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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La enfermedad COVID-19 es un reto que ha puesto a prueba los diferentes sistemas de salud en el mundo<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los pacientes cursan de forma favorable&#59; sin embargo&#44; el 20&#37; de los pacientes requieren hospitalizaci&#243;n y pueden progresar r&#225;pidamente a un s&#237;ndrome de distr&#233;s respiratorio del adulto &#40;SDRA&#41;&#44; fallo multiorg&#225;nico o&#44; incluso&#44; fallecer<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a>&#46; Adem&#225;s&#44; el cuadro cl&#237;nico se caracteriza por una disociaci&#243;n cl&#237;nico-radiol&#243;gica importante&#44; de manera que el deterioro cl&#237;nico se desarrolla s&#250;bitamente<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#44; por lo que la identificaci&#243;n de estos factores de riesgo es prioritaria para el correcto manejo de estos pacientes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El registro SEMI-COVID-19<span class="elsevierStyleHsp" style=""></span>ha puesto de manifiesto que la mortalidad en Espa&#241;a lleg&#243; hasta el 21&#37; con datos del 2020<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a>&#46; Adem&#225;s&#44; el porcentaje de pacientes que requiri&#243; ventilaci&#243;n mec&#225;nica lleg&#243; a alcanzar el 65&#37;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo del presente estudio fue identificar los factores de la mala evoluci&#243;n de la infecci&#243;n por SARS-CoV-2 en pacientes hospitalizados por COVID-19&#44; definida como aparici&#243;n de SDRA grave durante el ingreso &#40;PaFi &#8804; 100<span class="elsevierStyleHsp" style=""></span>mmHg&#41; o ingreso en la Unidad de Cuidados Intensivos &#40;UCI&#41; o muerte intrahospitalaria&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Este es un caso-control anidado dentro de COVID-19 Osakidetza &#40;NCT04463706&#41; en el que se han considerado casos&#44; pacientes ingresados en planta de hospitalizaci&#243;n por COVID-19&#44; que han presentado deterioro cl&#237;nico &#40;presencia a lo largo de la hospitalizaci&#243;n un SDRA grave &#91;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#8804; 100<span class="elsevierStyleHsp" style=""></span>mmHg&#93; o ingreso en la UCI o fallecimiento intrahospitalario&#41;&#46; Se consider&#243; controles a pacientes ingresados por COVID-19 que no presentaron SDRA grave y fueron emparejados por grupos de edad&#46; Se excluy&#243; a&#58; fallecidos en el servicio de Urgencias&#44; ingresados directamente en UCI o los que presentaron PaFi &#8804; 100<span class="elsevierStyleHsp" style=""></span>mmHg en las primeras 24 h de ingreso&#46; Se identificaron 2<span class="elsevierStyleHsp" style=""></span>controles por caso&#46; El per&#237;odo de inclusi&#243;n fue del 3 de marzo del 2020 al 10 de abril del 2020&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El proyecto fue aprobado por el Comit&#233; de &#233;tica de Euskadi &#40;PI2020059&#41;&#46; El muestreo fue aleatorio simple&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se incluyeron las variables del sistema de explotaci&#243;n de datos de la historia cl&#237;nica electr&#243;nica &#40;HCE&#41; de Osakidetza-Sistema Vasco de Salud y&#44; adem&#225;s&#44; mediante la revisi&#243;n de la HCE por revisores entrenados supervisados por colaboradores cl&#237;nicos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se recogieron datos sociodemogr&#225;ficos &#40;edad y sexo&#41;&#59; antecedentes personales &#40;comorbilidades recogidas en el &#237;ndice de Charlson&#41;&#59; historia de la enfermedad &#40;s&#237;ntomas y fecha de aparici&#243;n&#44; fecha del primer contacto con el sistema sanitario&#44; persistencia de los s&#237;ntomas&#44; tratamientos instaurados&#44; contactos con Atenci&#243;n Primaria en el mes previo&#41;&#59; episodio de hospitalizaci&#243;n actual &#40;s&#237;ntomas a la llegada a Urgencias&#41;&#44; constantes vitales &#40;incluida la saturaci&#243;n de ox&#237;geno por pulsioximetr&#237;a &#91;SaO<span class="elsevierStyleInf">2</span>p&#93;&#41;&#44; signos y exploraci&#243;n f&#237;sica&#44; y&#44; adem&#225;s&#44; pruebas de laboratorio al ingreso &#40;bioqu&#237;mica&#58; funci&#243;n renal&#44; alb&#250;mina&#44; perfil hep&#225;tico&#59; reactantes de fase aguda&#58; LDH&#44; PCR&#59; hemograma&#44; recuento y f&#243;rmula&#59; coagulaci&#243;n&#44; tiempo de protrombina&#44; d&#237;mero D&#41;&#44; radiograf&#237;a patol&#243;gica a la llegada si presentaba infiltrados o condensaciones no conocidos previamente o datos indicativos de SDRA &#40;presencia de opacidades bilaterales no totalmente explicadas por derrames&#44; colapso lobar o pulmonar o n&#243;dulos&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se calcul&#243; el nivel m&#225;s bajo de PaFi &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41; a la llegada a Urgencias&#44; el d&#237;a de llegada a planta y hasta el d&#237;a 3&#46; Se recogi&#243; adem&#225;s el nivel m&#225;s bajo de PaFi alcanzado durante la hospitalizaci&#243;n&#44; tanto en los casos como en los controles&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se defini&#243; caso como aquel paciente que