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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El virus SARS-CoV-2 es un coronavirus que empez&#243; a producir neumon&#237;as en Wuhan &#40;China&#41; en diciembre de 2019<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a>&#46; El diagn&#243;stico se hace fundamentalmente por la evaluaci&#243;n cl&#237;nica y la detecci&#243;n del virus por la reacci&#243;n en cadena de la polimerasa &#40;PCR&#41; en diferentes secreciones<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#46; El 30 de enero de 2020 la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41; consider&#243; la COVID &#40;enfermedad por SARS-CoV-2&#41; una emergencia de salud p&#250;blica de importancia internacional&#44; declar&#225;ndola epidemia<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a>&#46; En pocas semanas se convirti&#243; en una pandemia<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a>&#44; en la cual Italia fue completamente superada por el virus<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a>&#44; siendo el ejemplo m&#225;s cercano de lo que suceder&#237;a en Espa&#241;a&#46; Posteriormente&#44; el virus se extendi&#243; r&#225;pidamente por todo el territorio espa&#241;ol<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">6</span></a>&#46; Ha afectado a todas las comunidades del territorio nacional&#44; si bien se han observado variaciones en la tasa de contagio y en la mortalidad en funci&#243;n de la regi&#243;n&#46; Castilla-La Mancha&#44; en particular&#44; ha sido una de las regiones con mayor tasa de mortalidad y mayor incidencia de casos por cada 100&#46;000 habitantes<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a>&#44; lo que ha supuesto una carga importante de trabajo para los profesionales sanitarios de esta comunidad aut&#243;noma&#44; quienes han tenido que dedicar importantes recursos y esfuerzos en la atenci&#243;n a los enfermos por coronavirus&#46; Adem&#225;s&#44; las escasas medidas de protecci&#243;n<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> y los cambios en protocolos&#44; a pesar de que las sociedades cient&#237;ficas se pronunciaron pronto sobre el tema<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; han contribuido a la elevada tasa de contagios en Espa&#241;a en general y en Castilla-La Mancha en particular<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Durante esta situaci&#243;n se se&#241;alaron diferentes factores de riesgo&#58; la edad&#44; el sexo masculino y la hipertensi&#243;n arterial&#44; entre ellos&#46; La relaci&#243;n entre la enfermedad y el tabaquismo era incierta&#44; y se plantearon diversas hip&#243;tesis acerca de la posible eficacia terap&#233;utica de la nicotina o su potencial papel defensivo frente a la COVID-19<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a>&#46; Diferentes metaan&#225;lisis no han terminado de aclarar si el tabaco act&#250;a como factor agravante o protector ante esta enfermedad<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En este estudio se utiliza SAVANA Manager&#174; v3&#46;0&#44; una plataforma cl&#237;nica desarrollada por la empresa m&#233;dica SAVANA que permite analizar la informaci&#243;n incluida en el texto libre de las historias cl&#237;nicas electr&#243;nicas &#40;HCE&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Utilizando esta tecnolog&#237;a ya aplicada en SESCAM para indagar sobre c&#243;mo afecta la COVID-19 a los pacientes con asma<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#44; se plantea aclarar c&#243;mo afecta el tabaquismo a pacientes con infecci&#243;n por SARS-CoV-2 a nivel de ingreso en la UCI y mortalidad intrahospitalaria&#44; determinando si puede considerarse factor protector o agravante&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiza un estudio retrospectivo&#44; observacional y no intervencionista utilizando SAVANA Manager&#174; v3&#46;0 para capturar la informaci&#243;n del texto libre contenido en las HCE&#46; Se incluyeron en este estudio los datos de las HCE de todos los pacientes mayores de 18<span class="elsevierStyleHsp" style=""></span>a&#241;os diagnosticados de COVID entre el 1 de marzo de 2020 y el 28 de febrero de 2021 de Castilla-La Mancha registrados en SESCAM&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Consideraciones &#233;ticas</span><p id="par0030" class="elsevierStylePara elsevierViewall">El estudio se ha llevado a cabo de acuerdo con los requisitos legales y reglamentarios&#44; as&#237; como con prop&#243;sito&#44; valor y rigor cient&#237;ficos&#44; y ha seguido las pr&#225;cticas de investigaci&#243;n generalmente aceptadas descritas en la Gu&#237;a de Buenas Pr&#225;cticas Cl&#237;nicas&#44; la Declaraci&#243;n de Helsinki en su &#250;ltima edici&#243;n y Buenas Pr&#225;cticas de Farmacoepidemiolog&#237;a&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; &#201;tico de investigaci&#243;n del Complejo Hospitalario Universitario de Albacete&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis de datos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Los datos fueron recogidos de los informes de alta de consultas externas&#44; hospitalizaci&#243;n y urgencias e informes de farmacia de los diferentes hospitales del SESCAM&#44; as&#237; como de las HCE de atenci&#243;n primaria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">SAVANA permite la extracci&#243;n&#44; la integraci&#243;n y la explotaci&#243;n de los datos cl&#237;nicos no estructurados que existen dentro de la HCE<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">15</span></a>&#46; Para ello&#44; ha desarrollado EHRead&#174;&#44; una tecnolog&#237;a que aplica Procesamiento de Lenguaje Natural &#40;PLN&#41;&#44; aprendizaje autom&#225;tico y aprendizaje profundo al texto libre de las HCE extrayendo las variables cl&#237;nicas de inter&#233;s&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables</span><p id="par0050" class="elsevierStylePara elsevierViewall">El c&#243;mputo de conceptos o terminolog&#237;a considerado por SAVANA se basa en SNOMED<span class="elsevierStyleHsp" style=""></span>CT que contiene c&#243;digos&#44; conceptos&#44; sin&#243;nimos y definiciones<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a> y se ampl&#237;a con t&#233;rminos generados por SAVANA&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Para cumplir con los objetivos del estudio se extrajeron las siguientes variables estructuradas&#58; g&#233;nero&#44; edad&#44; ingreso en la UCI y d&#237;as de hospitalizaci&#243;n&#44; as&#237; como las siguientes variables de texto libre contempladas en la terminolog&#237;a&#58; infecci&#243;n por COVID&#44; tabaquismo &#40;no fumador&#44; fumador y exfumador&#41;&#44; <span class="elsevierStyleItalic">exitus</span> hospitalario&#44; hipertensi&#243;n arterial &#40;HTA&#41;&#44; dislipemia&#44; diabetes&#44; enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41;&#44; asma&#44; enfermedad intersticial pulmonar difusa &#40;EPID&#41;&#44; cardiopat&#237;a isqu&#233;mica &#40;CI&#41;&#44; enfermedad cerebrovascular &#40;ECV&#41;&#44; embolismo pulmonar &#40;TEP&#41;&#44; c&#225;ncer&#44; c&#225;ncer de pulm&#243;n&#44; neumon&#237;a&#44; bronquiectasias&#44; insuficiencia card&#237;aca y el uso de corticoides &#40;triamcinolona&#44; dexametasona&#44; prednisona&#44; prednisolona&#44; hidrocortisona&#44; parametasona acetato&#44; metilprednisolona&#44; betametasona&#44; fludrocortisona&#44; deflazacort&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Manejo de los datos</span><p id="par0060" class="elsevierStylePara elsevierViewall">Todo el proceso comienza con la fase de adquisici&#243;n de datos&#46; Los servicios de inform&#225;tica realizan una descarga y seudonimizaci&#243;n de los datos para enviarlos a SAVANA a trav&#233;s de un protocolo de transferencia segura de archivos &#40;SFTP&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Una vez se realiza la extracci&#243;n&#44; se procesa con la tecnolog&#237;a EHRead&#174; para identificar y extraer las variables cl&#237;nicas de inter&#233;s del texto libre&#44; generando as&#237; una base de datos estructurada con toda la informaci&#243;n agregada por paciente y por episodio&#46; Si se cumple la condici&#243;n en uno de los documentos de cada paciente&#44; se toma dicha condici&#243;n como afirmada&#59; tambi&#233;n se han agrupado los diagn&#243;sticos y los antecedentes personales&#44; de tal forma que se considera que el paciente cumple la condici&#243;n si se detecta la entidad como diagn&#243;stico o como antecedente personal&#46; Los que estaban en la base de datos como fumadores y exfumadores han sido identificados como fumadores&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Savana Manager no utiliza HCE de pacientes individuales&#44; sino informaci&#243;n cl&#237;nica