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a su vez&#44; se asocia a un peor pron&#243;stico en los pacientes con IC establecida<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La diabetes se asocia a una estancia hospitalaria m&#225;s prolongada y a mayores tasas de reingresos<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Adem&#225;s&#44; la diabetes confiere a los pacientes con IC mayor morbimortalidad cardiovascular<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a>&#46; Sin embargo&#44; el valor pron&#243;stico de la diabetes sobre la mortalidad hospitalaria y a largo plazo entre pacientes con IC sigue siendo controvertido<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os&#44; disponemos de nuevos f&#225;rmacos que han mejorado el pron&#243;stico de los pacientes con IC con fracci&#243;n de eyecci&#243;n &#40;FE&#41; reducida&#44; as&#237; como nuevos f&#225;rmacos hipoglucemiantes con beneficios cardiovasculares y en IC&#46; A pesar de estos avances&#44; el pron&#243;stico a largo plazo de los pacientes con IC y diabetes sigue siendo peor cuando lo comparamos con sus hom&#243;logos sin diabetes&#46; Sin embargo&#44; parece que este pron&#243;stico va mejorando en ambos grupos de forma progresiva<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Datos de centros espa&#241;oles tambi&#233;n revelan la estrecha relaci&#243;n entre la diabetes y las hospitalizaciones por IC en los &#250;ltimos a&#241;os&#46; Aunque la mortalidad total o los reingresos por IC aumentan en los pacientes con DM2<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#44; la mortalidad intrahospitalaria parece descender<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los objetivos de este estudio fueron evaluar cu&#225;nto sigue influyendo la DM2 en el pron&#243;stico de los pacientes hospitalizados por IC en el a&#241;o 2018 y compararlo con los resultados obtenidos en el estudio anterior &#40;2008-2011&#41;&#44; analizando c&#243;mo se ha modificado esta asociaci&#243;n a lo largo de la &#250;ltima d&#233;cada&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o y fuente de los datos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio de cohortes prospectivo a partir de los pacientes del Registro Nacional de Insuficiencia Card&#237;aca &#40;RICA&#41; perteneciente al Grupo de Trabajo de Insuficiencia Card&#237;aca y Fibrilaci&#243;n Auricular de la Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;&#46; Se trata de un registro multic&#233;ntrico&#44; prospectivo&#44; activo desde el a&#241;o 2008&#46; Incluye&#44; de forma &#250;nica y consecutiva&#44; a pacientes &#62;<span class="elsevierStyleHsp" style=""></span>50 a&#241;os con diagn&#243;stico de IC al alta hospitalaria tras episodio de descompensaci&#243;n o de nueva aparici&#243;n&#44; seg&#250;n las gu&#237;as europeas de cardiolog&#237;a actualmente vigentes<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El protocolo del registro se aprob&#243; inicialmente por el Comit&#233; &#201;tico del Hospital Universitario Reina Sof&#237;a de C&#243;rdoba&#46; Los datos se recogen a partir de una p&#225;gina web &#40;<a href="http://www.registrorica.org/">www&#46;registrorica&#46;org</a>&#41; que contiene la base de datos an&#243;nima y al que accede cada investigador a trav&#233;s de una clave personalizada&#46; Trat&#225;ndose de un estudio observacional de cohortes&#44; se siguieron las normas STROBE para esta metodolog&#237;a&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Poblaci&#243;n de estudio</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se estudi&#243; a todos los pacientes incluidos en el registro durante 2018&#46; Los pacientes se incluyeron en el grupo con diabetes cuando hab&#237;a un diagn&#243;stico previo&#44; tomaban hipoglucemiantes y todos los que&#44; no siendo registrados en el grupo de diabetes&#44; tuvieron una hemoglobina glucosilada &#40;HbA1c&#41; de &#8805; 6&#44;5&#37;&#46; Se excluy&#243; del an&#225;lisis de este estudio a los pacientes con hipertensi&#243;n pulmonar primaria&#44; diabetes mellitus tipo 1&#44; los que ten&#237;an una indicaci&#243;n de cirug&#237;a card&#237;aca&#44; imposibilidad de seguimiento ambulatorio y a aquellos que no dieron su consentimiento para participar&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se revis&#243; a todos los pacientes a los 12 meses y tambi&#233;n cada vez que fue necesario seg&#250;n el criterio cl&#237;nico&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables del estudio</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se evaluaron variables demogr&#225;ficas&#44; comorbilidades &#40;hipertensi&#243;n&#44; dislipidemia&#44; enfermedad renal cr&#243;nica&#44; enfermedad arterial perif&#233;rica&#44; ictus&#44; demencia&#44; enfermedad pulmonar obstructiva cr&#243;nica&#44; enfermedad coronaria&#44; anemia y fibrilaci&#243;n auricular&#41;&#44; datos cl&#237;nicos y prescripciones al alta hospitalaria&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se defini&#243; la hipertensi&#243;n arterial como la presencia de un diagn&#243;stico previo&#44; el tratamiento activo de f&#225;rmacos hipotensores o aquellos pacientes que presentaban de forma repetida determinaci&#243;n de una presi&#243;n arterial sist&#243;lica<span class="elsevierStyleHsp" style=""></span>&#62; 140<span class="elsevierStyleHsp" style=""></span>mmHg o una presi&#243;n arterial diast&#243;lica<span class="elsevierStyleHsp" style=""></span>&#62; 90<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Se consider&#243; anemia a una hemoglobina &#60;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>g&#47;dL en mujeres o &#60;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>g&#47;dL en hombres&#46; Se incluy&#243; a pacientes con FE preservada y reducida&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Las variables de laboratorio se tomaron de una muestra en ayunas en las primeras 24 h del ingreso&#46; Las determinaciones realizadas fueron las habituales&#58; creatinina&#44; urea&#44; filtrado glomerular &#40;FG&#41; por la ecuaci&#243;n de MDRD &#40;the Modification of Diet in Renal Disease&#41;&#44; hemoglobina&#44; l&#237;pidos&#44; glucosa&#44; sodio y la porci&#243;n N-terminal del prop&#233;ptido natriur&#233;tico tipo B &#40;NT-proBNP&#41;&#46; Se defini&#243; hiponatremia por un sodio &#60;<span class="elsevierStyleHsp" style=""></span>135 mEq&#47;L&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La variable dependiente &#40;resultado&#41; primaria fue la combinaci&#243;n de mortalidad total o reingreso por IC durante un seguimiento de 12 meses&#46; Las decisiones terap&#233;uticas fueron a criterio del investigador&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis de los datos</span><p id="par0070" class="elsevierStylePara elsevierViewall">Las variables cuantitativas continuas se resumen por media &#40;desviaci&#243;n est&#225;ndar&#41; y las variables continuas discretas y las nominales categ&#243;ricas se resumen con n&#250;meros &#40;&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Las variables categ&#243;ricas se compararon mediante el test de la chi al cuadrado&#46; Para valorar si una variable continua segu&#237;a una distribuci&#243;n normal se aplic&#243; el test de Kolmogorov-Smirnov y para comparar medias se utiliz&#243; la t de Student&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Para evaluar la fuerza de asociaci&#243;n&#44; hazard ratio &#40;HR&#41;&#44; de la diabetes sobre la mortalidad total o los reingresos&#44; se realiz&#243; a una regresi&#243;n de Cox por pasos multivariante&#46; Todas las variables con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1 fueron incluidas en el modelo&#46; Se evalu&#243; la relaci&#243;n del tratamiento antidiab&#233;tico al alta sobre la variable dependiente mediante la prueba de la chi al cuadrado&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis de los pacientes con diabetes en los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos se presentan las caracter&#237;sticas basales y los eventos&#44; utiliz&#225;ndose en su comparaci&#243;n los test correspondientes dependiendo del tipo de variables&#46; As&#237; mismo&#44; se evalu&#243; la relaci&#243;n independiente sobre la mortalidad total o los reingresos en la cohorte actual respecto a la inicial mediante una curva de supervivencia de Kaplan-Meier &#40;log-rank&#41;&#46; Por &#250;ltimo&#44; una regresi&#243;n de Cox por pasos multivariante evalu&#243; las variables que influyeron de forma independiente en la mortalidad&#47;reingresos entre los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Se analizaron todos los an&#225;lisis estad&#237;sticos mediante SPSS 26&#46;0 &#40;SPSS&#44; version 26&#46;0&#44; IBM&#44; Chicago&#44; IL&#41;&#46; La significaci&#243;n estad&#237;stica se estableci&#243; en p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados de la cohorte del 2018</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se incluy&#243; a un total de 936 pacientes en la cohorte del 2018&#44; de los cuales 446 &#40;48&#37;&#41; ten&#237;an diabetes&#46; Las caracter&#237;sticas basales de los pacientes con diabetes comparados con los pacientes sin diabetes est&#225;n resumidas en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Los pacientes con diabetes eran m&#225;s j&#243;venes&#44; pero con mayor n&#250;mero de comorbilidades&#46; Respecto al tratamiento modulador de la IC&#44; la proporci&#243;n de pacientes tratados con betabloqueantes y antialdoster&#243;nicos fue mayor entre los pacientes con diabetes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Un total de 309 &#40;33&#37;&#41; pacientes desarrollaron el evento combinado de muerte por cualquier causa o reingreso hospitalario por IC&#46; Las diferencias entre pacientes con&#47;sin diabetes no alcanzaron