present&#243; deterioro cl&#237;nico durante la hospitalizaci&#243;n con presencia de una PaFi &#8804; 100<span class="elsevierStyleHsp" style=""></span>mmHg o ingreso en la UCI o fallecimiento intrahospitalario &#40;fecha&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se ha realizado una estad&#237;stica descriptiva de las variables&#44; presentando mediante tablas de frecuencia y porcentajes las categ&#243;ricas&#44; y con medias y desviaciones t&#237;picas o medianas y rangos intercuartil las continuas&#46; En el an&#225;lisis univariable&#44; las variables se han comparado entre casos y controles utilizando modelos de regresi&#243;n log&#237;stica condicional&#44; tomando como variable dependiente el deterioro cl&#237;nico y el resto de variables como variables independientes&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Las pruebas de laboratorio al ingreso&#44; recogidas como variables continuas&#44; tambi&#233;n se han analizado categorizadas en 3 grupos&#58; valores en el rango normal &#40;definido en las tablas&#41;&#44; valores reducidos y valores aumentados&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para el modelo de regresi&#243;n log&#237;stica condicional&#44; se han considerado todas las variables independientes con p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;20 del an&#225;lisis univariable&#46; Los efectos se han considerado significativos con p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se han calculado las odds ratio &#40;OR&#41; y los intervalos de confianza del 95&#37; &#40;IC del 95&#37;&#41;&#46; La capacidad explicativa del modelo se ha analizado calculando el R<span class="elsevierStyleSup">2</span> y el &#225;rea bajo la curva &#40;AUC&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se han analizado las diferencias en la PaFi entre casos y controles mediante un diagrama de cajas correspondientes a los valores de PaFi en diferentes momentos del ingreso &#40;Urgencias&#44; llegada a planta&#44; d&#237;a 1&#44; d&#237;a 2&#44; d&#237;a 3 y d&#237;a cr&#237;tico&#41;&#46; Se ha realizado un an&#225;lisis de datos longitudinal para poder identificar diferencias en las tendencias de la evoluci&#243;n de la PaFi&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis estad&#237;sticos se han realizado utilizando SAS para Windows&#44; versi&#243;n 9&#46;4 &#40;SAS Institute&#44; Cary&#44; NC&#44; EE&#46; UU&#46;&#41; y R&#169;&#44; versi&#243;n 4&#46;0&#46;0&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se seleccion&#243; a 366 pacientes aleatoriamente de los 4&#46;447 pacientes que ingresaron en el mismo per&#237;odo en los centros participantes&#46; Una vez excluidos los pacientes no elegibles&#44; nuestra muestra se compone de 99 casos y 205 controles&#44; de los cuales cumpl&#237;an los criterios de selecci&#243;n del estudio 198&#44; siendo la ratio caso&#47;control de 1&#58;2 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">El sexo masculino fue m&#225;s frecuente entre los casos &#40;79&#37; vs&#46; 65&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; as&#237; como haber padecido infarto agudo de miocardio &#40;IAM&#41; &#40;14&#37; vs&#46; 4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; diabetes con da&#241;o org&#225;nico &#40;7&#37; vs&#46; 1&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41; e hipertensi&#243;n arterial &#40;63&#37; vs&#46; 49&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#46; Los casos presentaban con menor frecuencia que los controles&#58; tos seca &#40;51&#44;5&#37; vs&#46; 65&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41; y dolor de garganta &#40;5&#37; vs&#46; 18&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; Los casos hab&#237;an consultado con m&#225;s frecuencia a su m&#233;dico de Atenci&#243;n Primaria &#40;48&#44;5&#37; vs&#46; 34&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#46; La radiograf&#237;a simple fue patol&#243;gica con m&#225;s frecuencia en los casos &#40;91&#37; vs&#46; 77&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; Exist&#237;a asociaci&#243;n entre los niveles de glucosa&#44; LDH&#44; PCR y plaquetas con el deterioro cl&#237;nico&#44; siendo los pacientes que se deterioraban los que presentaban cifras m&#225;s altas de los 3<span class="elsevierStyleHsp" style=""></span>primeros par&#225;metros y m&#225;s bajos de plaquetas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Todas las variables descritas en el apartado de metodolog&#237;a se han considerado en el an&#225;lisis univariante &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Cuando se combinaron estas variables en un modelo multivariable&#44; los pacientes que presentaron saturaci&#243;n de O<span class="elsevierStyleInf">2</span> en Urgencias &#8804;<span class="elsevierStyleHsp" style=""></span>90&#37; presentaban un riesgo aumentado de deterioro cl&#237;nico &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44;57&#44; IC del 95&#37;&#44; 4-68&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; as&#237; como los que hab&#237;an presentado IAM &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#44;72&#44; IC del 95&#37;&#44; 3&#44;3-75&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0006&#41;&#44; hipertensi&#243;n arterial &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;21&#44; IC del 95&#37;&#44; 1&#44;1-4&#44;4&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41; y EPOC &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;05&#44; IC del 95&#37;&#44; 1&#44;4-6&#44;5&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; Adem&#225;s&#44; la presencia de radiolog&#237;a patol&#243;gica supon&#237;a un riesgo 5&#44;6 veces mayor&#46; Los niveles de PCR<span class="elsevierStyleHsp" style=""></span>&#62; 100 se relacionaban positivamente con la posibilidad de deterioro&#44; as&#237; como los niveles de glucemia<span class="elsevierStyleHsp" style=""></span>&#62; 200&#46; Los pacientes con nivel de plaquetas inferiores a 15<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;&#956;l presentaban 4 veces m&#225;s riesgo de deterioro que los que ten&#237;an cifras de plaquetas en rangos normales o elevados &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">La variabilidad explicada por el modelo medido por el R2 era del 25&#37; y la capacidad predictiva medida por el AUC fue 0&#44;86&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La PaFi es inferior en los casos&#44; en los diferentes momentos analizados &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 en todos&#41;&#46; La diferencia en la tendencia es tambi&#233;n estad&#237;sticamente significativa entre casos y controles &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; pero se puede dividir en 2<span class="elsevierStyleHsp" style=""></span>intervalos&#58; la diferencia no es significativa de la Urgencia hasta el d&#237;a 1 del ingreso y las tendencias son pr&#225;cticamente paralelas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;64&#41;&#46; Sin embargo&#44; a partir del d&#237;a 1 de ingreso los casos mantienen una tendencia decreciente&#44; mientras que los controles se estabilizan m&#225;s &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El segundo d&#237;a de ingreso el 75&#37; de los casos toman valores inferiores a 253&#44;6&#44; mientras que el 75&#37; de los controles toman valores superiores a 271&#44;4&#46; La ca&#237;da del tercer d&#237;a de ingreso hasta el d&#237;a que presentaron el deterioro o d&#237;a cr&#237;tico es m&#225;s pronunciada en los casos &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n y conclusiones</span><p id="par0110" class="elsevierStylePara elsevierViewall">El presente estudio pone de manifiesto las caracter&#237;sticas cl&#237;nicas principales de los pacientes hospitalizados por COVID-19 que presentan una mala evoluci&#243;n&#44; definida como PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#8804; 100&#44; ingreso en UCI o muerte&#46; De este modo&#44; se ha podido identificar que la presencia de SaO<span class="elsevierStyleInf">2</span> &#8804; 90&#37;&#44; hiperglucemia&#44; PCR elevada y trombocitopenia&#44; as&#237; como la radiograf&#237;a patol&#243;gica al ingreso y una enfermedad asociada previamente &#40;IAM&#44; EPOC o hipertensi&#243;n arterial&#41; se asociaban con el deterioro cl&#237;nico&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Numerosos estudios coinciden en destacar la edad&#44; el sexo masculino y la presencia de disnea como factores predictores de mortalidad o ingreso en UCI<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Como en el estudio se han emparejado casos y controles por edad&#44; no hemos podido evaluar el efecto de esta variable de la edad en el resultado&#46; En el presente estudio&#44; el 78&#44;79&#37; de los pacientes que desarrollaron deterioro cl&#237;nico eran varones&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Jain y Yuan<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> evaluaron en un metaan&#225;lisis los s&#237;ntomas y las comorbilidades predictores de gravedad e ingreso en la UCI en pacientes con COVID-19 y la disnea fue el &#250;nico s&#237;ntoma predictor de ambas variables&#46; A diferencia de los trabajos publicados&#44; la disnea no fue significativamente m&#225;s frecuente entre los casos&#44; lo que probablemente tenga relaci&#243;n con la exclusi&#243;n de los pacientes que requirieron ventilaci&#243;n mec&#225;nica en las primeras 24 h&#44; dado que los pacientes que ingresaban en UCI en ese per&#237;odo lo hac&#237;an por presencia de SDRA grave&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Hay que se&#241;alar que nuestro objetivo principal fue identificar a los pacientes que&#44; hospitalizados en fase pulmonar de la enfermedad seg&#250;n las fases propuestas por Siddiqi y Mehra<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a>&#44; presentaron deterioro cl&#237;nico durante la hospitalizaci&#243;n&#46; De este modo&#44; los casos presentaban m&#225;s frecuentemente una SaO<span class="elsevierStyleInf">2</span>p menor que los controles a la llegada al servicio de Urgencias&#46; A pesar de tratarse de valores de ox&#237;geno pr&#225;cticamente dentro de la normalidad&#44; existe una repercusi&#243;n cl&#237;nica objetiva ya que&#44; en consonancia&#44; los casos tambi&#233;n presentaban con m&#225;s frecuencia taquipnea&#44; sin duda&#44; un factor determinante para la mala evoluci&#243;n en las neumon&#237;as e incluida en escalas de gravedad para