agregada&#46; Esta tecnolog&#237;a permite una completa disociaci&#243;n entre los datos obtenidos para el presente estudio y los datos personales del paciente&#44; debido a la seudonimizaci&#243;n de los datos y la posterior obtenci&#243;n de la informaci&#243;n de forma agregada&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El rendimiento y la precisi&#243;n de la tecnolog&#237;a EHRead en la identificaci&#243;n de las variables del estudio vienen indicados por la Precisi&#243;n &#40;P&#41;&#44; la cobertura &#40;R&#41; y la F-score&#46; Para este estudio se reutilizaron las m&#233;tricas obtenidas para los mismos modelos aplicados a los mismos datos en el contexto de otros estudios&#46; Dichos estudios provienen del mismo conjunto de hospitales y se centran en pacientes con EPOC<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a>&#44; asma<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a> y COVID<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis estad&#237;stico</span><p id="par0080" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables&#46; Para las variables cualitativas se utilizaron frecuencias relativas y absolutas&#44; mientras que para las variables cuantitativas se emplearon medidas estad&#237;sticas&#44; como la media y la desviaci&#243;n est&#225;ndar&#46; Con el fin de examinar la posible relaci&#243;n entre las variables se utiliz&#243; la prueba de chi-cuadrado para las variables cualitativas&#44; y para las cuantitativas&#44; la t de Student&#46; Se estableci&#243; un nivel de significaci&#243;n de 0&#44;05 para determinar si los resultados fueron estad&#237;sticamente significativos&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Del total de pacientes de la poblaci&#243;n de Castilla-La Mancha con HCE disponible durante el periodo de estudio &#40;1 de marzo de 2020 a 28 de febrero de 2021&#41;&#44; se identificaron 293&#46;126 pacientes con infecci&#243;n por el virus SARS-CoV-2&#46; La evaluaci&#243;n ling&#252;&#237;stica del t&#233;rmino &#171;infecci&#243;n por el virus SARS-CoV-2&#187; obtuvo&#44; para otros estudios que utilizaron los mismos modelos de detecci&#243;n de entidades&#44; una precisi&#243;n&#44; cobertura y F-score de 0&#44;99&#44; 0&#44;75 y 0&#44;93&#44; respectivamente&#44; indicando la correcta identificaci&#243;n de estos pacientes<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#46; La identificaci&#243;n de pacientes se llev&#243; a cabo exclusivamente mediante diagn&#243;sticos confirmados e indicados en la historia cl&#237;nica&#44; sin recurrir a inferencias m&#233;dicas para la detecci&#243;n de casos de infecci&#243;n&#46; Esto implica que aunque un paciente presente s&#237;ntomas de la enfermedad o un resultado confirmado de PCR para SARS-CoV-2&#44; dicho paciente no se ha identificado en nuestra poblaci&#243;n&#46; Se asume esta limitaci&#243;n con la posibilidad de que se hayan pasado por alto algunos casos de la enfermedad&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> presenta las principales caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de estos 293&#46;126 pacientes identificados&#46; La edad media de la poblaci&#243;n de estudio fue de 56&#44;8<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;DE&#58; 26&#44;7&#41;&#44; siendo 55&#44;2<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;DE&#58; 26&#46;4&#41; para no fumadores&#44; 56&#44;8 &#40;DE&#58; 15&#44;3&#41; para fumadores y m&#225;s elevada en el caso de exfumadores&#58; 65&#44;5 &#40;DE&#58; 15&#44;3&#41;&#46; Todas estas diferencias de edad fueron significativas&#46; El 47&#37; de los pacientes con SARS-CoV-2 en el SESCAM eran hombres&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Se observ&#243; que los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular &#40;hipertensi&#243;n arterial&#44; dislipemia y diabetes&#41;&#44; EPOC&#44; asma&#44; EPID&#44; CI&#44; ECV&#44; TEP&#44; c&#225;ncer en general y c&#225;ncer de pulm&#243;n en particular&#44; bronquiectasias&#44; insuficiencia card&#237;aca y antecedentes de neumon&#237;a &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46; Todo esto de forma significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En cuanto al uso de corticoides&#44; fue porcentualmente mayor en los fumadores y exfumadores con respecto a los no fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; no existiendo diferencias significativas entre los fumadores y lo exfumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;15&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En todos los subgrupos&#44; la estancia media hospitalaria fue de 4<span class="elsevierStyleHsp" style=""></span>d&#237;as&#46; En cuanto a los ingresos en la UCI&#44; el porcentaje de pacientes fumadores ingresados fue mayor que el de los no fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; siendo menor en los exfumadores respecto a los fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En cuanto al <span class="elsevierStyleItalic">exitus</span> hospitalario &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; fue mayor en el caso de los fumadores con respecto a los no fumadores&#44; siendo los exfumadores los que presentaban mayor porcentaje &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; si bien estos resultados pueden deberse a la mayor edad presentada en este &#250;ltimo subgrupo&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">En el caso de los hombres &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; la edad media era de 57<span class="elsevierStyleHsp" style=""></span>a&#241;os&#59; la de los no fumadores&#44; de 52&#59; la de los fumadores&#44; de 60&#44; y la de los exfumadores&#44; de 67 &#40;estas diferencias fueron significativas&#41;&#46; Al igual que en el global de la poblaci&#243;n de estudio&#44; se observ&#243; un mayor porcentaje de todas las comorbilidades testadas en los fumadores frente a los no fumadores&#44; as&#237; como en los ingresos en la UCI y en las muertes intrahospitalarias&#46; Entre los fumadores y exfumadores no se observ&#243; un cambio significativo en el porcentaje de pacientes con EPOC&#44; asma&#44; EPID&#44; c&#225;ncer y bronquiectasias&#44; ni en el porcentaje de pacientes ingresados en la UCI&#44; aunque s&#237; hubo un cambio significativo a nivel de mortalidad intrahospitalaria y el resto de comorbilidades no mencionadas&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Cuando se tiene en cuenta la cohorte de mujeres &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; la edad media era de 56<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; siendo de 57<span class="elsevierStyleHsp" style=""></span>a&#241;os en el caso de las no fumadoras&#44; de 51 para las fumadoras y de 55 para las no fumadoras &#40;las diferencias de edad fueron significativas&#41;&#46; Las comorbilidades y las muertes aumentaron en las que hab&#237;an tenido relaci&#243;n con el tabaco con respecto a las que no&#46; Todas las comorbilidades tambi&#233;n aumentaron de forma significativa entre las que dejaron de fumar y las que continuaban&#44; excepto el c&#225;ncer de pulm&#243;n&#46; Las muertes intrahospitalarias y los ingresos en la UCI tampoco aumentaron de forma significativa entre exfumadoras y fumadoras&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudio tiene una importancia transcendental&#44; ya que se ha utilizado a toda la poblaci&#243;n de Castilla-La Mancha&#44; en vez de seleccionar una muestra de la misma&#46; As&#237;&#44; se han podido verificar los diferentes porcentajes en las diferentes poblaciones de no fumadores&#44; fumadores y exfumadores en los pacientes con diagn&#243;stico de COVID en el SESCAM&#46; En el estudio se observa que los fumadores tienen m&#225;s proporci&#243;n de comorbilidades que los no fumadores&#44; y que los exfumadores tienen incluso una mayor proporci&#243;n&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En cuanto a las muertes intrahospitalarias&#44; eran mayores en los fumadores que en los no fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Estas muertes&#44; adem&#225;s de por el tabaco en s&#237;&#44; podr&#237;an estar mediadas por el aumento de las comorbilidades&#46; No se considera la edad como un factor influyente&#44; ya que esta era pr&#225;cticamente la misma entre los fumadores y los no fumadores &#40;56&#44;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;3 vs 55&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#44;4&#41;&#46; En el caso del aumento de la mortalidad en los exfumadores&#44; s&#237; podr&#237;a tener m&#225;s peso el aumento de edad &#40;65&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#41; como factor de riesgo para la mayor&#237;a de las comorbilidades y la mortalidad&#46; Este efecto ya se vio en un metaan&#225;lisis publicado en el a&#241;o 2022&#44; donde se observaba