significaci&#243;n estad&#237;stica&#58; 162 &#40;36&#37;&#41; pacientes con diabetes frente a 147 &#40;30&#37;&#41; pacientes sin diabetes&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;051&#44; fallecieron o reingresaron por IC en el a&#241;o de seguimiento &#40;<span class="elsevierStyleItalic">hazard ratio</span> &#91;HR&#93; 1&#44;25&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93; 1&#44;0-1&#44;57&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de los eventos de forma independiente&#44; 202 &#40;22&#37;&#41; pacientes fallecieron&#44; 101 &#40;23&#37;&#41; con diabetes y 101 &#40;21&#37;&#41; sin diabetes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;475&#41;&#44; HR 1&#44;11 &#40;IC95&#37; 0&#44;84-1&#44;46&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;478&#41;&#46; Por otro lado&#44; 178 &#40;19&#37;&#41; pacientes requirieron una nueva hospitalizaci&#243;n&#44; 98 &#40;22&#37;&#41; con diabetes y 80 &#40;16&#37;&#41; sin diabetes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41;&#44; HR 1&#44;40 &#40;IC95&#37; 1&#44;04-1&#44;88&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>A&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Aunque en el an&#225;lisis basal la diabetes se relacion&#243; con la mortalidad total o los reingresos hospitalarios como se ha comentado anteriormente&#44; tras el an&#225;lisis multivariante no alcanz&#243; la significaci&#243;n estad&#237;stica&#46; Las variables asociadas de forma independiente a un evento combinado fueron&#58; la edad &#40;HR 1&#44;02&#59; IC95&#37; 1&#44;00-1&#44;03&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;033&#41;&#44; la fibrilaci&#243;n auricular &#40;HR 1&#44;53&#59; IC95&#37; 1&#44;18-1&#44;97&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y la enfermedad arterial perif&#233;rica &#40;HR 1&#44;58&#59; IC95&#37; 1&#44;08-2&#44;31&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; Respecto a las variables de laboratorio&#44; fueron la hemoglobina &#40;HR 0&#44;92&#59; IC95&#37; 0&#44;87-0&#44;98&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; y el FG &#40;HR 0&#44;992&#59; IC95&#37; 0&#44;991-0&#44;993&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El tratamiento con betabloqueantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41; y antialdoster&#243;nicos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; consigui&#243; una reducci&#243;n de eventos a lo largo del seguimiento &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">La metformina fue el f&#225;rmaco m&#225;s utilizado &#40;35&#37;&#41;&#46; El uso de iSGLT2 &#40;2&#44;69&#37;&#41; y arGLP1 &#40;1&#44;12&#37;&#41; fue a&#250;n muy reducido&#46; Se objetiva una tendencia no significativa en la reducci&#243;n de eventos en pacientes tratados con iSGL2 &#40;0&#44;62&#37; vs&#46; 3&#44;9&#37; respectivamente&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;063&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>B&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados de la cohorte de 2008-2011</span><p id="par0120" class="elsevierStylePara elsevierViewall">Los resultados de la variable principal previamente publicados demostraron un exceso de mortalidad y reingresos por IC en los pacientes con diabetes&#46; Un total de 233 &#40;47&#44;5&#37;&#41; pacientes con diabetes fallecieron o reingresaron por IC &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; De estos&#44; 151 &#40;31&#44;3&#37;&#41; pacientes con diabetes fallecieron frente a 136 &#40;23&#37;&#41; sin diabetes&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; HR 1&#44;54 &#40;IC95&#37; 1&#44;20-1&#44;97&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y 197 &#40;40&#44;9&#37;&#41; pacientes con diabetes reingresaron respecto a 186 &#40;31&#44;4&#37;&#41; sin diabetes&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; HR 1&#44;46 &#40;IC95&#37; 1&#44;18-1&#44;80&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Comparaci&#243;n de las 2<span class="elsevierStyleHsp" style=""></span>cohortes</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los pacientes con diabetes de la cohorte de 2018 son mayores&#44; hab&#237;a m&#225;s varones&#44; mayor prevalencia de hiperlipidemia y un FG superior&#46; Como era esperable se objetiva un aumento significativo del uso de betabloqueantes&#44; antialdoster&#243;nicos y ARNI &#40;inhibidor dual receptor angiotensina y neprilisina&#41;&#44; manteni&#233;ndose el uso de IECA&#47;ARA-2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Tras comparar a los pacientes con diabetes de la cohorte 2018 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>446&#41; con la de 2008-2011 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>490&#41; se observa una disminuci&#243;n significativa de eventos combinados &#40;36&#37; vs&#46; 47&#44;5&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En el an&#225;lisis independiente&#44; tanto la mortalidad total &#40;30&#44;8&#37; vs&#46; 23&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; como las hospitalizaciones &#40;22&#37; vs&#46; 40&#44;2&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; disminuyeron de forma significativa &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>A&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante revel&#243; un exceso significativo de eventos combinados en la cohorte de 2008-2011 &#40;HR 1&#44;48&#59; IC95&#37; 1&#44;18-1&#44;85&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; respecto a la cohorte de 2018&#46; Los eventos de la cohorte inicial se relacionaron de forma proporcional con la edad&#44; las comorbilidades medidas por el &#237;ndice de Charlson y la FE del ventr&#237;culo izquierdo&#46; Los betabloqueantes fueron protectores de eventos &#40;con mayor uso en la cohorte de 2018&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">En las <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>A-C se muestra el an&#225;lisis de supervivencia mediante curvas de Kaplan-Meier que compara mortalidad o ingreso hospitalario&#44; mortalidad total o ingresos hospitalarios a un a&#241;o de seguimiento entre las cohortes 2018 y 2008-2011&#46; Los pacientes con diabetes de la cohorte 2018 mostraron reducciones significativas en los 3<span class="elsevierStyleHsp" style=""></span>desenlaces con respecto a la cohorte 2008-2011&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">El presente estudio concluye que el pron&#243;stico de los pacientes con DM2 hospitalizados por IC ha mejorado en los &#250;ltimos a&#241;os&#44; con una reducci&#243;n significativa de la mortalidad total y de los reingresos por IC&#46; El objetivo principal del presente estudio fue comparar el pron&#243;stico de los pacientes con diabetes en ambos per&#237;odos&#44; observ&#225;ndose que la prevalencia de DM2 experimentaba un ligero aumento no significativo en los &#250;ltimos a&#241;os&#46; Nuestros resultados confirman tambi&#233;n la reducci&#243;n significativa de la mortalidad de los pacientes con DM2 hospitalizados por IC y de los reingresos por IC&#46; Los pacientes con diabetes de la cohorte de 2008-2011 ten&#237;an 1&#44;5 veces m&#225;s riesgo de mortalidad o reingreso comparado con los pacientes con diabetes de 2018&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Los resultados proceden de una cohorte de pacientes con IC cr&#243;nica descompensada en condiciones de vida real&#44; comprob&#225;ndose una prevalencia de diabetes de casi un 50&#37;&#44; siendo similar a otros registros que muestran un incremento progresivo de la relaci&#243;n entre diabetes e IC en los &#250;ltimos a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;9&#44;10&#44;14</span></a>&#46; En Espa&#241;a&#44; la situaci&#243;n es bastante similar con un aumento de la incidencia de hospitalizaciones en pacientes con IC y DM2<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#46; La diabetes suele estar infraestimada cuando se utilizan altas hospitalarias donde ocasionalmente se omite el t&#233;rmino diabetes como diagn&#243;stico secundario<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La diabetes no se relaciona con una mortalidad mayor en la cohorte del 2018<span class="elsevierStyleItalic">&#44;</span> pero s&#237; con los reingresos hospitalarios&#46; En los pacientes de este mismo registro reclutados entre 2008 y 2011 se observ&#243; una asociaci&#243;n significativa de la diabetes con la mortalidad por cualquier causa o las hospitalizaciones por IC<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46; En esta l&#237;nea&#44; los pacientes ingresados en unidades coronarias por IC desde 1985 hasta 2008 presentaron m&#225;s eventos adversos&#44; incluida mortalidad y hospitalizaciones en la poblaci&#243;n diab&#233;tica&#44; tendencia que mejoraba a lo largo del tiempo en ambos grupos<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46; En contraste&#44; Mu&#241;oz-Rivas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a> reportaron que la mortalidad intrahospitalaria en pacientes con DM2 fue menor comparada con los pacientes sin diabetes en el per&#237;odo 2001-2015&#46; Respecto a las hospitalizaciones por IC&#44; los pacientes con diabetes ten&#237;an mayor probabilidad de reingreso respecto a los pacientes sin diabetes&#44; pero esta observaci&#243;n se amortiguaba en el per&#237;odo 2008-2015&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Todo indica que algo est&#225; cambiando en el abordaje de los pacientes con IC y DM2&#44; pero lo que no est&#225; claro es c&#243;mo explicar esta tendencia&#46; La reducci&#243;n de la mortalidad se puede deber a un mejor control gluc&#233;mico de los pacientes con diabetes durante la hospitalizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> o al impacto de los programas de abordaje espec&#237;fico de la IC en unidades