COVID-19<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Fu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> llevaron a cabo un estudio en 200 pacientes y observaron que tanto la edad y las comorbilidades como una baja oxigenaci&#243;n se asociaban con una mayor mortalidad&#46; Por lo tanto&#44; parece que los valores m&#225;s bajos de oxigenaci&#243;n al ingreso pueden predecir un deterioro posterior&#46; M&#225;s all&#225;&#44; tal y como muestra la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#44; existe un punto de inflexi&#243;n en la oxigenaci&#243;n&#44; el denominado d&#237;a cr&#237;tico de los pacientes&#46; Por eso resulta crucial una correcta identificaci&#243;n de las caracter&#237;sticas cl&#237;nicas de estos pacientes con alto riesgo de empeorar&#46; La afectaci&#243;n pulmonar bilateral y las opacidades en vidrio deslustrado han demostrado ser la forma de presentaci&#243;n radiol&#243;gica m&#225;s frecuente en la literatura<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Si bien es cierto que en nuestro estudio no se pudo constatar el tipo de afectaci&#243;n radiol&#243;gica&#58; los pacientes que desarrollaron deterioro cl&#237;nico en la evoluci&#243;n presentaban alg&#250;n tipo de alteraci&#243;n radiol&#243;gica inicial frente a los controles con radiograf&#237;a normal&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En el caso de las enfermedades asociadas&#44; parece l&#243;gico pensar que aquellos pacientes con enfermedades cr&#243;nicas como la EPOC&#44; que presentan una inflamaci&#243;n cr&#243;nica del par&#233;nquima pulmonar&#44; limitaci&#243;n al flujo a&#233;reo espiratorio y una mayor susceptibilidad a las infecciones&#44; sean m&#225;s vulnerables a la enfermedad<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a>&#46; Asimismo&#44; coincidiendo con otras cohortes espa&#241;olas<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a>&#44; se ha observado una mayor asociaci&#243;n entre la EPOC y el deterioro cl&#237;nico en probable relaci&#243;n con la presencia de un mayor n&#250;mero de comorbilidades que habitualmente presentan estos pacientes<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La hipertensi&#243;n arterial y el IAM se relacionan de forma significativa con el deterioro cl&#237;nico<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a>&#46; Zhao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> identificaron que la edad<span class="elsevierStyleHsp" style=""></span>&#62; 60 a&#241;os&#44; la enfermedad cardiovascular&#44; la hipertensi&#243;n y la diabetes eran factores independientes de la mortalidad por COVID-19&#46; Otros 2<span class="elsevierStyleHsp" style=""></span>estudios recientes se&#241;alan que estos pacientes presentan con m&#225;s frecuencia da&#241;o mioc&#225;rdico y arritmias durante el ingreso&#44; lo cual se asocia con una mayor mortalidad<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; La afectaci&#243;n viral directa&#44; as&#237; como la inflamaci&#243;n secundaria a la tormenta de citocinas existente en la infecci&#243;n por SARS-CoV-2&#44; podr&#237;a estar detr&#225;s del da&#241;o mioc&#225;rdico<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a>&#46; A&#250;n queda por dilucidar el potencial impacto que este da&#241;o tendr&#225; a largo plazo&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; la elevaci&#243;n de los niveles de glucosa y de la PCR fueron predictores del deterioro cl&#237;nico&#44; ambos par&#225;metros anal&#237;ticos ampliamente estudiados en las neumon&#237;as&#46; La hiperglucemia&#44; bien secundaria al estr&#233;s de la infecci&#243;n o a la presencia de diabetes&#46; o un s&#237;ndrome metab&#243;lico subyacente pueden aumentar la mortalidad de los pacientes con COVID-19<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">20-22</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La diabetes es una de las comorbilidades m&#225;s frecuentes en la COVID-19 y que&#44; adem&#225;s&#44; puede empeorar el pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a>&#46; Una respuesta inmunitaria inadecuada junto a la exacerbaci&#243;n de la cascada proinflamatoria podr&#237;an explicar dicha asociaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a>&#46; Sin duda&#44; un correcto manejo y control de los niveles de glucemia deber&#237;a formar parte primordial del tratamiento de la COVID-19&#46; En cuanto a la PCR&#44; su elevaci&#243;n se ha asociado con la gravedad de la enfermedad y&#44; adem&#225;s&#44; parece haber superado a otros biomarcadores m&#225;s com&#250;nmente utilizados en la sepsis<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Por el contrario&#44; los casos presentaron niveles m&#225;s bajos de plaquetas que los controles&#46; En un estudio retrospectivo reciente con 1&#46;476 pacientes incluidos observaron que el 20&#44;7&#37; de la muestra presentaba trombocitopenia y adem&#225;s se asociaba de forma significativa con la mortalidad intrahospitalaria<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a>&#46; Se ha observado que la coagulaci&#243;n intravascular diseminada es frecuente entre los fallecidos por la infecci&#243;n SARS-CoV-2&#44; lo que podr&#237;a justificar el aumento de consumo de plaquetas<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">El