un aumento de mortalidad en fumadores y en exfumadores<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a>&#46; El aumento relativo de la mortalidad en los exfumadores respecto a los otros se puede explicar por este incremento de edad&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En cuanto a la edad teniendo en cuenta el estudio sobre mujeres&#44; se puede observar que las fumadoras y exfumadoras presentan m&#225;s mortalidad y comorbilidades que las no fumadoras&#44; a pesar de ser 6<span class="elsevierStyleHsp" style=""></span>a&#241;os m&#225;s j&#243;venes las fumadoras y 2<span class="elsevierStyleHsp" style=""></span>a&#241;os las exfumadoras&#46; Refuerza la idea de la relaci&#243;n entre el tabaquismo y las comorbilidades&#44; como ya se ha observado en diferentes estudios<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">20-22</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En este estudio se confirman los aspectos observados en revisiones anteriores&#44; donde se relacionaba el tabaco actual y pasado con el aumento de ingresos en la UCI y el de muertes<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">23&#44;24</span></a>&#46; Hay que destacar en Espa&#241;a el estudio SEMI-COVID<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a>&#44; donde se registraron m&#225;s de 14&#46;000 pacientes que estuvieron hospitalizados durante los primeros meses de la pandemia y se vio&#44; como en este estudio&#44; que la mortalidad hospitalaria est&#225; asociada al hecho de fumar o haber fumado&#46; Adem&#225;s&#44; el fumar o haber fumado se observ&#243; que era factor independiente para un peor pron&#243;stico en estos pacientes&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Este trabajo es coherente con diferentes metaan&#225;lisis&#44; como se ha demostrado&#44; pero tambi&#233;n con estudios casos-controles&#44; como el de Ir&#225;n<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a>&#44; o con cohortes inglesas<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">27</span></a>&#46; Es el estudio que ha tenido en cuenta a la mayor muestra de pacientes infectados con el virus SARS-CoV-2&#44; con 293&#46;126 enfermos&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Los resultados obtenidos no respaldan la pol&#233;mica hip&#243;tesis que se inici&#243; al principio de la pandemia&#44; en la que se especul&#243; que el tabaco pod&#237;a ser un factor protector contra la infecci&#243;n por COVID<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">28&#44;29</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Se observan otras consistencias importantes con el conocimiento actual de la medicina y con la literatura previa&#46; Siendo el tabaquismo el principal factor de riesgo para desarrollar EPOC<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a>&#44; ser&#237;a esperable que el porcentaje de no fumadores que desarrollan esta enfermedad fuera m&#237;nimo&#46; Con los datos se comprueba que es menor al 1&#37; de la poblaci&#243;n estudiada &#40;0&#44;91&#37;&#41;&#44; mientras que en fumadores y exfumadores sobrepasa el 10&#37; &#40;10&#44;66&#37; y 18&#44;94&#37;&#44; respectivamente&#41;&#46; Pasa algo parecido con el c&#225;ncer de pulm&#243;n&#44; una patolog&#237;a en la que el tabaquismo es un factor de riesgo muy importante<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a>&#44; siendo del 0&#44;12&#37; la proporci&#243;n en no fumadores&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Hay que considerar que es un estudio retrospectivo y observacional&#59; sin embargo&#44; la principal fortaleza de esta metodolog&#237;a basada en datos es que no existe un sesgo en la selecci&#243;n de la poblaci&#243;n a nivel hospitalario&#44; a diferencia de los estudios observacionales tradicionales&#46; La aplicaci&#243;n de PLN en las historias cl&#237;nicas permite analizar el curso cl&#237;nico completo de los pacientes del centro participante&#44; por lo que el n&#250;mero de pacientes es la cantidad total de pacientes existentes&#44; incluidos aquellos pacientes fallecidos o sin seguimiento&#59; la naturaleza de la informaci&#243;n no est&#225; influenciada por el estudio o el observador&#44; y el n&#250;mero de variables es tan grande como la cantidad total de informaci&#243;n cl&#237;nica recopilada a lo largo de los contactos previos con el centro&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A pesar de ser una herramienta novedosa&#44; ya se ha visto la utilidad pr&#225;ctica en este tipo de estudios&#44; como por ejemplo en el an&#225;lisis que se realiz&#243; en pacientes con EPOC de Castilla-La Mancha y que concluy&#243; que hab&#237;a importantes deficiencias tanto en el diagn&#243;stico como en el tratamiento de esta enfermedad<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a>&#44; por lo que esta tecnolog&#237;a tiene importantes aplicaciones diagn&#243;sticas y pron&#243;sticas<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">33&#44;34</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">En cuanto a las limitaciones&#44; al tratarse de un estudio basado en Big Data&#44; el n&#250;mero potencial de variables a incluir se limita exclusivamente a la informaci&#243;n contenida en las HCE&#46; Adem&#225;s&#44; la falta de estandarizaci&#243;n en las HCE en cuanto al tipo de datos recogidos&#44; el uso de terminolog&#237;a m&#233;dica est&#225;ndar frente a la propia y la omisi&#243;n de informaci&#243;n o el mal uso de las secciones en las HCE son posibles limitaciones&#46; Estas limitaciones se ven compensadas por la gran cantidad de pacientes incluidos y por la enorme cantidad de datos que maneja esta tecnolog&#237;a&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; existe un mayor riesgo de mortalidad hospitalaria o ingreso en la UCI en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado&#46; Adem&#225;s&#44; estos pacientes presentan un aumento de comorbilidades importantes con respecto a los no fumadores&#46; Probablemente&#44; estas relaciones no se puedan explicar completamente por la diferencia de edad&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financiaci&#243;n</span><p id="par0195" class="elsevierStylePara elsevierViewall">Esta investigaci&#243;n no recibi&#243; financiaci&#243;n de entidades p&#250;blicas&#44; comerciales ni sin &#225;nimo de lucro&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0200" class="elsevierStylePara elsevierViewall">Los autores declaran carecer de conflictos de intereses&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Agradecimientos</span><p id="par0190" class="elsevierStylePara elsevierViewall">Agradecemos la colaboraci&#243;n a SAVANA para la elaboraci&#243;n de este art&#237;culo&#46;</p></span></span>"
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    "fechaRecibido" => "2023-04-06"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Durante la pandemia de COVID se especul&#243; que los pacientes con el virus que ten&#237;an relaci&#243;n con el tabaco podr&#237;an tener una menor probabilidad de agravamiento de la enfermedad o muerte&#46; Para evaluar si existe una asociaci&#243;n entre el tabaquismo y el riesgo de mortalidad intrahospitalaria se utiliza la tecnolog&#237;a de Big Data y Procesamiento del Lenguaje Natural &#40;PLN&#41; de SAVANA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se llev&#243; a cabo un estudio de cohortes retrospectivo&#44; observacional y sin intervenci&#243;n basado en datos de vida real extra&#237;dos de registros m&#233;dicos de toda Castilla-La Mancha utilizando las t&#233;cnicas de PLN e inteligencia artificial desarrolladas por SAVANA&#46; El estudio abarc&#243; toda la poblaci&#243;n de esta Comunidad con historia cl&#237;nica electr&#243;nica en SESCAM que presentara diagn&#243;stico de COVID desde el 1 de marzo de 2020 al 28 de febrero de 2021&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular &#40;hipertensi&#243;n arterial&#44; dislipemia y diabetes&#41;&#44; EPOC&#44; asma&#44; EPID&#44; CI&#44; ECV&#44; TEP&#44; c&#225;ncer en general y c&#225;ncer de pulm&#243;n en particular&#44; bronquiectasias&#44; insuficiencia card&#237;aca y antecedentes de neumon&#237;a&#44; de forma significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Los pacientes exfumadores&#44; fumadores y no fumadores tienen una diferencia de edad significativa&#46; En cuanto a las muertes hospitalarias&#44; fueron m&#225;s frecuentes en el caso de los exfumadores&#44; siguiendo los fumadores y luego los no fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Existe un mayor riesgo de mortalidad intrahospitalaria en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">During the COVID pandemic&#44; it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death&#46; To assess whether there is an association between smoking and risk of in-hospital