multidisciplinarias como el programa Unidades de Manejo Integral para Pacientes con Insuficiencia Card&#237;aca &#40;UMIPIC&#41;&#46; Los programas de UMIPIC han demostrado que reducen las hospitalizaciones y visitas a Urgencias&#44; pero no la mortalidad<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Otras explicaciones pueden ser los avances en el tratamiento de la IC con FE reducida con la incorporaci&#243;n de los ARNI y un mayor uso de f&#225;rmacos moduladores del pron&#243;stico&#44; y la incorporaci&#243;n de nuevos f&#225;rmacos hipoglucemiantes con mejor perfil metab&#243;lico y beneficios adicionales sobre la mortalidad&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Las hospitalizaciones por IC siguen siendo m&#225;s frecuentes en los pacientes con diabetes&#44; aunque la diferencia entre los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos se ha reducido considerablemente&#46; En el per&#237;odo de 2008-2011 un aumento relativo del 10&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y para el 2018 fue solo del 6&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41;&#46; Estos hallazgos podr&#237;an tambi&#233;n explicarse por el impacto progresivo de los programas de UMIPIC o simplemente consultas monogr&#225;ficas de IC y por la introducci&#243;n de los iSGLT2 en el tratamiento de la DM2&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Estos datos concuerdan con lo publicados por Mu&#241;oz-Rivas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#44; estabilizaci&#243;n de hospitalizaciones por IC entre los pacientes con diabetes y una tendencia a la disminuci&#243;n de la mortalidad a lo largo del per&#237;odo estudiado &#40;2001-2015&#41;&#46; Nuestros resultados ampl&#237;an esta observaci&#243;n con datos del 2018&#46; La mortalidad intrahospitalaria de los pacientes con diabetes e IC parece estar reduci&#233;ndose desde la pasada d&#233;cada a pesar del incremento de la prevalencia de la diabetes<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Los pacientes con diabetes contin&#250;an teniendo mayor n&#250;mero de comorbilidades que los pacientes sin diabetes&#44; siendo esto un hallazgo com&#250;n en todos los estudios publicados<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#46; Las variables independientes asociadas a las variables finales de mortalidad por cualquier causa o reingreso por IC son las esperables en una cohorte de pacientes con elevada validez externa por representar la situaci&#243;n real de nuestras plantas de hospitalizaci&#243;n&#46; La edad avanzada&#44; la presencia de comorbilidades como la fibrilaci&#243;n auricular&#44; la enfermedad renal cr&#243;nica&#44; la enfermedad arterial perif&#233;rica y la anemia son variables asociadas cl&#225;sicamente al mal pron&#243;stico de estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;6</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Como se ha mencionado&#44; la aparici&#243;n de nuevos f&#225;rmacos para el tratamiento de la IC podr&#237;a ayudar a explicar los cambios observados&#46; Sin embargo&#44; la utilizaci&#243;n de los ARNI no estaba suficientemente extendida en 2018&#44; por lo que no ha podido influir de forma sustancial en nuestros resultados<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18&#44;19</span></a>&#46; El aumento del uso de betabloqueantes y los antagonistas de los receptores de aldosterona se asoci&#243; a una reducci&#243;n de eventos a pesar que la mayor&#237;a de los pacientes ten&#237;an FE preservada&#59; este hecho tiene dif&#237;cil explicaci&#243;n&#44; pero podr&#237;a estar en relaci&#243;n con una mejora en la optimizaci&#243;n terap&#233;utica de los pacientes&#46; Respecto al tratamiento de la DM2&#44; el uso de iSGLT2 fue bastante bajo en 2018&#44; solo 12 pacientes &#40;2&#44;7&#37;&#41; del total de la cohorte de pacientes con diabetes&#46; Sin embargo&#44; solo uno de los pacientes reingres&#243; frente a los 11 pacientes que no &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;067&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;063&#46; Aunque este hecho no es suficiente para explicar la reducci&#243;n de hospitalizaciones por IC en nuestra cohorte&#44; s&#237; que est&#225; en la l&#237;nea de las observaciones de estudios similares con iSGLT2<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">As&#237; pues&#44; nuestro estudio observacional demuestra la tendencia en la reducci&#243;n en la mortalidad total y en las hospitalizaciones por IC&#44; pero no puede explicar su causa&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Hay que interpretar estos resultados teniendo en cuenta sus limitaciones&#46; Primero&#44; adem&#225;s de nuevo diagn&#243;stico&#44; la definici&#243;n de DM2 se basa en las historias cl&#237;nicas y en el registro de f&#225;rmacos antidiab&#233;ticos&#46; Segundo&#44; la determinaci&#243;n de HbA1c no se realiz&#243; de forma sistem&#225;ticamente&#46; Tercero&#44; los resultados solo pueden extrapolarse a pacientes con IC cr&#243;nica tras una agudizaci&#243;n&#46; Cuarto&#44; el uso de los f&#225;rmacos con beneficios sobre la evoluci&#243;n de la IC y de la DM2 era a&#250;n muy anecd&#243;tica&#46; Por &#250;ltimo&#44; aunque el an&#225;lisis ha sido ajustado con diferentes covariables cl&#237;nicamente relevantes&#44; no se pueden excluir variables no medidas que podr&#237;an modificar los resultados&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusiones</span><p id="par0200" class="elsevierStylePara elsevierViewall">La diabetes sigue relacion&#225;ndose con una mayor tasa de reingresos por IC&#44; pero la mortalidad tiende a igualarse si se compara con pacientes sin diabetes&#46; La mortalidad total y las hospitalizaciones en pacientes con diabetes e IC cr&#243;nica se han reducido significativamente en la &#250;ltima d&#233;cada&#46; La explicaci&#243;n de este hallazgo probablemente sea multifactorial&#44; precis&#225;ndose estudios espec&#237;ficos que esclarezcan este hecho&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0205" class="elsevierStylePara elsevierViewall">El registro RICA pertenece a la Sociedad Espa&#241;ola de Medicina Interna y est&#225; liderado por el Grupo de Trabajo de Insuficiencia Card&#237;aca y Fibrilaci&#243;n Auricular&#46; Este estudio no ha recibido ninguna subvenci&#243;n de organismos p&#250;blicos ni privados&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0210" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Dise&#241;o y fuente de los datos"
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              "titulo" => "Resultados de la cohorte del 2018"
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              "titulo" => "Resultados de la cohorte de 2008-2011"
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              "titulo" => "Comparaci&#243;n de las 2 cohortes"
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          "titulo" => "Discusi&#243;n"
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    "fechaRecibido" => "2020-12-05"
    "fechaAceptado" => "2021-04-29"
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            0 => "Diabetes mellitus"
            1 => "Insuficiencia card&#237;aca"
            2 => "Mortalidad"
            3 => "Hospitalizaci&#243;n"
            4 => "Reingresos"
            5 => "Pron&#243;stico"
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            0 => "Diabetes mellitus"
            1 => "Heart failure"
            2 => "Mortality"
            3 => "Hospitalization"
            4 => "Readmissions"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La insuficiencia card&#237;aca &#40;IC&#41; y la diabetes son 2<span class="elsevierStyleHsp" style=""></span>procesos fuertemente asociados&#46; El objetivo principal fue analizar la evoluci&#243;n del pron&#243;stico de los pacientes con diabetes que ingresan por IC a lo largo de 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo para comparar el pron&#243;stico a un a&#241;o de seguimiento entre los pacientes con diabetes que ingresan por IC en 2008-2011 y 2018&#46; Los pacientes proceden del Registro Nacional de Insuficiencia Card&#237;aca &#40;RICA&#41; de la Sociedad Espa&#241;ola de Medicina Interna&#46; El objetivo primario fue analizar el desenlace combinado de mortalidad total o ingreso por IC durante 12 meses&#46; Se utiliz&#243; una regresi&#243;n multivariante de Cox para evaluar la fuerza de asociaci&#243;n &#40;hazard ratio &#91;HR&#93;&#41; de la diabetes y los desenlaces entre ambos per&#237;odos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a un total de 936 pacientes en la cohorte de 2018&#44; de los que 446 &#40;48&#37;&#41; ten&#237;an diabetes&#46; Las caracter&#237;sticas basales de la poblaci&#243;n de los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos fueron similares&#46; En los pacientes con diabetes se observ&#243; el desenlace combinado en 233 &#40;47&#44;5&#37;&#41; en la cohorte de 2008-2011 y 162 &#40;36&#37;&#41; en la cohorte de 2018 &#40;HR 1&#44;48&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93; 1&#44;18-1&#44;85&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La proporci&#243;n de ingresos &#40;HR 1&#44;39&#59; IC95&#37; 1&#44;07-1&#44;80&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; y la mortalidad total &#40;HR 1&#44;60&#59; IC95&#37; 1&#44;20-2&#44;14&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; tambi&#233;n fueron significativamente mayores en los pacientes con diabetes de la cohorte de 2008-2011 con respecto a la del 2018&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En 2018 se observa una mejor&#237;a del pron&#243;stico de la mortalidad total y los reingresos durante un a&#241;o de seguimiento en pacientes con diabetes hospitalizados por IC con respecto al per&#237;odo de 2008-2011&#46;</p></span>"