presente estudio posee ciertas limitaciones inherentes al dise&#241;o caso-control&#46; Adem&#225;s&#44; no pudo identificarse el tipo de afectaci&#243;n radiol&#243;gica espec&#237;fica&#59; existen algunas p&#233;rdidas en las variables anal&#237;ticas y los resultados no son extrapolables a los pacientes excluidos del estudio por deterioro en las primeras 24 h&#46; Seg&#250;n el per&#237;odo de estudio&#44; en las primeras fases de la pandemia es menos probable que los pacientes ingresaran con afectaci&#243;n leve-moderada&#44; siendo en su mayor&#237;a pacientes graves&#46; Adem&#225;s&#44; no se han incluido variables que luego han resultado ser predictoras de mala evoluci&#243;n en estos pacientes porque en el momento del reclutamiento no se ped&#237;an de manera rutinaria &#40;p&#46; ej&#46;&#44; la ferritina&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Se necesita seguir con estudios nuevos que ayuden a identificar a los pacientes con riesgo de deterioro cl&#237;nico para que los profesionales sanitarios puedan tomar decisiones adecuadas sobre su destino y tratamiento&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0170" class="elsevierStylePara elsevierViewall">Este proyecto ha sido financiado por el Instituto de Salud Carlos III en la convocatoria extraordinaria de proyectos de investigaci&#243;n sobre el SARS-CoV-2 y la enfermedad COVID-19&#44; n&#250;mero de expediente COV20&#47;0459&#44; y la Red de Investigaci&#243;n en Servicios Sanitarios en Enfermedades Cr&#243;nicas &#40;REDISSEC&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de inter&#233;s&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Existe controversia sobre los mejores factores predictores de deterioro cl&#237;nico en la COVID-19&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Identificar factores predictores de riesgo de deterioro en pacientes hospitalizados por COVID-19&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos Dise&#241;o</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">caso-control anidado dentro de una cohorte&#46; &#193;mbito&#58; 13 centros de agudos de Osakidetza-Servicio Vasco de Salud&#46; Participantes&#58; se consider&#243; casos a pacientes hospitalizados por COVID-19 con deterioro cl&#237;nico&#44; definido como la aparici&#243;n de s&#237;ndrome de distr&#233;s respiratorio del adulto grave&#44; ingreso en UCI o fallecimiento&#46; Se emparejaron 2<span class="elsevierStyleHsp" style=""></span>controles por caso en funci&#243;n de la edad&#46; Se recogieron variables sociodemogr&#225;ficas&#44; comorbilidades&#44; tratamientos basales&#44; s&#237;ntomas y fecha de inicio&#44; consultas previas&#44; as&#237; como variables cl&#237;nicas&#44; anal&#237;ticas y radiol&#243;gicas&#46; Se cre&#243; un modelo explicativo del deterioro cl&#237;nico mediante regresi&#243;n log&#237;stica condicional&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 99 casos y 198 controles&#46; Mediante an&#225;lisis de regresi&#243;n log&#237;stica las variables independientes asociadas con deterioro cl&#237;nico fueron&#58; saturaci&#243;n de O<span class="elsevierStyleInf">2</span> en Urgencias &#8804; 90&#37; &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44;6&#44; IC del 95&#37;&#44; 4-68&#41;&#44; radiograf&#237;a de t&#243;rax patol&#243;gica &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;6&#44; IC del 95&#37;&#44; 1&#44;7-18&#44;4&#41;&#44; PCR<span class="elsevierStyleHsp" style=""></span>&#62; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;62&#44; IC del 95&#37; 1&#44;62-8&#41; y trombocitopenia &#60;<span class="elsevierStyleHsp" style=""></span>150&#46;000 plaquetas &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44; IC del 95&#37;&#44; 1&#44;84-8&#44;6&#41; y&#44; entre los antecedentes&#44; haber padecido infarto agudo de miocardio &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#44;7&#44; IC del 95&#37;&#44; 3&#44;29-75&#44;09&#41;&#44; EPOC &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;05&#44; IC del 95&#37;&#44; 1&#44;43-6&#44;5&#41; o hipertensi&#243;n arterial &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;21&#44; IC del 95&#37;1&#44;11-4&#44;4&#41;&#46; El &#225;rea bajo la curva alcanzado por el modelo fue 0&#44;86&#46; En el an&#225;lisis univariado&#44; se asociaron con mejor evoluci&#243;n cl&#237;nica el sexo femenino&#44; la presencia de tos seca y dolor de garganta&#44; pero no resultaron significativas en el an&#225;lisis multivariado&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las variables identificadas podr&#237;an ser de utilidad en la pr&#225;ctica cl&#237;nica para la detecci&#243;n de pacientes con alto riesgo de mala evoluci&#243;n&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">There is controversy regarding the best predictors of clinical deterioration in COVID-19&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">This work aims to identify predictors of risk factors for deterioration in patients hospitalized due to COVID-19&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods Design</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nested case-control study within a cohort&#46; Setting&#58; 13 acute care centers of the Osakidetza-Basque Health Service&#46; Participants&#58; Patients