mortality&#44; SAVANA&#39;s big data and natural language processing &#40;NLP&#41; technology is used&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective&#44; observational&#44; non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA&#46; The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1&#44; 2020 to February 28&#44; 2021&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Smokers had a significantly higher percentage of cardiovascular risk factors &#40;hypertension&#44; dyslipidemia and diabetes&#41;&#44; COPD&#44; asthma&#44; IDP&#44; IC&#44; CVD&#44; PTE&#44; cancer in general and lung cancer in particular&#44; bronchiectasis&#44; heart failure and a history of pneumonia &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; Former smokers&#44; current smokers and non-smokers have a significant age difference&#46; As for in-hospital deaths&#44; they were more frequent in the case of ex-smokers&#44; followed by smokers and then non-smokers &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past&#46;</p></span>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\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>Pacientes con ingreso en la UCI&#44; n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">99&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>Media de hospitalizaci&#243;n &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="left" 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  " align="left" valign="\n
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                  \t\t\t\t">15&#46;840&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>Dislipemia&#44; n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41&#46;093&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;207&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#46;546&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>Diabetes&#44; n&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">53&#46;113&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34&#46;687&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;494&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#46;932&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>EPOC&#44; n&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">8&#46;539&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;285&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;881&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;373&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00001&#47; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00001&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASMA&#44; n&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">17&#46;103&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#46;290&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;829&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;984&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">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00001&#47; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00001&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>EPID&#44; n&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">542&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">259&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">82&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">201&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">Total&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 fumador&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">Fumador&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">Ex fumador&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">Total&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 fumador&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">Fumador&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">Ex fumador&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">Total&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 fumador&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">Fumador&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">Ex fumador&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">Exitus</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">7&#46;278 &#40;2&#44;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">5&#46;243 &#40;2&#44;08&#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">589 &#40;3&#44;34&#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">1&#46;446 &#40;6&#44;26&#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">3&#46;575 &#40;2&#44;28&#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">3&#46;058 &#40;2&#44;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">337 &#40;2&#44;68&#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">180 &#40;3&#44;05&#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">1&#46;718 &#40;2&#44;74&#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">2&#46;207 &#40;1&#44;93&#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">256 &#40;5&#44;02&#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">1&#46;275 &#40;7&#44;39&#37;&#41;&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">UCI&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">148 &#40;0&#44;05&#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">99 &#40;0&#44;04&#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">13 &#40;0&#44;07&#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">36 &#40;0&#44;02&#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">50 &#40;0&#44;03&#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">42 &#40;0&#44;03&#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">4 &#40;0&#44;03&#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">4 &#40;0&#44;07&#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">89 &#40;0&#44;07&#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">51 &#40;0&#44;04&#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">7 &#40;0&#44;14&#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">31 &#40;0&#44;18&#37;&#41;&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">HTA&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">75&#46;444 &#40;25&#44;74&#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">51&#46;601 &#40;20&#44;45&#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">8&#46;003 &#40;45&#44;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">15&#46;840 &#40;68&#44;60&#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">38&#46;613 &#40;24&#44;67&#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">30&#46;664 &#40;22&#44;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">5&#46;005 &#40;39&#44;77&#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">2&#46;944 &#40;49&#44;82&#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">36&#46;823 &#40;26&#44;96&#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">20&#46;929 &#40;18&#44;32&#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">2&#46;998 &#40;58&#44;74&#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">12&#46;896 &#40;74&#44;77&#37;&#41;&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">Dislipemia&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">75&#46;444 &#40;21&#44;10&#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&#46;093 &#40;16&#44;28&#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">7&#46;207 &#40;40&#44;84&#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">13&#46;546 &#40;58&#44;66&#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">31&#46;719 &#40;20&#44;27&#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">26&#46;090 &#40;18&#44;91&#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">4&#46;542 &#40;36&#44;09&#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">1&#46;087 &#40;18&#44;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">30&#46;125 &#40;22&#44;06&#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">24&#46;688 &#40;21&#44;61&#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">2&#46;665 &#40;52&#44;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">2&#46;772 &#40;16&#44;07&#37;&#41;&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">Diabetes&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">53&#46;113 &#40;18&#44;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
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;687 &#40;13&#44;74&#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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Original
Fumadores y riesgo de muerte hospitalaria por COVID calculado con el procesamiento de lenguaje natural de SAVANA en el ámbito de Castilla-La Mancha
Smokers and risk of hospital death by COVID calculated with SAVANA's natural language processing in the Castilla-La Mancha area
R. Godoy Mayorala,
Autor para correspondencia
godoymayoral@gmail.com

Autor para correspondencia.