        "secciones" => array:4 [
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          1 => array:2 [
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            "titulo" => "M&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Heart failure &#40;HF&#41; and diabetes are 2<span class="elsevierStyleHsp" style=""></span>strongly associated diseases&#46; The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2<span class="elsevierStyleHsp" style=""></span>time periods&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018&#46; The patients are from the Spanish Society of Internal Medicine&#39;s National Heart Failure Registry &#40;RICA&#44; for its initials in Spanish&#41;&#46; The primary endpoint was to analyze the composite outcome of total mortality and&#47;or readmission due to HF in 12 months&#46; A multivariate Cox regression model was used to evaluate the strength of association &#40;hazard ratio &#91;HR&#93;&#41; between diabetes and the outcomes between both periods&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 936 patients were included in the 2018 cohort&#44; of which 446 &#40;48&#37;&#41; had diabetes&#46; The baseline characteristics of the populations from the 2<span class="elsevierStyleHsp" style=""></span>periods were similar&#46; In patients with diabetes&#44; the composite outcome was observed in 233 &#40;47&#46;5&#37;&#41; in the 2008-2011 cohort and 162 &#40;36&#37;&#41; in the 2018 cohort &#91;HR 1&#46;48&#59; 95&#37; confidence interval &#40;95&#37;CI&#41; 1&#46;18-1&#46;85&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#93;&#46; The proportion of readmissions &#40;HR 1&#46;39&#59; 95&#37;CI 1&#46;07-1&#46;80&#59; <span class="elsevierStyleItalic">p</span>&#61;&#46;015&#41; and total mortality &#40;HR 1&#46;60&#59; 95&#37;CI 1&#46;20-2&#46;14&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41; were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In 2018&#44; an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Los nombres de los componentes del Registro RICA est&#225;n relacionados en el <a class="elsevierStyleCrossRef" href="#sec0075">anexo 1</a>&#46;</p>"
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            "apendice" => "<p id="par0220" class="elsevierStylePara elsevierViewall">&#193;lvarez Rocha&#44; P&#46;&#59; Anarte&#44; L&#46;&#59; Aramburu-Bodas&#44; O&#46;&#59; Ar&#233;valo-Lorido&#44; J&#46;C&#46;&#59; Arias Jim&#233;nez&#44; J&#46;L&#46;&#59; Carrasco S&#225;nchez&#44; F&#46;J&#46;&#59; Carrascosa&#44; S&#46;&#59; Cepeda&#44; J&#46;M&#46;&#59; Cerqueiro&#44; J&#46;M&#46;&#59; Conde-Martel&#44; A&#46;&#59; D&#225;vila Ramos&#44; M&#46;F&#46;&#59; Epelde&#44; F&#46;&#59; Garc&#237;a Campos&#44; A&#46;&#59; Gonz&#225;lez Franco&#44; A&#46;&#59; Le&#243;n Acu&#241;a&#44; A&#46;&#59; L&#243;pez Castellanos&#44; G&#46;&#59; Lorente Furi&#243;&#44; O&#46;&#59; Manzano&#44; L&#46;&#59; Montero-P&#233;rez-Barquero&#44; M&#46;&#59; Moreno Garc&#237;a&#44; M&#46;C&#46;&#59; Ormaechea Gorricho&#44; G&#46;&#59; Quesada Sim&#243;n&#44; M&#46;A&#46;&#59; R&#225;bago Lorite&#44; I&#46;<span class="elsevierStyleSmallCaps">&#59;</span> Ruiz Ortega&#44; R&#46;&#59; Salamanca Bautista&#44; M&#46;P&#46;&#59; Silvera&#44; G&#46;&#59; Soler Rangel&#44; L&#46;&#44; y Trull&#224;s&#44; J&#46;C&#46;</p>"
            "etiqueta" => "Anexo 1"
            "titulo" => "Miembros del Registro RICA&#58;"
            "identificador" => "sec0075"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DM &#40;2018&#41;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>446&#40;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No DM &#40;2018&#41;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>488&#40;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DM&#40;2008-2011&#41;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>490&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">pDM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muerte o reingreso por IC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">309 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">162 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">233 &#40;47&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;25 &#40;1&#44;00-1&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mortalidad total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">202 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;475&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;30&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;11 &#40;0&#44;84-1&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reingreso por IC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">197 &#40;40&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;40 &#40;1&#44;04-1&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2822002.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">B&#46; Mortalidad total y&#47;o reingresos atendiendo al tratamiento antidiab&#233;tico al alta de la cohorte del 2018</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TotalN<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>446&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NoN<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>284&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metformina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sulfonilureas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;5&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Charlson&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Variables de laboratorio</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sodio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ARNI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Univariante</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multivariante</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;03 &#40;1&#44;01-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;03 &#40;1&#44;02-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo &#40;hombre&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;02 &#40;0&#44;84-1&#44;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;860&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97 &#40;0&#44;95-0&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Historia m&#233;dica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;13 &#40;0&#44;75-1&#44;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;560&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;90 &#40;0&#44;74-1&#44;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad renal cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;55 &#40;1&#44;27-1&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad arterial perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;34 &#40;1&#44;04-1&#44;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrilaci&#243;n auricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;18 &#40;0&#44;96-1&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ictus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;31 &#40;1&#44;01-1&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Demencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;48 &#40;1&#44;00-2&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;17 &#40;0&#44;94-1&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;167&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anemia<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;09 &#40;0&#44;75-1&#44;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;a hipertensiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;a isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Charlson&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Variables de laboratorio</span></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>creatinina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sodio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Filtrado glomerular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HbA1c&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento de la insuficiencia card&#237;aca al alta</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diur&#233;ticos tiaz&#237;dicos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antialdoster&#243;nicos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;96 &#40;0&#44;77-1&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;683&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IECA&#47;ARA-2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;841&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Predictores independientes de mortalidad o reingresos hospitalarios a los 12 meses de seguimiento en pacientes con diabetes atendiendo a la inclusi&#243;n en 2008-2011 frente a 2018&#46; An&#225;lisis multivariante mediante regresi&#243;n de Cox</p>"
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                          "etal" => false
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                      "titulo" => "Association between type-2 diabetes mellitus and post-discharge outcomes in heart failure patients&#58; Findings from the RICA registry"
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                      "titulo" => "In-hospital and 1-year mortality associated with diabetes in patients with acute heart failure&#58; Results from the ESC-HFA Heart Failure Long-Term Registry"
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ORIGINAL
Evolución de la asociación de diabetes y eventos posalta en pacientes con insuficiencia cardíaca crónica descompensada: hallazgos del registro RICA
Changes over time in the association between type 2 diabetes and post-discharge outcomes in decompensated chronic heart failure patients: Findings from the RICA Registry
F.J. Carrasco-Sáncheza,
Autor para correspondencia
franciscoj.carrasco.sspa@juntadeandalucia.es

Autor para correspondencia.