hospitalized for COVID-19 with clinical deterioration&#8212;defined as onset of severe ARDS&#44; ICU admission&#44; or death&#8212;were considered cases&#46; Two controls were matched to each case based on age&#46; Sociodemographic data&#59; comorbidities&#59; baseline treatment&#59; symptoms&#59; date of onset&#59; previous consultations&#59; and clinical&#44; analytical&#44; and radiological variables were collected&#46; An explanatory model of clinical deterioration was created by means of conditional logistic regression&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 99 cases and 198 controls were included&#46; According to the logistic regression analysis&#44; the independent variables associated with clinical deterioration were&#58; emergency department O<span class="elsevierStyleInf">2</span> saturation &#8804;90&#37; &#40;OR 16&#46;6&#59; 95&#37;CI 4-68&#41;&#44; pathological chest X-ray &#40;OR 5&#46;6&#59; 95&#37;CI 1&#46;7-18&#46;4&#41;&#44; CRP<span class="elsevierStyleHsp" style=""></span>&#62;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;OR 3&#46;62&#59; 95&#37;CI 1&#46;62-8&#41;&#44; thrombocytopenia with &#60;<span class="elsevierStyleHsp" style=""></span>150&#44;000 platelets &#40;OR 4&#59; 95&#37;CI 1&#46;84-8&#46;6&#41;&#59; and a medical history of acute myocardial infarction &#40;OR 15&#46;7&#59; 95&#37;CI&#44; 3&#46;29-75&#46;09&#41;&#44; COPD &#40;OR 3&#46;05&#59; 95&#37;CI 1&#46;43-6&#46;5&#41;&#44; or HT &#40;OR 2&#46;21&#59; 95&#37;CI 1&#46;11-4&#46;4&#41;&#46; The model&#39;s AUC was 0&#46;86&#46; On the univariate analysis&#44; female sex and presence of dry cough and sore throat were associated with better clinical progress&#44; but were not found to be significant on the multivariate analysis&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The variables identified could be useful in clinical practice for the detection of patients at high risk of poor outcomes&#46;</p></span>"
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            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">El grupo de trabajo COVID-Osakidetza incluye a los siguientes investigadores&#58; Susana Garc&#237;a-Guti&#233;rrez&#44; Miren Orive&#44; Nerea Gonz&#225;lez&#44; Iratxe Lafuente&#44; Ane Ant&#243;n&#44; Ane Villanueva&#44; Josune Mart&#237;n&#44; Cristina Mu&#241;oz&#44; Mar&#237;a Jos&#233; Legarreta&#44; Urko Aquirre y Jos&#233; Mar&#237;a Quintana &#40;Unidad de investigaci&#243;n&#44; Hospital de Galdakao-Usansolo&#41;&#59; Pedro Pablo Espa&#241;a Yandiola&#44; Ane Uranga&#44; Mikel Egurrola&#44; Amaia Aramburu&#44; Amaia Artaraz&#44; Leire Chasco&#44; Olaia Bronte&#44; Patricia Garc&#237;a&#44; Ana Jodar&#44; Virginia Fern&#225;ndez y Crist&#243;bal Esteban &#40;Unidad respiratoria&#44; Hospital de Galdakao-Usansolo&#41;&#59; Naia Mas &#40;UCI&#44; Hospital de Galdakao-Usansolo&#41;&#59; Esther Pulido &#40;Urgencias&#44; Hospital de Galdakao-Usansolo&#41;&#59; Itxaso Bengoetxea &#40;Hospitalizaci&#243;n a domicilio&#44; Organizaci&#243;n Sanitaria Galdakao-Barrualde&#41;&#59; Antonio Escobar Mart&#237;nez&#44; Amaia Bilbao y I&#241;igo Gorostiza &#40;Unidad de investigaci&#243;n&#44; Hospital Universitario de Basurto&#41;&#59; I&#241;aki Arriaga &#40;Unidad respiratoria&#44; Hospital Universitario de Basurto&#41;&#59; Jos&#233; Joaqu&#237;n Portu Zapiarain &#40;Medicina Interna&#44; Instituto Bioaraba&#41;&#59; Naiara Parraza &#40;Unidad de investigaci&#243;n&#44; Instituto Bioaraba&#41;&#59; Milagros Iriberri&#44; Rafael Zalaca&#237;n&#44; Luis Alberto Ruiz y Leyre Serrano &#40;Unidad respiratoria&#44; Hospital Universitario de Cruces&#41;&#59; Adriana Couto y Oier Ateka &#40;Medicina Interna&#44; Hospital Universitario Donostia&#41;&#59; Arantza Cano &#40;Unidad respiratoria&#44; Hospital Santa Marina&#41;&#59; Maria Olatz Ibarra &#40;Farmacia&#44; Hospital de Urduliz&#41;&#59; Eduardo Mill&#225;n&#44; Mayte Bacigalupe&#44; Jon Letona y Andoni Arcelay &#40;Servicios Centrales Osakidetza&#41; e I&#241;aki Berraondo &#40;Departamento de Salud&#44; Gobierno Vasco&#41;&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Anexo 1"
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                  \t\t\t\t">128 &#40;64&#44;65&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&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">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consulta &#250;ltimo mes por s&#237;ntomas&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">258 &#40;87&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">81 &#40;81&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">177 &#40;89&#44;95&#41;&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"><span class="elsevierStyleHsp" style=""></span>Contacto con Atenci&#243;n Primaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tiempo entre inicio de los s&#237;ntomas y primer contacto<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \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">50 &#40;51&#44;55&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;65&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Astenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;13&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;19&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;18&#44;69&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>101-200&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Taquipneico