, M. Benavent Núñezb, J. Cruz Ruiza, G. López Yepesc, A. Parralejo Jiménezd, F.J. Callejas Gonzáleza, J.L. Izquierdo Alonsoe
a Servicio de Neumología, Complejo Hospitalario Universitario de Albacete, Albacete, España
b Hospital Operations Specialist, Medsavana SL, Madrid, España
c Junior Data Engineer, Medsavana SL, Madrid, España
d Team Lead de Hospitales, Medsavana SL, Madrid, España
e Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El virus SARS-CoV-2 es un coronavirus que empez&#243; a producir neumon&#237;as en Wuhan &#40;China&#41; en diciembre de 2019<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a>&#46; El diagn&#243;stico se hace fundamentalmente por la evaluaci&#243;n cl&#237;nica y la detecci&#243;n del virus por la reacci&#243;n en cadena de la polimerasa &#40;PCR&#41; en diferentes secreciones<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#46; El 30 de enero de 2020 la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41; consider&#243; la COVID &#40;enfermedad por SARS-CoV-2&#41; una emergencia de salud p&#250;blica de importancia internacional&#44; declar&#225;ndola epidemia<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a>&#46; En pocas semanas se convirti&#243; en una pandemia<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a>&#44; en la cual Italia fue completamente superada por el virus<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a>&#44; siendo el ejemplo m&#225;s cercano de lo que suceder&#237;a en Espa&#241;a&#46; Posteriormente&#44; el virus se extendi&#243; r&#225;pidamente por todo el territorio espa&#241;ol<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">6</span></a>&#46; Ha afectado a todas las comunidades del territorio nacional&#44; si bien se han observado variaciones en la tasa de contagio y en la mortalidad en funci&#243;n de la regi&#243;n&#46; Castilla-La Mancha&#44; en particular&#44; ha sido una de las regiones con mayor tasa de mortalidad y mayor incidencia de casos por cada 100&#46;000 habitantes<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a>&#44; lo que ha supuesto una carga importante de trabajo para los profesionales sanitarios de esta comunidad aut&#243;noma&#44; quienes han tenido que dedicar importantes recursos y esfuerzos en la atenci&#243;n a los enfermos por coronavirus&#46; Adem&#225;s&#44; las escasas medidas de protecci&#243;n<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> y los cambios en protocolos&#44; a pesar de que las sociedades cient&#237;ficas se pronunciaron pronto sobre el tema<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; han contribuido a la elevada tasa de contagios en Espa&#241;a en general y en Castilla-La Mancha en particular<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Durante esta situaci&#243;n se se&#241;alaron diferentes factores de riesgo&#58; la edad&#44; el sexo masculino y la hipertensi&#243;n arterial&#44; entre ellos&#46; La relaci&#243;n entre la enfermedad y el tabaquismo era incierta&#44; y se plantearon diversas hip&#243;tesis acerca de la posible eficacia terap&#233;utica de la nicotina o su potencial papel defensivo frente a la COVID-19<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a>&#46; Diferentes metaan&#225;lisis no han terminado de aclarar si el tabaco act&#250;a como factor agravante o protector ante esta enfermedad<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En este estudio se utiliza SAVANA Manager&#174; v3&#46;0&#44; una plataforma cl&#237;nica desarrollada por la empresa m&#233;dica SAVANA que permite analizar la informaci&#243;n incluida en el texto libre de las historias cl&#237;nicas electr&#243;nicas &#40;HCE&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Utilizando esta tecnolog&#237;a ya aplicada en SESCAM para indagar sobre c&#243;mo afecta la COVID-19 a los pacientes con asma<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#44; se plantea aclarar c&#243;mo afecta el tabaquismo a pacientes con infecci&#243;n por SARS-CoV-2 a nivel de ingreso en la UCI y mortalidad intrahospitalaria&#44; determinando si puede considerarse factor protector o agravante&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiza un estudio retrospectivo&#44; observacional y no intervencionista utilizando SAVANA Manager&#174; v3&#46;0 para capturar la informaci&#243;n del texto libre contenido en las HCE&#46; Se incluyeron en este estudio los datos de las HCE de todos los pacientes mayores de 18<span class="elsevierStyleHsp" style=""></span>a&#241;os diagnosticados de COVID entre el 1 de marzo de 2020 y el 28 de febrero de 2021 de Castilla-La Mancha registrados en SESCAM&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Consideraciones &#233;ticas</span><p id="par0030" class="elsevierStylePara elsevierViewall">El estudio se ha llevado a cabo de acuerdo con los requisitos legales y reglamentarios&#44; as&#237; como con prop&#243;sito&#44; valor y rigor cient&#237;ficos&#44; y ha seguido las pr&#225;cticas de investigaci&#243;n generalmente aceptadas descritas en la Gu&#237;a de Buenas Pr&#225;cticas Cl&#237;nicas&#44; la Declaraci&#243;n de Helsinki en su &#250;ltima edici&#243;n y Buenas Pr&#225;cticas de Farmacoepidemiolog&#237;a&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; &#201;tico de investigaci&#243;n del Complejo Hospitalario Universitario de Albacete&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis de datos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Los datos fueron recogidos de los informes de alta de consultas externas&#44; hospitalizaci&#243;n y urgencias e informes de farmacia de los diferentes hospitales del SESCAM&#44; as&#237; como de las HCE de atenci&#243;n primaria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">SAVANA permite la extracci&#243;n&#44; la integraci&#243;n y la explotaci&#243;n de los datos cl&#237;nicos no estructurados que existen dentro de la HCE<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">15</span></a>&#46; Para ello&#44; ha desarrollado EHRead&#174;&#44; una tecnolog&#237;a que aplica Procesamiento de Lenguaje Natural &#40;PLN&#41;&#44; aprendizaje autom&#225;tico y aprendizaje profundo al texto libre de las HCE extrayendo las variables cl&#237;nicas de inter&#233;s&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables</span><p id="par0050" class="elsevierStylePara elsevierViewall">El c&#243;mputo de conceptos o terminolog&#237;a considerado por SAVANA se basa en SNOMED<span class="elsevierStyleHsp" style=""></span>CT que contiene c&#243;digos&#44; conceptos&#44; sin&#243;nimos y definiciones<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a> y se ampl&#237;a con t&#233;rminos generados por SAVANA&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Para cumplir con los objetivos del estudio se extrajeron las siguientes variables estructuradas&#58; g&#233;nero&#44; edad&#44; ingreso en la UCI y d&#237;as de hospitalizaci&#243;n&#44; as&#237; como las siguientes variables de texto libre contempladas en la terminolog&#237;a&#58; infecci&#243;n por COVID&#44; tabaquismo &#40;no fumador&#44; fumador y exfumador&#41;&#44; <span class="elsevierStyleItalic">exitus</span> hospitalario&#44; hipertensi&#243;n arterial &#40;HTA&#41;&#44; dislipemia&#44; diabetes&#44; enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41;&#44; asma&#44; enfermedad intersticial pulmonar difusa &#40;EPID&#41;&#44; cardiopat&#237;a isqu&#233;mica &#40;CI&#41;&#44; enfermedad cerebrovascular &#40;ECV&#41;&#44; embolismo pulmonar &#40;TEP&#41;&#44; c&#225;ncer&#44; c&#225;ncer de pulm&#243;n&#44; neumon&#237;a&#44; bronquiectasias&#44; insuficiencia card&#237;aca y el uso de corticoides &#40;triamcinolona&#44; dexametasona&#44; prednisona&#44; prednisolona&#44; hidrocortisona&#44; parametasona acetato&#44; metilprednisolona&#44; betametasona&#44; fludrocortisona&#44; deflazacort&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Manejo de los datos</span><p id="par0060" class="elsevierStylePara elsevierViewall">Todo el proceso comienza con la fase de adquisici&#243;n de datos&#46; Los servicios de inform&#225;tica realizan una descarga y seudonimizaci&#243;n de los datos para enviarlos a SAVANA a trav&#233;s de un protocolo de transferencia segura de archivos &#40;SFTP&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Una vez se realiza la extracci&#243;n&#44; se procesa con la tecnolog&#237;a EHRead&#174; para identificar y extraer las variables cl&#237;nicas de inter&#233;s del texto libre&#44; generando as&#237; una base de datos estructurada con toda la informaci&#243;n agregada por paciente y por episodio&#46; Si se cumple la condici&#243;n en uno de los documentos de cada paciente&#44; se toma dicha condici&#243;n como afirmada&#59; tambi&#233;n se han agrupado los diagn&#243;sticos y los antecedentes personales&#44; de tal forma que se considera que el paciente cumple la condici&#243;n si se detecta la entidad como diagn&#243;stico o como antecedente personal&#46; Los que estaban en la base de datos como fumadores y exfumadores han sido identificados como fumadores&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Savana Manager no utiliza