, M.I. Páez-Rubioa, J.C. Arévalo-Loridob, J. Carretero-Gómezb, A. Conde-Martelc, F. Epelded, P. Álvarez-Rochae, M.P. Salamanca-Bautistaf, J.M. Cepeda-Rodrigog, M. Montero-Pérez-Barqueroh, en representación del Registro RICA ◊
a Área de Insuficiencia Cardíaca, Diabetes y Riesgo Vascular, UGC Medicina Interna y Cuidados Paliativos, Hospital Universitario Juan Ramón Jiménez, Huelva, España
b Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, España
c Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
d Unidad de Estancia Corta, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
e Unidad Multidisciplinaria de Insuficiencia Cardíaca, Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
f Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España
g Servicio de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, España
h Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, España
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disponemos de nuevos f&#225;rmacos que han mejorado el pron&#243;stico de los pacientes con IC con fracci&#243;n de eyecci&#243;n &#40;FE&#41; reducida&#44; as&#237; como nuevos f&#225;rmacos hipoglucemiantes con beneficios cardiovasculares y en IC&#46; A pesar de estos avances&#44; el pron&#243;stico a largo plazo de los pacientes con IC y diabetes sigue siendo peor cuando lo comparamos con sus hom&#243;logos sin diabetes&#46; Sin embargo&#44; parece que este pron&#243;stico va mejorando en ambos grupos de forma progresiva<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Datos de centros espa&#241;oles tambi&#233;n revelan la estrecha relaci&#243;n entre la diabetes y las hospitalizaciones por IC en los &#250;ltimos a&#241;os&#46; Aunque la mortalidad total o los reingresos por IC aumentan en los pacientes con DM2<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#44; 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perteneciente al Grupo de Trabajo de Insuficiencia Card&#237;aca y Fibrilaci&#243;n Auricular de la Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;&#46; Se trata de un registro multic&#233;ntrico&#44; prospectivo&#44; activo desde el a&#241;o 2008&#46; Incluye&#44; de forma &#250;nica y consecutiva&#44; a pacientes &#62;<span class="elsevierStyleHsp" style=""></span>50 a&#241;os con diagn&#243;stico de IC al alta hospitalaria tras episodio de descompensaci&#243;n o de nueva aparici&#243;n&#44; seg&#250;n las gu&#237;as europeas de cardiolog&#237;a actualmente vigentes<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El protocolo del registro se aprob&#243; inicialmente por el Comit&#233; &#201;tico del Hospital Universitario Reina Sof&#237;a de C&#243;rdoba&#46; Los datos se recogen a partir de una p&#225;gina web &#40;<a href="http://www.registrorica.org/">www&#46;registrorica&#46;org</a>&#41; que contiene la base de datos an&#243;nima y al que accede cada investigador a trav&#233;s de una clave personalizada&#46; Trat&#225;ndose de un estudio observacional de cohortes&#44; se siguieron las normas STROBE para esta metodolog&#237;a&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Poblaci&#243;n de estudio</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se estudi&#243; a todos los pacientes incluidos en el registro durante 2018&#46; Los pacientes se incluyeron en el grupo con diabetes cuando hab&#237;a un diagn&#243;stico previo&#44; tomaban hipoglucemiantes y todos los que&#44; no siendo registrados en el grupo de diabetes&#44; tuvieron una hemoglobina glucosilada &#40;HbA1c&#41; de &#8805; 6&#44;5&#37;&#46; Se excluy&#243; del an&#225;lisis de este estudio a los pacientes con hipertensi&#243;n pulmonar primaria&#44; diabetes mellitus tipo 1&#44; los que ten&#237;an una indicaci&#243;n de cirug&#237;a card&#237;aca&#44; imposibilidad de seguimiento ambulatorio y a aquellos que no dieron su consentimiento para participar&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se revis&#243; a todos los pacientes a los 12 meses y tambi&#233;n cada vez que fue necesario seg&#250;n el criterio cl&#237;nico&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables del estudio</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se evaluaron variables demogr&#225;ficas&#44; comorbilidades &#40;hipertensi&#243;n&#44; dislipidemia&#44; enfermedad renal cr&#243;nica&#44; enfermedad arterial perif&#233;rica&#44; ictus&#44; demencia&#44; enfermedad pulmonar obstructiva cr&#243;nica&#44; enfermedad coronaria&#44; anemia y fibrilaci&#243;n auricular&#41;&#44; datos cl&#237;nicos y prescripciones al alta hospitalaria&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se defini&#243; la hipertensi&#243;n arterial como la presencia de un diagn&#243;stico previo&#44; el tratamiento activo de f&#225;rmacos hipotensores o aquellos pacientes que presentaban de forma repetida determinaci&#243;n de una presi&#243;n arterial sist&#243;lica<span class="elsevierStyleHsp" style=""></span>&#62; 140<span class="elsevierStyleHsp" style=""></span>mmHg o una presi&#243;n arterial diast&#243;lica<span class="elsevierStyleHsp" style=""></span>&#62; 90<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Se consider&#243; anemia a una hemoglobina &#60;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>g&#47;dL en mujeres o &#60;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>g&#47;dL en hombres&#46; Se incluy&#243; a pacientes con FE preservada y reducida&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Las variables de laboratorio se tomaron de una muestra en ayunas en las primeras 24 h del ingreso&#46; Las determinaciones realizadas fueron las habituales&#58; creatinina&#44; urea&#44; filtrado glomerular &#40;FG&#41; por la ecuaci&#243;n de MDRD &#40;the Modification of Diet in Renal Disease&#41;&#44; hemoglobina&#44; l&#237;pidos&#44; glucosa&#44; sodio y la porci&#243;n N-terminal del prop&#233;ptido natriur&#233;tico tipo B &#40;NT-proBNP&#41;&#46; Se defini&#243; hiponatremia por un sodio &#60;<span class="elsevierStyleHsp" style=""></span>135 mEq&#47;L&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La variable dependiente &#40;resultado&#41; primaria fue la combinaci&#243;n de mortalidad total o reingreso por IC durante un seguimiento de 12 meses&#46; Las decisiones terap&#233;uticas fueron a criterio del investigador&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis de los datos</span><p id="par0070" class="elsevierStylePara elsevierViewall">Las variables cuantitativas continuas se resumen por media &#40;desviaci&#243;n est&#225;ndar&#41; y las variables continuas discretas y las nominales categ&#243;ricas se resumen con n&#250;meros &#40;&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Las variables categ&#243;ricas se compararon mediante el test de la chi al cuadrado&#46; Para valorar si una variable continua segu&#237;a una distribuci&#243;n normal se aplic&#243; el test de Kolmogorov-Smirnov y para comparar medias se utiliz&#243; la t de Student&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Para evaluar la fuerza de asociaci&#243;n&#44; hazard ratio &#40;HR&#41;&#44; de la diabetes sobre la mortalidad total o los reingresos&#44; se realiz&#243; a una regresi&#243;n de Cox por pasos multivariante&#46; Todas las variables con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1 fueron incluidas en el modelo&#46; Se evalu&#243; la relaci&#243;n del tratamiento antidiab&#233;tico al alta sobre la variable dependiente mediante la prueba de la chi al cuadrado&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis de los pacientes con diabetes en los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos se presentan las caracter&#237;sticas basales y los eventos&#44; utiliz&#225;ndose en su comparaci&#243;n los test correspondientes dependiendo del tipo de variables&#46; As&#237; mismo&#44; se evalu&#243; la relaci&#243;n independiente sobre la mortalidad total o los reingresos en la cohorte actual respecto a la inicial mediante una curva de supervivencia de Kaplan-Meier &#40;log-rank&#41;&#46; Por &#250;ltimo&#44; una regresi&#243;n de Cox por pasos multivariante evalu&#243; las variables que influyeron de forma independiente en la mortalidad&#47;reingresos entre los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Se analizaron todos los an&#225;lisis estad&#237;sticos mediante SPSS 26&#46;0 &#40;SPSS&#44; version 26&#46;0&#44; IBM&#44; Chicago&#44; IL&#41;&#46; La significaci&#243;n estad&#237;stica se estableci&#243; en p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados de la cohorte del 2018</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se incluy&#243; a un total de 936 pacientes en la cohorte del 2018&#44; de los cuales 446 &#40;48&#37;&#41; ten&#237;an diabetes&#46; Las caracter&#237;sticas basales de los pacientes con diabetes comparados con los pacientes sin diabetes est&#225;n resumidas en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Los pacientes con diabetes eran m&#225;s j&#243;venes&#44; pero con mayor n&#250;mero de comorbilidades&#46; Respecto al tratamiento modulador de la IC&#44; la proporci&#243;n de pacientes tratados con betabloqueantes y antialdoster&#243;nicos fue mayor entre los pacientes con diabetes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Un total de 309 &#40;33&#37;&#41; pacientes desarrollaron el evento combinado de muerte por cualquier causa o reingreso hospitalario por IC&#46; Las diferencias entre pacientes con&#47;sin diabetes no alcanzaron significaci&#243;n estad&#237;stica&#58; 162 &#40;36&#37;&#41; pacientes con diabetes frente a 147 &#40;30&#37;&#41; pacientes sin diabetes&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;051&#44; fallecieron o reingresaron por IC en el a&#241;o de seguimiento &#40;<span class="elsevierStyleItalic">hazard ratio</span> &#91;HR&#93; 1&#44;25&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93; 1&#44;0-1&#44;57&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de los eventos de forma independiente&#44; 202 &#40;22&#37;&#41; pacientes fallecieron&#44; 101 &#40;23&#37;&#41; con diabetes y 101 &#40;21&#37;&#41; sin diabetes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;475&#41;&#44; HR 1&#44;11 &#40;IC95&#37; 0&#44;84-1&#44;46&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;478&#41;&#46; Por otro lado&#44; 178 &#40;19&#37;&#41; pacientes requirieron una nueva hospitalizaci&#243;n&#44; 98 &#40;22&#37;&#41; con diabetes y 80 &#40;16&#37;&#41; sin diabetes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41;&#44; HR 1&#44;40 &#40;IC95&#37; 