en Urgencias</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Saturaci&#243;n O</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">en Urgencias</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IAM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;7&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0030</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad vascular perif&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Demencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;3&#44;54&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">8028</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;28&#44;96&#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 &#40;34&#44;34&#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">52 &#40;26&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1327</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad hep&#225;tica leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;8&#44;75&#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;13&#44;13&#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;6&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0718</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DM con da&#241;o org&#225;nico&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">10 &#40;3&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;7&#44;07&#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 &#40;1&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0256</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad renal&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 &#40;8&#44;08&#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">11 &#40;11&#44;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;6&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1707</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">160 &#40;53&#44;87&#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">62 &#40;62&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98 &#40;49&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0306</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coagulopat&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#44;02&#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;4&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1094</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sangrado gastrointestinal&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">9 &#40;3&#44;03&#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 &#40;5&#44;05&#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;2&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1720</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma&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">43 &#40;14&#44;48&#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 &#40;15&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;14&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">8137</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anal&#237;ticas basales</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinina<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;01 &#40;0&#44;64&#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&#44;09 &#40;0&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;96 &#40;0&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1459</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Glucosa<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109 &#91;97-126&#93;&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">117 &#91;102-140&#93;&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">105 &#91;95 - 120&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0009</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDH<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">286&#44;06 &#91;229-368&#93;&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">323&#44;21 &#91;259-425&#93;&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">273 &#91;217&#44;28-330&#44;27&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0006</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PCR<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;37 &#91;27&#44;67-106&#44;57&#93;&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">87&#44;97 &#91;44&#44;7-122&#44;12&#93;&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">48&#44;3 &#91;21&#44;12-89&#44;48&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0008</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sodio<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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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&#44;43 &#40;1&#44;709-14&#44;295&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0032&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>Disnea &#40;s&#237; vs<span class="elsevierStyleItalic">&#46;</span> no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;19 &#40;0&#44;13&#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&#44;454 &#40;0&#44;874-2&#44;418&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1495&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>Radiograf&#237;a