa; López Miguel, Patricia; Alda Lozano, Alicia; Llamas, Pilar; Durán Barata, Diego; Jenab, Yaser; Monreal, Manuel; López Sáez, José Juan Bosco Venous thromboembolism (VTE) is a major global health concern and a leading cause of morbidity and mortality. While anticoagulation effectively reduces the risk of recurrent VTE, it is associated with an inherent risk of bleeding. Identifying patient characteristics that influence these risks is critical for personalized management. Baseline hemoglobin (Hb) values have emerged as a potential prognostic marker [1-5], reflecting both underlying comorbidities and hemostatic alterations. However, the impact of Hb values on both thrombotic and bleeding complications in anticoagulated VTE patients remains insufficiently characterized. We analyzed data from 111,646 patients with acute VTE included in the RIETE registry, a large multinational prospective cohort (ClinicalTrials.gov identifier: NCT02832245) [6]. Patients were stratified into Hb quintiles: < 11.4, 11.4–12.6, 12.7–13.6 (reference), 13.7–14.7, and > 14.7 g/dL. We assessed 90-day rates of recurrent VTE, major bleeding, arterial ischemic events (myocardial infarction, ischemic stroke, or limb amputation), and all-cause mortality. Multivariable logistic regression models were adjusted for demographic and clinical characteristics, including VTE risk factors, initial VTE presentation, comorbidities, renal function, leukocyte and platelet counts, anticoagulant strategy, and concomitant medications.

Extracción de hemocultivos a pacientes adultos atendidos en el servicio de urgencias con sospecha de infección grave o sepsis

2026-02-20T01:02:10Z

Extracción de hemocultivos a pacientes adultos atendidos en el servicio de urgencias con sospecha de infección grave o sepsis Gamazo Del Río, Julio Javier; López Izquierdo, Raúl; Delgado Cárdenas, Gema; Estella García, Ángel; García, Darío Eduardo; Julián-Jiménez, A. En la actualidad, continúan existiendo demasiadas controversias en relación a la obtención adecuada de hemocultivos (HC) en los servicios de urgencias hospitalarios (SUH). Y la pregunta ¿a qué pacientes adultos debemos extraer HC en el SUH? no está resuelta ni consensuada. En este escenario, la identificación desde los SUH de los pacientes con riesgo de bacteriemia verdadera (BV) es crucial: una bacteriemia no tratada puede evolucionar a estadíos más graves como el shock séptico y aumentar la mortalidad del enfermo. El objetivo principal de este artículo especial es revisar la evidencia científica disponible entre la población adulta atendida en los SUH con sospecha de sepsis o infección grave para intentar definir a qué pacientes se les debería extraer HC en el SUH, por el impacto que un aislamiento microbiológico representaría para su pronóstico, evolución y mortalidad. Y, tras ello, elaborar distintas recomendaciones consensuadas por parte de los autores sobre la indicación de obtener HC en los pacientes con infección grave y sepsis en los SUH.; Too much controversy continues to surround the issue of ordering blood cultures in the emergency department (ED). The key question of which of our ED patients should have blood extracted remains unresolved. Nor is there clear consensus. Against this background it is still crucial to identify patients at risk of true bacteremia, as untreated bacteremia can lead to more serious life-threatening events such as septic shock. The main purpose of this narrative review was to look at the evidence on ED treatment of adults with suspected sepsis or serious infection in an attempt to define when cultures should be ordered, given that the results of microbiology can have an impact on prognosis, progression, and mortality. The authors report their consensus on recommendations for ordering cultures in cases of serious infection or sepsis attended in EDs.

Prevalence of Stroke in Spain and Its Impact on Quality of Life: Socioeconomic Inequalities and Access to Rehabilitation

2026-02-18T01:07:17Z

Prevalence of Stroke in Spain and Its Impact on Quality of Life: Socioeconomic Inequalities and Access to Rehabilitation García Campanario, Ismael; Viñolo Gil, María Jesús Stroke is a cerebrovascular syndrome due to a sudden interruption of blood flow to the brain that causes transient or permanent damage. Despite advances in the field of medical science, stroke is still common and continues to have a significant effect on quality of life. Objective: The objective of the study was to analyze the prevalence of strokes in Spain, considering differences in sociodemographic factors, functional limitations, and access to rehabilitation, with special attention to sex-related disparities. Methodology: A cross-sectional study was conducted using data from the latest European Health Survey in Spain carried out between 2019 and 2020 on a total of 22,072 people. Individuals over 16 years of age with a medical diagnosis of stroke were selected for this study. Sociodemographic variables, self-perception of health, limitations in daily activities, level of physical activity, and access to rehabilitation treatment were analyzed. Descriptive measures and inferential tests were applied for statistical analysis. Results: The prevalence of strokes occurring in Spain was estimated at 2.02%, which is lower than European figures. Men tend to have strokes at younger ages (50% between 36 and 73 years), while women report a poorer quality of life after the incident. Most patients had not received rehabilitation services in the last year. Conclusions: Given the aging population, it is essential to reinforce prevention, early detection and rehabilitation therapies to improve quality of life and reduce the burden of care.