1&#44;04-1&#44;88&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>A&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Aunque en el an&#225;lisis basal la diabetes se relacion&#243; con la mortalidad total o los reingresos hospitalarios como se ha comentado anteriormente&#44; tras el an&#225;lisis multivariante no alcanz&#243; la significaci&#243;n estad&#237;stica&#46; Las variables asociadas de forma independiente a un evento combinado fueron&#58; la edad &#40;HR 1&#44;02&#59; IC95&#37; 1&#44;00-1&#44;03&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;033&#41;&#44; la fibrilaci&#243;n auricular &#40;HR 1&#44;53&#59; IC95&#37; 1&#44;18-1&#44;97&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y la enfermedad arterial perif&#233;rica &#40;HR 1&#44;58&#59; IC95&#37; 1&#44;08-2&#44;31&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; Respecto a las variables de laboratorio&#44; fueron la hemoglobina &#40;HR 0&#44;92&#59; IC95&#37; 0&#44;87-0&#44;98&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; y el FG &#40;HR 0&#44;992&#59; IC95&#37; 0&#44;991-0&#44;993&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El tratamiento con betabloqueantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41; y antialdoster&#243;nicos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; consigui&#243; una reducci&#243;n de eventos a lo largo del seguimiento &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">La metformina fue el f&#225;rmaco m&#225;s utilizado &#40;35&#37;&#41;&#46; El uso de iSGLT2 &#40;2&#44;69&#37;&#41; y arGLP1 &#40;1&#44;12&#37;&#41; fue a&#250;n muy reducido&#46; Se objetiva una tendencia no significativa en la reducci&#243;n de eventos en pacientes tratados con iSGL2 &#40;0&#44;62&#37; vs&#46; 3&#44;9&#37; respectivamente&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;063&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>B&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados de la cohorte de 2008-2011</span><p id="par0120" class="elsevierStylePara elsevierViewall">Los resultados de la variable principal previamente publicados demostraron un exceso de mortalidad y reingresos por IC en los pacientes con diabetes&#46; Un total de 233 &#40;47&#44;5&#37;&#41; pacientes con diabetes fallecieron o reingresaron por IC &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; De estos&#44; 151 &#40;31&#44;3&#37;&#41; pacientes con diabetes fallecieron frente a 136 &#40;23&#37;&#41; sin diabetes&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; HR 1&#44;54 &#40;IC95&#37; 1&#44;20-1&#44;97&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y 197 &#40;40&#44;9&#37;&#41; pacientes con diabetes reingresaron respecto a 186 &#40;31&#44;4&#37;&#41; sin diabetes&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; HR 1&#44;46 &#40;IC95&#37; 1&#44;18-1&#44;80&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Comparaci&#243;n de las 2<span class="elsevierStyleHsp" style=""></span>cohortes</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los pacientes con diabetes de la cohorte de 2018 son mayores&#44; hab&#237;a m&#225;s varones&#44; mayor prevalencia de hiperlipidemia y un FG superior&#46; Como era esperable se objetiva un aumento significativo del uso de betabloqueantes&#44; antialdoster&#243;nicos y ARNI &#40;inhibidor dual receptor angiotensina y neprilisina&#41;&#44; manteni&#233;ndose el uso de IECA&#47;ARA-2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Tras comparar a los pacientes con diabetes de la cohorte 2018 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>446&#41; con la de 2008-2011 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>490&#41; se observa una disminuci&#243;n significativa de eventos combinados &#40;36&#37; vs&#46; 47&#44;5&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En el an&#225;lisis independiente&#44; tanto la mortalidad total &#40;30&#44;8&#37; vs&#46; 23&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; como las hospitalizaciones &#40;22&#37; vs&#46; 40&#44;2&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; disminuyeron de forma significativa &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>A&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante revel&#243; un exceso significativo de eventos combinados en la cohorte de 2008-2011 &#40;HR 1&#44;48&#59; IC95&#37; 1&#44;18-1&#44;85&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; respecto a la cohorte de 2018&#46; Los eventos de la cohorte inicial se relacionaron de forma proporcional con la edad&#44; las comorbilidades medidas por el &#237;ndice de Charlson y la FE del ventr&#237;culo izquierdo&#46; Los betabloqueantes fueron protectores de eventos &#40;con mayor uso en la cohorte de 2018&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">En las <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>A-C se muestra el an&#225;lisis de supervivencia mediante curvas de Kaplan-Meier que compara mortalidad o ingreso hospitalario&#44; mortalidad total o ingresos hospitalarios a un a&#241;o de seguimiento entre las cohortes 2018 y 2008-2011&#46; Los pacientes con diabetes de la cohorte 2018 mostraron reducciones significativas en los 3<span class="elsevierStyleHsp" style=""></span>desenlaces con respecto a la cohorte 2008-2011&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">El presente estudio concluye que el pron&#243;stico de los pacientes con DM2 hospitalizados por IC ha mejorado en los &#250;ltimos a&#241;os&#44; con una reducci&#243;n significativa de la mortalidad total y de los reingresos por IC&#46; El objetivo principal del presente estudio fue comparar el pron&#243;stico de los pacientes con diabetes en ambos per&#237;odos&#44; observ&#225;ndose que la prevalencia de DM2 experimentaba un ligero aumento no significativo en los &#250;ltimos a&#241;os&#46; Nuestros resultados confirman tambi&#233;n la reducci&#243;n significativa de la mortalidad de los pacientes con DM2 hospitalizados por IC y de los reingresos por IC&#46; Los pacientes con diabetes de la cohorte de 2008-2011 ten&#237;an 1&#44;5 veces m&#225;s riesgo de mortalidad o reingreso comparado con los pacientes con diabetes de 2018&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Los resultados proceden de una cohorte de pacientes con IC cr&#243;nica descompensada en condiciones de vida real&#44; comprob&#225;ndose una prevalencia de diabetes de casi un 50&#37;&#44; siendo similar a otros registros que muestran un incremento progresivo de la relaci&#243;n entre diabetes e IC en los &#250;ltimos a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;9&#44;10&#44;14</span></a>&#46; En Espa&#241;a&#44; la situaci&#243;n es bastante similar con un aumento de la incidencia de hospitalizaciones en pacientes con IC y DM2<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#46; La diabetes suele estar infraestimada cuando se utilizan altas hospitalarias donde ocasionalmente se omite el t&#233;rmino diabetes como diagn&#243;stico secundario<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La diabetes no se relaciona con una mortalidad mayor en la cohorte del 2018<span class="elsevierStyleItalic">&#44;</span> pero s&#237; con los reingresos hospitalarios&#46; En los pacientes de este mismo registro reclutados entre 2008 y 2011 se observ&#243; una asociaci&#243;n significativa de la diabetes con la mortalidad por cualquier causa o las hospitalizaciones por IC<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a>&#46; En esta l&#237;nea&#44; los pacientes ingresados en unidades coronarias por IC desde 1985 hasta 2008 presentaron m&#225;s eventos adversos&#44; incluida mortalidad y hospitalizaciones en la poblaci&#243;n diab&#233;tica&#44; tendencia que mejoraba a lo largo del tiempo en ambos grupos<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46; En contraste&#44; Mu&#241;oz-Rivas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a> reportaron que la mortalidad intrahospitalaria en pacientes con DM2 fue menor comparada con los pacientes sin diabetes en el per&#237;odo 2001-2015&#46; Respecto a las hospitalizaciones por IC&#44; los pacientes con diabetes ten&#237;an mayor probabilidad de reingreso respecto a los pacientes sin diabetes&#44; pero esta observaci&#243;n se amortiguaba en el per&#237;odo 2008-2015&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Todo indica que algo est&#225; cambiando en el abordaje de los pacientes con IC y DM2&#44; pero lo que no est&#225; claro es c&#243;mo explicar esta tendencia&#46; La reducci&#243;n de la mortalidad se puede deber a un mejor control gluc&#233;mico de los pacientes con diabetes durante la hospitalizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> o al impacto de los programas de abordaje espec&#237;fico de la IC en unidades multidisciplinarias como el programa Unidades de Manejo Integral para Pacientes con Insuficiencia Card&#237;aca &#40;UMIPIC&#41;&#46; Los programas de UMIPIC han demostrado que reducen las hospitalizaciones y visitas a Urgencias&#44; pero no la mortalidad<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Otras explicaciones pueden ser los avances en el tratamiento de la IC con FE reducida con la incorporaci&#243;n de los ARNI y un mayor uso de f&#225;rmacos moduladores del pron&#243;stico&#44; y la incorporaci&#243;n de nuevos f&#225;rmacos hipoglucemiantes con mejor perfil metab&#243;lico y beneficios adicionales sobre la mortalidad&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Las hospitalizaciones por IC siguen siendo m&#225;s frecuentes en los pacientes con diabetes&#44; aunque la diferencia entre los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos se ha reducido considerablemente&#46; En el per&#237;odo de 2008-2011 un aumento relativo del 10&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y para el 2018 fue solo del 6&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41;&#46; Estos hallazgos podr&#237;an tambi&#233;n explicarse por el impacto progresivo de los programas de UMIPIC o simplemente consultas monogr&#225;ficas de IC y por la introducci&#243;n de los iSGLT2 en el tratamiento de la DM2&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Estos datos concuerdan con lo publicados por Mu&#241;oz-Rivas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#44; estabilizaci&#243;n de hospitalizaciones por IC entre los pacientes con diabetes y una tendencia a la disminuci&#243;n de la mortalidad a lo largo del per&#237;odo estudiado &#40;2001-2015&#41;&#46; Nuestros resultados ampl&#237;an esta observaci&#243;n con datos del 2018&#46; La mortalidad intrahospitalaria de los