patol&#243;gica &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;65 &#40;0&#44;23&#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&#44;692 &#40;1&#44;514-9&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\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>101-200 vs&#46;<span class="elsevierStyleHsp" style=""></span>&#62; 300&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">&#8211;0&#44;46 &#40;0&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;250 &#40;0&#44;023-2&#44;757&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;3113&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>201-300 vs&#46;<span class="elsevierStyleHsp" style=""></span>&#62; 300&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">&#8211;0&#44;46 &#40;0&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;250 &#40;0&#44;017-3&#44;660&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4235&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Taquipneico en Urgencias &#40;s&#237; vs&#46; no&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;36 &#40;0&#44;16&#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&#44;041 &#40;1&#44;096-3&#44;799&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Saturaci&#243;n O</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">en Urgencias &#40;&#8804; 90 vs&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62; 90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92 &#40;0&#44;23&#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">6&#44;291 &#40;2&#44;517-15&#44;722&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\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>IAM &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;78 &#40;0&#44;26&#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&#44;785 &#40;1&#44;699-13&#44;477&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad vascular perif&#233;rica &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;37 &#40;0&#44;22&#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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0828&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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;826 &#40;0&#44;185-3&#44;697&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;21 &#40;0&#44;14&#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&#44;526 &#40;0&#44;880-2&#44;646&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1327&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad hep&#225;tica leve &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;36 &#40;0&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;066 &#40;0&#44;938-4&#44;552&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DM con da&#241;o org&#225;nico &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;77 &#40;0&#44;35&#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&#44;667 &#40;1&#44;207-18&#44;046&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad renal &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;31 &#40;0&#44;22&#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&#44;846 &#40;0&#44;768-4&#44;436&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1707&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>HTA &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;28 &#40;0&#44;13&#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&#44;755 &#40;1&#44;054-2&#44;923&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0306&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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;79 &#40;0&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;211 &#40;1&#44;112-4&#44;397&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;0237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Saturaci&#243;n O<span class="elsevierStyleInf">2</span> &#8804; 90&#37; en urgencias &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;81 &#40;0&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;571 &#40;4&#44;030-68&#44;130&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Radiograf&#237;a patol&#243;gica &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;73 &#40;0&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Trombocitopenia<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a> &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan&#44; China"
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                    0 => array:2 [
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ORIGINAL
Factores de riesgo de deterioro clínico en pacientes ingresados por COVID-19: estudio caso-control
Risk factors for clinical deterioration in patients admitted for COVID-19: A case-control study
A. Urangaa, A. Villanuevab, I. Lafuenteb, N. Gonzálezb,c, M.J. Legarretab, U. Aguirreb,c, P.P. Españaa, J.M. Quintanab,c, S. García-Gutiérrezb,c,
Autor para correspondencia
susana.garciagutierrez@osakidetza.eus

Autor para correspondencia.
, grupo de trabajo COVID-19-Osakidetza
a Servicio de Respiratorio, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, España
b Unidad de Investigación Hospital Galdakao-Usansolo, Galdakao, Bizkaia, España
c Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, España

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