HCE de pacientes individuales&#44; sino informaci&#243;n cl&#237;nica agregada&#46; Esta tecnolog&#237;a permite una completa disociaci&#243;n entre los datos obtenidos para el presente estudio y los datos personales del paciente&#44; debido a la seudonimizaci&#243;n de los datos y la posterior obtenci&#243;n de la informaci&#243;n de forma agregada&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El rendimiento y la precisi&#243;n de la tecnolog&#237;a EHRead en la identificaci&#243;n de las variables del estudio vienen indicados por la Precisi&#243;n &#40;P&#41;&#44; la cobertura &#40;R&#41; y la F-score&#46; Para este estudio se reutilizaron las m&#233;tricas obtenidas para los mismos modelos aplicados a los mismos datos en el contexto de otros estudios&#46; Dichos estudios provienen del mismo conjunto de hospitales y se centran en pacientes con EPOC<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a>&#44; asma<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a> y COVID<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis estad&#237;stico</span><p id="par0080" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables&#46; Para las variables cualitativas se utilizaron frecuencias relativas y absolutas&#44; mientras que para las variables cuantitativas se emplearon medidas estad&#237;sticas&#44; como la media y la desviaci&#243;n est&#225;ndar&#46; Con el fin de examinar la posible relaci&#243;n entre las variables se utiliz&#243; la prueba de chi-cuadrado para las variables cualitativas&#44; y para las cuantitativas&#44; la t de Student&#46; Se estableci&#243; un nivel de significaci&#243;n de 0&#44;05 para determinar si los resultados fueron estad&#237;sticamente significativos&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Del total de pacientes de la poblaci&#243;n de Castilla-La Mancha con HCE disponible durante el periodo de estudio &#40;1 de marzo de 2020 a 28 de febrero de 2021&#41;&#44; se identificaron 293&#46;126 pacientes con infecci&#243;n por el virus SARS-CoV-2&#46; La evaluaci&#243;n ling&#252;&#237;stica del t&#233;rmino &#171;infecci&#243;n por el virus SARS-CoV-2&#187; obtuvo&#44; para otros estudios que utilizaron los mismos modelos de detecci&#243;n de entidades&#44; una precisi&#243;n&#44; cobertura y F-score de 0&#44;99&#44; 0&#44;75 y 0&#44;93&#44; respectivamente&#44; indicando la correcta identificaci&#243;n de estos pacientes<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#46; La identificaci&#243;n de pacientes se llev&#243; a cabo exclusivamente mediante diagn&#243;sticos confirmados e indicados en la historia cl&#237;nica&#44; sin recurrir a inferencias m&#233;dicas para la detecci&#243;n de casos de infecci&#243;n&#46; Esto implica que aunque un paciente presente s&#237;ntomas de la enfermedad o un resultado confirmado de PCR para SARS-CoV-2&#44; dicho paciente no se ha identificado en nuestra poblaci&#243;n&#46; Se asume esta limitaci&#243;n con la posibilidad de que se hayan pasado por alto algunos casos de la enfermedad&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> presenta las principales caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de estos 293&#46;126 pacientes identificados&#46; La edad media de la poblaci&#243;n de estudio fue de 56&#44;8<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;DE&#58; 26&#44;7&#41;&#44; siendo 55&#44;2<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;DE&#58; 26&#46;4&#41; para no fumadores&#44; 56&#44;8 &#40;DE&#58; 15&#44;3&#41; para fumadores y m&#225;s elevada en el caso de exfumadores&#58; 65&#44;5 &#40;DE&#58; 15&#44;3&#41;&#46; Todas estas diferencias de edad fueron significativas&#46; El 47&#37; de los pacientes con SARS-CoV-2 en el SESCAM eran hombres&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Se observ&#243; que los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular &#40;hipertensi&#243;n arterial&#44; dislipemia y diabetes&#41;&#44; EPOC&#44; asma&#44; EPID&#44; CI&#44; ECV&#44; TEP&#44; c&#225;ncer en general y c&#225;ncer de pulm&#243;n en particular&#44; bronquiectasias&#44; insuficiencia card&#237;aca y antecedentes de neumon&#237;a &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46; Todo esto de forma significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En cuanto al uso de corticoides&#44; fue porcentualmente mayor en los fumadores y exfumadores con respecto a los no fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; no existiendo diferencias significativas entre los fumadores y lo exfumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;15&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En todos los subgrupos&#44; la estancia media hospitalaria fue de 4<span class="elsevierStyleHsp" style=""></span>d&#237;as&#46; En cuanto a los ingresos en la UCI&#44; el porcentaje de pacientes fumadores ingresados fue mayor que el de los no fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; siendo menor en los exfumadores respecto a los fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En cuanto al <span class="elsevierStyleItalic">exitus</span> hospitalario &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; fue mayor en el caso de los fumadores con respecto a los no fumadores&#44; siendo los exfumadores los que presentaban mayor porcentaje &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; si bien estos resultados pueden deberse a la mayor edad presentada en este &#250;ltimo subgrupo&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">En el caso de los hombres &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; la edad media era de 57<span class="elsevierStyleHsp" style=""></span>a&#241;os&#59; la de los no fumadores&#44; de 52&#59; la de los fumadores&#44; de 60&#44; y la de los exfumadores&#44; de 67 &#40;estas diferencias fueron significativas&#41;&#46; Al igual que en el global de la poblaci&#243;n de estudio&#44; se observ&#243; un mayor porcentaje de todas las comorbilidades testadas en los fumadores frente a los no fumadores&#44; as&#237; como en los ingresos en la UCI y en las muertes intrahospitalarias&#46; Entre los fumadores y exfumadores no se observ&#243; un cambio significativo en el porcentaje de pacientes con EPOC&#44; asma&#44; EPID&#44; c&#225;ncer y bronquiectasias&#44; ni en el porcentaje de pacientes ingresados en la UCI&#44; aunque s&#237; hubo un cambio significativo a nivel de mortalidad intrahospitalaria y el resto de comorbilidades no mencionadas&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Cuando se tiene en cuenta la cohorte de mujeres &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; la edad media era de 56<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; siendo de 57<span class="elsevierStyleHsp" style=""></span>a&#241;os en el caso de las no fumadoras&#44; de 51 para las fumadoras y de 55 para las no fumadoras &#40;las diferencias de edad fueron significativas&#41;&#46; Las comorbilidades y las muertes aumentaron en las que hab&#237;an tenido relaci&#243;n con el tabaco con respecto a las que no&#46; Todas las comorbilidades tambi&#233;n aumentaron de forma significativa entre las que dejaron de fumar y las que continuaban&#44; excepto el c&#225;ncer de pulm&#243;n&#46; Las muertes intrahospitalarias y los ingresos en la UCI tampoco aumentaron de forma significativa entre exfumadoras y fumadoras&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudio tiene una importancia transcendental&#44; ya que se ha utilizado a toda la poblaci&#243;n de Castilla-La Mancha&#44; en vez de seleccionar una muestra de la misma&#46; As&#237;&#44; se han podido verificar los diferentes porcentajes en las diferentes poblaciones de no fumadores&#44; fumadores y exfumadores en los pacientes con diagn&#243;stico de COVID en el SESCAM&#46; En el estudio se observa que los fumadores tienen m&#225;s proporci&#243;n de comorbilidades que los no fumadores&#44; y que los exfumadores tienen incluso una mayor proporci&#243;n&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En cuanto a las muertes intrahospitalarias&#44; eran mayores en los fumadores que en los no fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Estas muertes&#44; adem&#225;s de por el tabaco en s&#237;&#44; podr&#237;an estar mediadas por el aumento de las comorbilidades&#46; No se considera la edad como un factor influyente&#44; ya que esta era pr&#225;cticamente la misma entre los fumadores y los no fumadores &#40;56&#44;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;3 vs 55&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#44;4&#41;&#46; En el caso del aumento de la mortalidad en los exfumadores&#44; s&#237; podr&#237;a tener m&#225;s peso el aumento de edad &#40;65&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#41; como factor de riesgo para la mayor&#237;a de las comorbilidades y la mortalidad&#46; Este efecto ya se vio en un metaan&#225;lisis publicado en el a&#241;o 2022&#44; donde se observaba un aumento de mortalidad en fumadores y en exfumadores<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a>&#46; El aumento relativo de la mortalidad en los exfumadores respecto a los otros se