pacientes con diabetes e IC parece estar reduci&#233;ndose desde la pasada d&#233;cada a pesar del incremento de la prevalencia de la diabetes<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Los pacientes con diabetes contin&#250;an teniendo mayor n&#250;mero de comorbilidades que los pacientes sin diabetes&#44; siendo esto un hallazgo com&#250;n en todos los estudios publicados<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#46; Las variables independientes asociadas a las variables finales de mortalidad por cualquier causa o reingreso por IC son las esperables en una cohorte de pacientes con elevada validez externa por representar la situaci&#243;n real de nuestras plantas de hospitalizaci&#243;n&#46; La edad avanzada&#44; la presencia de comorbilidades como la fibrilaci&#243;n auricular&#44; la enfermedad renal cr&#243;nica&#44; la enfermedad arterial perif&#233;rica y la anemia son variables asociadas cl&#225;sicamente al mal pron&#243;stico de estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;6</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Como se ha mencionado&#44; la aparici&#243;n de nuevos f&#225;rmacos para el tratamiento de la IC podr&#237;a ayudar a explicar los cambios observados&#46; Sin embargo&#44; la utilizaci&#243;n de los ARNI no estaba suficientemente extendida en 2018&#44; por lo que no ha podido influir de forma sustancial en nuestros resultados<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18&#44;19</span></a>&#46; El aumento del uso de betabloqueantes y los antagonistas de los receptores de aldosterona se asoci&#243; a una reducci&#243;n de eventos a pesar que la mayor&#237;a de los pacientes ten&#237;an FE preservada&#59; este hecho tiene dif&#237;cil explicaci&#243;n&#44; pero podr&#237;a estar en relaci&#243;n con una mejora en la optimizaci&#243;n terap&#233;utica de los pacientes&#46; Respecto al tratamiento de la DM2&#44; el uso de iSGLT2 fue bastante bajo en 2018&#44; solo 12 pacientes &#40;2&#44;7&#37;&#41; del total de la cohorte de pacientes con diabetes&#46; Sin embargo&#44; solo uno de los pacientes reingres&#243; frente a los 11 pacientes que no &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;067&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;063&#46; Aunque este hecho no es suficiente para explicar la reducci&#243;n de hospitalizaciones por IC en nuestra cohorte&#44; s&#237; que est&#225; en la l&#237;nea de las observaciones de estudios similares con iSGLT2<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">As&#237; pues&#44; nuestro estudio observacional demuestra la tendencia en la reducci&#243;n en la mortalidad total y en las hospitalizaciones por IC&#44; pero no puede explicar su causa&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Hay que interpretar estos resultados teniendo en cuenta sus limitaciones&#46; Primero&#44; adem&#225;s de nuevo diagn&#243;stico&#44; la definici&#243;n de DM2 se basa en las historias cl&#237;nicas y en el registro de f&#225;rmacos antidiab&#233;ticos&#46; Segundo&#44; la determinaci&#243;n de HbA1c no se realiz&#243; de forma sistem&#225;ticamente&#46; Tercero&#44; los resultados solo pueden extrapolarse a pacientes con IC cr&#243;nica tras una agudizaci&#243;n&#46; Cuarto&#44; el uso de los f&#225;rmacos con beneficios sobre la evoluci&#243;n de la IC y de la DM2 era a&#250;n muy anecd&#243;tica&#46; Por &#250;ltimo&#44; aunque el an&#225;lisis ha sido ajustado con diferentes covariables cl&#237;nicamente relevantes&#44; no se pueden excluir variables no medidas que podr&#237;an modificar los resultados&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusiones</span><p id="par0200" class="elsevierStylePara elsevierViewall">La diabetes sigue relacion&#225;ndose con una mayor tasa de reingresos por IC&#44; pero la mortalidad tiende a igualarse si se compara con pacientes sin diabetes&#46; La mortalidad total y las hospitalizaciones en pacientes con diabetes e IC cr&#243;nica se han reducido significativamente en la &#250;ltima d&#233;cada&#46; La explicaci&#243;n de este hallazgo probablemente sea multifactorial&#44; precis&#225;ndose estudios espec&#237;ficos que esclarezcan este hecho&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0205" class="elsevierStylePara elsevierViewall">El registro RICA pertenece a la Sociedad Espa&#241;ola de Medicina Interna y est&#225; liderado por el Grupo de Trabajo de Insuficiencia Card&#237;aca y Fibrilaci&#243;n Auricular&#46; Este estudio no ha recibido ninguna subvenci&#243;n de organismos p&#250;blicos ni privados&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0210" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
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              "titulo" => "Dise&#241;o y fuente de los datos"
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              "titulo" => "Resultados de la cohorte del 2018"
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              "titulo" => "Resultados de la cohorte de 2008-2011"
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              "titulo" => "Comparaci&#243;n de las 2 cohortes"
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          "titulo" => "Discusi&#243;n"
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          "titulo" => "Financiaci&#243;n"
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          "titulo" => "Conflicto de intereses"
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          "titulo" => "Agradecimientos"
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    "fechaRecibido" => "2020-12-05"
    "fechaAceptado" => "2021-04-29"
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          "palabras" => array:6 [
            0 => "Diabetes mellitus"
            1 => "Insuficiencia card&#237;aca"
            2 => "Mortalidad"
            3 => "Hospitalizaci&#243;n"
            4 => "Reingresos"
            5 => "Pron&#243;stico"
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          "palabras" => array:6 [
            0 => "Diabetes mellitus"
            1 => "Heart failure"
            2 => "Mortality"
            3 => "Hospitalization"
            4 => "Readmissions"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La insuficiencia card&#237;aca &#40;IC&#41; y la diabetes son 2<span class="elsevierStyleHsp" style=""></span>procesos fuertemente asociados&#46; El objetivo principal fue analizar la evoluci&#243;n del pron&#243;stico de los pacientes con diabetes que ingresan por IC a lo largo de 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo para comparar el pron&#243;stico a un a&#241;o de seguimiento entre los pacientes con diabetes que ingresan por IC en 2008-2011 y 2018&#46; Los pacientes proceden del Registro Nacional de Insuficiencia Card&#237;aca &#40;RICA&#41; de la Sociedad Espa&#241;ola de Medicina Interna&#46; El objetivo primario fue analizar el desenlace combinado de mortalidad total o ingreso por IC durante 12 meses&#46; Se utiliz&#243; una regresi&#243;n multivariante de Cox para evaluar la fuerza de asociaci&#243;n &#40;hazard ratio &#91;HR&#93;&#41; de la diabetes y los desenlaces entre ambos per&#237;odos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a un total de 936 pacientes en la cohorte de 2018&#44; de los que 446 &#40;48&#37;&#41; ten&#237;an diabetes&#46; Las caracter&#237;sticas basales de la poblaci&#243;n de los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos fueron similares&#46; En los pacientes con diabetes se observ&#243; el desenlace combinado en 233 &#40;47&#44;5&#37;&#41; en la cohorte de 2008-2011 y 162 &#40;36&#37;&#41; en la cohorte de 2018 &#40;HR 1&#44;48&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93; 1&#44;18-1&#44;85&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La proporci&#243;n de ingresos &#40;HR 1&#44;39&#59; IC95&#37; 1&#44;07-1&#44;80&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; y la mortalidad total &#40;HR 1&#44;60&#59; IC95&#37; 1&#44;20-2&#44;14&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; tambi&#233;n fueron significativamente mayores en los pacientes con diabetes de la cohorte de 2008-2011 con respecto a la del 2018&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En 2018 se observa una mejor&#237;a del pron&#243;stico de la mortalidad total y los reingresos durante un a&#241;o de seguimiento en pacientes con diabetes hospitalizados por IC con respecto al per&#237;odo de 2008-2011&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
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            "titulo" => "Resultados"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Heart failure &#40;HF&#41; and diabetes are 2<span class="elsevierStyleHsp" style=""></span>strongly associated diseases&#46; The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2<span class="elsevierStyleHsp" style=""></span>time periods&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018&#46; The patients are from the Spanish Society of Internal Medicine&#39;s National Heart Failure Registry &#40;RICA&#44; for its initials in Spanish&#41;&#46; The primary endpoint was to analyze the composite outcome of total mortality and&#47;or readmission due to HF in 12 months&#46; A multivariate Cox regression model was used to evaluate the strength of association &#40;hazard ratio &#91;HR&#93;&#41; between diabetes and the outcomes between both periods&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 936 patients were included in the 2018 cohort&#44; of which 446 &#40;48&#37;&#41; had diabetes&#46; The baseline characteristics of the populations from the 2<span class="elsevierStyleHsp" style=""></span>periods were similar&#46; In patients with diabetes&#44; the composite outcome was observed in 233 &#40;47&#46;5&#37;&#41; in the 2008-2011 cohort and 162 &#40;36&#37;&#41; in the 2018 cohort &#91;HR 1&#46;48&#59; 95&#37; confidence interval &#40;95&#37;CI&#41; 1&#46;18-1&#46;85&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#93;&#46; The proportion of readmissions &#40;HR 1&#46;39&#59; 95&#37;CI 1&#46;07-1&#46;80&#59; <span class="elsevierStyleItalic">p</span>&#61;&#46;015&#41; and total mortality &#40;HR 1&#46;60&#59; 95&#37;CI 1&#46;20-2&#46;14&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41; were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In 2018&#44; an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Los nombres de los componentes del Registro RICA est&#225;n relacionados en el <a class="elsevierStyleCrossRef" href="#sec0075">anexo 1</a>&#46;</p>"