puede explicar por este incremento de edad&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En cuanto a la edad teniendo en cuenta el estudio sobre mujeres&#44; se puede observar que las fumadoras y exfumadoras presentan m&#225;s mortalidad y comorbilidades que las no fumadoras&#44; a pesar de ser 6<span class="elsevierStyleHsp" style=""></span>a&#241;os m&#225;s j&#243;venes las fumadoras y 2<span class="elsevierStyleHsp" style=""></span>a&#241;os las exfumadoras&#46; Refuerza la idea de la relaci&#243;n entre el tabaquismo y las comorbilidades&#44; como ya se ha observado en diferentes estudios<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">20-22</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En este estudio se confirman los aspectos observados en revisiones anteriores&#44; donde se relacionaba el tabaco actual y pasado con el aumento de ingresos en la UCI y el de muertes<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">23&#44;24</span></a>&#46; Hay que destacar en Espa&#241;a el estudio SEMI-COVID<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a>&#44; donde se registraron m&#225;s de 14&#46;000 pacientes que estuvieron hospitalizados durante los primeros meses de la pandemia y se vio&#44; como en este estudio&#44; que la mortalidad hospitalaria est&#225; asociada al hecho de fumar o haber fumado&#46; Adem&#225;s&#44; el fumar o haber fumado se observ&#243; que era factor independiente para un peor pron&#243;stico en estos pacientes&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Este trabajo es coherente con diferentes metaan&#225;lisis&#44; como se ha demostrado&#44; pero tambi&#233;n con estudios casos-controles&#44; como el de Ir&#225;n<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a>&#44; o con cohortes inglesas<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">27</span></a>&#46; Es el estudio que ha tenido en cuenta a la mayor muestra de pacientes infectados con el virus SARS-CoV-2&#44; con 293&#46;126 enfermos&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Los resultados obtenidos no respaldan la pol&#233;mica hip&#243;tesis que se inici&#243; al principio de la pandemia&#44; en la que se especul&#243; que el tabaco pod&#237;a ser un factor protector contra la infecci&#243;n por COVID<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">28&#44;29</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Se observan otras consistencias importantes con el conocimiento actual de la medicina y con la literatura previa&#46; Siendo el tabaquismo el principal factor de riesgo para desarrollar EPOC<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a>&#44; ser&#237;a esperable que el porcentaje de no fumadores que desarrollan esta enfermedad fuera m&#237;nimo&#46; Con los datos se comprueba que es menor al 1&#37; de la poblaci&#243;n estudiada &#40;0&#44;91&#37;&#41;&#44; mientras que en fumadores y exfumadores sobrepasa el 10&#37; &#40;10&#44;66&#37; y 18&#44;94&#37;&#44; respectivamente&#41;&#46; Pasa algo parecido con el c&#225;ncer de pulm&#243;n&#44; una patolog&#237;a en la que el tabaquismo es un factor de riesgo muy importante<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a>&#44; siendo del 0&#44;12&#37; la proporci&#243;n en no fumadores&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Hay que considerar que es un estudio retrospectivo y observacional&#59; sin embargo&#44; la principal fortaleza de esta metodolog&#237;a basada en datos es que no existe un sesgo en la selecci&#243;n de la poblaci&#243;n a nivel hospitalario&#44; a diferencia de los estudios observacionales tradicionales&#46; La aplicaci&#243;n de PLN en las historias cl&#237;nicas permite analizar el curso cl&#237;nico completo de los pacientes del centro participante&#44; por lo que el n&#250;mero de pacientes es la cantidad total de pacientes existentes&#44; incluidos aquellos pacientes fallecidos o sin seguimiento&#59; la naturaleza de la informaci&#243;n no est&#225; influenciada por el estudio o el observador&#44; y el n&#250;mero de variables es tan grande como la cantidad total de informaci&#243;n cl&#237;nica recopilada a lo largo de los contactos previos con el centro&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A pesar de ser una herramienta novedosa&#44; ya se ha visto la utilidad pr&#225;ctica en este tipo de estudios&#44; como por ejemplo en el an&#225;lisis que se realiz&#243; en pacientes con EPOC de Castilla-La Mancha y que concluy&#243; que hab&#237;a importantes deficiencias tanto en el diagn&#243;stico como en el tratamiento de esta enfermedad<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a>&#44; por lo que esta tecnolog&#237;a tiene importantes aplicaciones diagn&#243;sticas y pron&#243;sticas<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">33&#44;34</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">En cuanto a las limitaciones&#44; al tratarse de un estudio basado en Big Data&#44; el n&#250;mero potencial de variables a incluir se limita exclusivamente a la informaci&#243;n contenida en las HCE&#46; Adem&#225;s&#44; la falta de estandarizaci&#243;n en las HCE en cuanto al tipo de datos recogidos&#44; el uso de terminolog&#237;a m&#233;dica est&#225;ndar frente a la propia y la omisi&#243;n de informaci&#243;n o el mal uso de las secciones en las HCE son posibles limitaciones&#46; Estas limitaciones se ven compensadas por la gran cantidad de pacientes incluidos y por la enorme cantidad de datos que maneja esta tecnolog&#237;a&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; existe un mayor riesgo de mortalidad hospitalaria o ingreso en la UCI en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado&#46; Adem&#225;s&#44; estos pacientes presentan un aumento de comorbilidades importantes con respecto a los no fumadores&#46; Probablemente&#44; estas relaciones no se puedan explicar completamente por la diferencia de edad&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financiaci&#243;n</span><p id="par0195" class="elsevierStylePara elsevierViewall">Esta investigaci&#243;n no recibi&#243; financiaci&#243;n de entidades p&#250;blicas&#44; comerciales ni sin &#225;nimo de lucro&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0200" class="elsevierStylePara elsevierViewall">Los autores declaran carecer de conflictos de intereses&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Agradecimientos</span><p id="par0190" class="elsevierStylePara elsevierViewall">Agradecemos la colaboraci&#243;n a SAVANA para la elaboraci&#243;n de este art&#237;culo&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Durante la pandemia de COVID se especul&#243; que los pacientes con el virus que ten&#237;an relaci&#243;n con el tabaco podr&#237;an tener una menor probabilidad de agravamiento de la enfermedad o muerte&#46; Para evaluar si existe una asociaci&#243;n entre el tabaquismo y el riesgo de mortalidad intrahospitalaria se utiliza la tecnolog&#237;a de Big Data y Procesamiento del Lenguaje Natural &#40;PLN&#41; de SAVANA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se llev&#243; a cabo un estudio de cohortes retrospectivo&#44; observacional y sin intervenci&#243;n basado en datos de vida real extra&#237;dos de registros m&#233;dicos de toda Castilla-La Mancha utilizando las t&#233;cnicas de PLN e inteligencia artificial desarrolladas por SAVANA&#46; El estudio abarc&#243; toda la poblaci&#243;n de esta Comunidad con historia cl&#237;nica electr&#243;nica en SESCAM que presentara diagn&#243;stico de COVID desde el 1 de marzo de 2020 al 28 de febrero de 2021&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular &#40;hipertensi&#243;n arterial&#44; dislipemia y diabetes&#41;&#44; EPOC&#44; asma&#44; EPID&#44; CI&#44; ECV&#44; TEP&#44; c&#225;ncer en general y c&#225;ncer de pulm&#243;n en particular&#44; bronquiectasias&#44; insuficiencia card&#237;aca y antecedentes de neumon&#237;a&#44; de forma significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Los pacientes exfumadores&#44; fumadores y no fumadores tienen una diferencia de edad significativa&#46; En cuanto a las muertes hospitalarias&#44; fueron m&#225;s frecuentes en el caso de los exfumadores&#44; siguiendo los fumadores y luego los no fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Existe un mayor riesgo de mortalidad intrahospitalaria en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">During the COVID pandemic&#44; it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death&#46; To assess whether there is an association between smoking and risk of in-hospital mortality&#44; SAVANA&#39;s big data and natural language processing &#40;NLP&#41; technology is used&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective&#44; observational&#44; non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA&#46; The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1&#44; 2020 to February 28&#44; 2021&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Smokers had a significantly higher percentage of cardiovascular risk factors &#40;hypertension&#44; dyslipidemia and diabetes&#41;&#44; COPD&#44; asthma&#44; IDP&#44; IC&#44; CVD&#44; PTE&#44; cancer in general and lung cancer in particular&#44; bronchiectasis&#44; heart failure and a history of pneumonia &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; Former smokers&#44; current smokers and non-smokers have a significant age difference&#46; As for in-hospital deaths&#44; they were more frequent in the case of ex-smokers&#44; followed by smokers and then non-smokers &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past&#46;</p></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC&#44; n&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\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASMA&#44; n&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\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\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPID&#44; n&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">542&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
                  \t\t\t\t">259&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
                  \t\t\t\t">82&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
                  \t\t\t\t">201&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\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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;a isqu&#233;mica&#44; n&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\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</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ECV&#44; n&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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;765&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">668&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;715&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>TEP&#44; n&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">4&#46;121&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">2&#46;648&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">460&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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;958&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
                  \t\t\t\t">3&#46;329&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
                  \t\t\t\t">904&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">299&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\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;074&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
                  \t\t\t\t">19&#46;956&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">6&#46;575&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bronquiectasias&#44; n&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
                  \t\t\t\t">1&#46;814&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">934&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">253&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">627&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\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>Insuficiencia card&#237;aca&#44; n&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
                  \t\t\t\t">12&#46;650&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
                  \t\t\t\t">8&#46;408&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&#46;180&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">3&#46;062&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">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00001&#47; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00001&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>Corticoides&#44; n&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&#46;355&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">24&#46;366&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">3&#46;081&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">3&#46;908&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">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00001&#47; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;154707&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3436354.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas cl&#237;nicas y demogr&#225;ficas de los pacientes con diagn&#243;stico de COVID</p>"
        ]
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      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \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">&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  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Poblaci&#243;n total 293&#46;126</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mujeres &#40;53&#44;4&#37;&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Varones &#40;46&#44;6&#37;&#41;</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">Total&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 fumador&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">Fumador&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">Ex fumador&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">Total&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 fumador&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">Fumador&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">Ex fumador&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">Total&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 fumador&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">Fumador&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">Ex fumador&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="elsevierStyleItalic">Exitus</span>&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">7&#46;278 &#40;2&#44;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">5&#46;243 &#40;2&#44;08&#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">589 &#40;3&#44;34&#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">1&#46;446 &#40;6&#44;26&#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">3&#46;575 &#40;2&#44;28&#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">3&#46;058 &#40;2&#44;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">337 &#40;2&#44;68&#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">180 &#40;3&#44;05&#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">1&#46;718 &#40;2&#44;74&#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">2&#46;207 &#40;1&#44;93&#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">256 &#40;5&#44;02&#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">1&#46;275 &#40;7&#44;39&#37;&#41;&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">UCI&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">148 &#40;0&#44;05&#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">99 &#40;0&#44;04&#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">13 &#40;0&#44;07&#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">36 &#40;0&#44;02&#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">50 &#40;0&#44;03&#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">42 &#40;0&#44;03&#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">4 &#40;0&#44;03&#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">4 &#40;0&#44;07&#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">89 &#40;0&#44;07&#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">51 &#40;0&#44;04&#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">7 &#40;0&#44;14&#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">31 &#40;0&#44;18&#37;&#41;&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">HTA&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">75&#46;444 &#40;25&#44;74&#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">51&#46;601 &#40;20&#44;45&#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">8&#46;003 &#40;45&#44;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">15&#46;840 &#40;68&#44;60&#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">38&#46;613 &#40;24&#44;67&#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">30&#46;664 &#40;22&#44;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">5&#46;005 &#40;39&#44;77&#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">2&#46;944 &#40;49&#44;82&#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">36&#46;823 &#40;26&#44;96&#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">20&#46;929 &#40;18&#44;32&#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">201 &#40;0&#44;87&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">241 &#40;0&#44;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42 &#40;0&#44;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;0&#44;61&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">303 &#40;0&#44;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96 &#40;0&#44;08&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40 &#40;0&#44;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">167 &#40;0&#44;97&#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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Información del artículo
ISSN: 00142565
Idioma original: Español
DOI:10.1016/j.rce.2023.11.007
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