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            "apendice" => "<p id="par0220" class="elsevierStylePara elsevierViewall">&#193;lvarez Rocha&#44; P&#46;&#59; Anarte&#44; L&#46;&#59; Aramburu-Bodas&#44; O&#46;&#59; Ar&#233;valo-Lorido&#44; J&#46;C&#46;&#59; Arias Jim&#233;nez&#44; J&#46;L&#46;&#59; Carrasco S&#225;nchez&#44; F&#46;J&#46;&#59; Carrascosa&#44; S&#46;&#59; Cepeda&#44; J&#46;M&#46;&#59; Cerqueiro&#44; J&#46;M&#46;&#59; Conde-Martel&#44; A&#46;&#59; D&#225;vila Ramos&#44; M&#46;F&#46;&#59; Epelde&#44; F&#46;&#59; Garc&#237;a Campos&#44; A&#46;&#59; Gonz&#225;lez Franco&#44; A&#46;&#59; Le&#243;n Acu&#241;a&#44; A&#46;&#59; L&#243;pez Castellanos&#44; G&#46;&#59; Lorente Furi&#243;&#44; O&#46;&#59; Manzano&#44; L&#46;&#59; Montero-P&#233;rez-Barquero&#44; M&#46;&#59; Moreno Garc&#237;a&#44; M&#46;C&#46;&#59; Ormaechea Gorricho&#44; G&#46;&#59; Quesada Sim&#243;n&#44; M&#46;A&#46;&#59; R&#225;bago Lorite&#44; I&#46;<span class="elsevierStyleSmallCaps">&#59;</span> Ruiz Ortega&#44; R&#46;&#59; Salamanca Bautista&#44; M&#46;P&#46;&#59; Silvera&#44; G&#46;&#59; Soler Rangel&#44; L&#46;&#44; y Trull&#224;s&#44; J&#46;C&#46;</p>"
            "etiqueta" => "Anexo 1"
            "titulo" => "Miembros del Registro RICA&#58;"
            "identificador" => "sec0075"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curvas de Kaplan-Meier libre de eventos al a&#241;o de seguimiento comparando las 2<span class="elsevierStyleHsp" style=""></span>cohortes&#46; Pacientes con diabetes de la cohorte del 2018 &#40;curva superior&#44; verde&#41; y pacientes con diabetes de la cohorte de 2008-2011 &#40;curva inferior&#44; azul&#41;&#46; Mortalidad total o hospitalizaciones por insuficiencia card&#237;aca&#44; log-rank &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 &#40;A&#41;&#46; Mortalidad total&#44; log-rank 0&#44;007 &#40;B&#41;&#46; Reingresos por insuficiencia card&#237;aca&#44; log-rank 0&#44;015 &#40;C&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">p para diferencias entre grupos&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">En negrita&#44; p con significaci&#243;n estad&#237;stica&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">ARNI&#58; angiotensin receptor-neprilysin inhibitor &#40;inhibidor dual receptor angiotensina y neprilisina&#41;&#59; CPH&#58; cardiopat&#237;a hipertensiva&#59; CPI&#58; cardiopat&#237;a isqu&#233;mica&#59; DE&#58; desviaci&#243;n est&#225;ndar&#59; DM&#58; diabetes mellitus&#59; EAP&#58; enfermedad arterial perif&#233;rica&#59; EPOC&#58; enfermedad obstructiva pulmonar cr&#243;nica&#59; ERC&#58; enfermedad renal cr&#243;nica&#59; FA&#58; fibrilaci&#243;n auricular&#59; FEVI&#58; fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo&#59; FG&#58; filtrado glomerular&#59; HbA1c&#58; hemoglobina glucosilada&#59; IECA&#47;ARA-2&#58; inhibidores de la enzima conversora de angiotensina&#47;antagonistas de los receptores la angiotensina 2&#59; IMC&#58; &#237;ndice de masa corporal&#59; NT-proBNP&#58; prohormona N-terminal del p&#233;ptido natriur&#233;tico cerebral&#59; NYHA&#58; New York Association&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total2018N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>934&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No DM &#40;2018&#41;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>488&#40;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p2018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DM&#40;2008-2011&#41;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>490&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">pDM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo &#40;hombre&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">487 &#40;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">245 &#40;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">242 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">217 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;3 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;9 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;6 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;1&#40;6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;267&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Historia m&#233;dica&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">817 &#40;87&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">416 &#40;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">401 &#40;82&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">424 &#40;86&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">503 &#40;54&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">311 &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">192 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">285 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">383 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">172 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">235 &#40;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;845&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EAP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">76 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;054&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">607 &#40;65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">276 &#40;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">331 &#40;68&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">286 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ictus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas basales de la poblaci&#243;n de la cohorte del 2018 atendiendo a la condici&#243;n de diabetes y comparaci&#243;n de los pacientes con diabetes con la cohorte de 2008-2011</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A&#46; Eventos durante el seguimiento entre los pacientes con diabetes de la cohorte del 2018 y de 2008-2011</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">147 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">233 &#40;47&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;25 &#40;1&#44;00-1&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Mortalidad total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">101 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">HR 1&#44;11 &#40;0&#44;84-1&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reingreso por IC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;40 &#40;1&#44;04-1&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2822002.png"
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            1 => array:2 [
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                0 => """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">B&#46; Mortalidad total y&#47;o reingresos atendiendo al tratamiento antidiab&#233;tico al alta de la cohorte del 2018</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>162&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NoN<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>284&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Metformina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Sulfonilureas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;5&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">iDPP4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;937&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Insulina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Filtrado glomerular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NT-proBNP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo &#40;hombre&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;02 &#40;0&#44;84-1&#44;24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;97 &#40;0&#44;95-0&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Historia m&#233;dica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;90 &#40;0&#44;74-1&#44;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad renal cr&#243;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;55 &#40;1&#44;27-1&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad arterial perif&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;34 &#40;1&#44;04-1&#44;74&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrilaci&#243;n auricular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ictus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;31 &#40;1&#44;01-1&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Demencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;17 &#40;0&#44;94-1&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anemia<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;09 &#40;0&#44;75-1&#44;59&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;640&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;a hipertensiva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;94 &#40;0&#44;77-1&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;574&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;a isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;13 &#40;0&#44;92-1&#44;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;237&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Charlson&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;08 &#40;1&#44;05-1&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;06 &#40;1&#44;02-1&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Variables de laboratorio</span></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>creatinina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sodio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Filtrado glomerular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NT-proBNP<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEVI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HbA1c&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diur&#233;ticos tiaz&#237;dicos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;678&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antialdoster&#243;nicos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;96 &#40;0&#44;77-1&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;683&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IECA&#47;ARA-2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;98 &#40;0&#44;79-1&#44;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Betabloqueantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;72 &#40;0&#44;59-0&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00142565
Idioma original: Español
DOI:10.1016/j.rce.2021.04.006
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