Javier Trujillano
Universitat de Lleida, Cirurgia, Faculty Member
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) has a prognostic value in locally advanced rectal cancer (LARC). This study aimed to evaluate the ability to predict pCR using inflammatory markers,... more
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) has a prognostic value in locally advanced rectal cancer (LARC). This study aimed to evaluate the ability to predict pCR using inflammatory markers, facilitating the selection of the optimal treatment strategy. METHODS: Patients undergoing primary tumor resection after long-cycle NCRT at a single center (2012 to 2018) were retrospectively collected (n=130). Patient demographics, preoperative laboratory measurements, tumor characteristics, treatment strategy, and postoperative anatomopathological variables were collected. The association of factors to pCR was examined using binary logistic regression, odds ratio (OR) (95% confidence interval), and the discriminative capacity with the ROC curve. RESULTS: Out of 130 patients, 42 pCRs occurred, equal to 32.3% of the sample. Variables identified as useful to predict pCR were total neutrophil count (3; OR 7.6), intravenous 5-FU chemotherapy strategy (OR 3.2), and absence of diabetes (OR 3.4). Patients having all three of them had a 55.3% chance of pCR. CONCLUSIONS: The absolute neutrophil count better predicts pCR than other inflammatory indices in selected patients with LARC undergoing long-cycle NCRT. A neutrophil count less than 6400 cells/mm3, absence of diabetes, and intravenous 5-FU NCRT therapy lead to a relative rise in pCR.
Research Interests:
Research Interests:
A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery... more
A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.
Research Interests:
Research Interests:
Research Interests:
Purpose Patients with pulmonary tuberculosis (PTB) disease and positive sputum cultures are the main source of infection. Culture conversion time is inconsistent and defining the length of respiratory isolation is challenging. The... more
Purpose Patients with pulmonary tuberculosis (PTB) disease and positive sputum cultures are the main source of infection. Culture conversion time is inconsistent and defining the length of respiratory isolation is challenging. The objective of this study is to develop a score to predict the length of isolation period. Methods A retrospective study was carried out to evaluated risk factors associated with persistent positive sputum cultures after 4 weeks of treatment in 229 patients with PTB. A multivariable logistic regression model was used to determinate predictors for positive culture and a scoring system was created based on the coefficients of the final model. Results Sputum culture was persistently positive in 40.6%. Fever at consultation (1.87, 95% CI:1.02–3.41), smoking (2.44, 95% CI:1.36–4.37), > 2 affected lung lobes (1.95, 95% CI:1.08–3.54), and neutrophil-to-lymphocyte ratio > 3.5 (2.22, 95% CI:1.24–3.99), were significantly associated with delayed culture conversi...
Research Interests:
Objetivo: a) establecer que variables funcionales, de tratamiento y analiticas tienen capacidad pronostica independiente en pacientes con cancer en situacion de enfermedad terminal; y b) desarrollar una ecuacion logistica que defina un... more
Objetivo: a) establecer que variables funcionales, de tratamiento y analiticas tienen capacidad pronostica independiente en pacientes con cancer en situacion de enfermedad terminal; y b) desarrollar una ecuacion logistica que defina un modelo predictivo util para un paciente con cancer terminal. Material y metodo: estudio prospectivo realizado en pacientes con cancer avanzado sin tratamiento curativo. Variable dependiente: supervivencia igual o inferior a 30 dias; variables independientes: situacion funcional, tratamiento, parametros bioquimicos y hematologicos procedentes de una muestra de sangre periferica y accesibles al medico de cabecera. Analisis estadistico: descriptivo; univariable mediante t de Student y Chi cuadrado y multivariable mediante regresion logistica. Paquete SPSS Windows 2000. Resultados: se incluyeron 130 evaluaciones procedentes de 73 pacientes. La edad media fue de 68.89 (DT 11,54). El 60% fueron hombres. Las neoplasias mas frecuentes fueron: tubo digestivo 3...
Research Interests:
Research Interests:
Research Interests:
Background: Reference intervals are a fundamental tool for characterizing the health status in a given population and play a central role in defining diagnostic values in clinical applications. Estimation of the conditional distribution... more
Background: Reference intervals are a fundamental tool for characterizing the health status in a given population and play a central role in defining diagnostic values in clinical applications. Estimation of the conditional distribution of a variable, as the body mass index (BMI), is necessary for providing reference values when there is a trend as a function of the covariate. Subjects and method: We studied 1453 boys and young between 5 and 16 years old measured in a study carried out in the schools of Lleida (Spain). BMI conditional distributions with age have been derived using a new parametric method based on the one proposed by Sorribas et al. [Stat. Med. (2000) 19:697-713]. This method is based on S-distributions as a parametric model for the distribution and uses maximum likelihood estimation of the conditional distribution. Results: The methods commonly used for estimating reference curves are based on a smoothing of sample quantiles using different techniques. However, these methods do not provide information on the conditional distribution of the target variable. Our method provides an estimation of such distribution and the corresponding reference curves for the quantiles as a function of a covariate, in our case age. Conclusions: The suggested methodology provides appropriate reference quantiles for the BMI. Our results allow characterizing the change in distribution within the age range considered. Besides describing a raise in BMI with age, we observe an increase in dispersion around puberty. This must be considered when using BMI as a diagnostic variable.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
... Figs. 2a y b. Comparación entre la neurona biológica (A) y la neurona artifi-cial (B). (Véase texto.) Sinapsis Potencial de acción Axón Dendritas a1 a2 a3 an Wj1 Wj2 Wj3 Wjn f( ) θj ∑ Sj Wji ai θj i = 0 n = Función de red Sj Yi Axón... more
... Figs. 2a y b. Comparación entre la neurona biológica (A) y la neurona artifi-cial (B). (Véase texto.) Sinapsis Potencial de acción Axón Dendritas a1 a2 a3 an Wj1 Wj2 Wj3 Wjn f( ) θj ∑ Sj Wji ai θj i = 0 n = Función de red Sj Yi Axón Función de activación Dendritas A B Page 3. ...
Research Interests:
Objective: To compare the ability of an artificial neural network (ANN) to predict hospital mortality with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) system and multiple logistic regression (LR). A secondary... more
Objective: To compare the ability of an artificial neural network (ANN) to predict hospital mortality with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) system and multiple logistic regression (LR). A secondary objective was to compare the allocation of individual probability among the models. Method: The variables required for calculating the APACHE II were prospectively collected. A total of 1146 patients were divided (randomly 70% and 30%) into the Development (800) and the Validation (346) sets. With the same variables an LR model and an ANN were carried out (a 3-layer perceptron trained by algorithm backpropagation with bootstrap resampling and with 9 nodes in the hidden layer) in the Development set. The models developed were contrasted with the Validation set and their discrimination properties were evaluated using the area under the ROC curve (AUC [95% CI]) and calibration with the Hosmer-Lemeshow C (HLC) test. Differences between the probabilities were evaluated using the Bland-Altman test. Results: The Validation set showed an APACHE II with an AUC = 0.79 (0.75-0.84) and HLC = 11 (p = 0.329); LR model AUC = 0.81 (0.76-0.85) and HLC = 29 (p = 0.0001) and an ANN AUC = 0.82 (0.77-0.86) and HLC = 10 (p = 0.404). The patients with the most important differences in the allocation of probability between LR and ANN (8% of the total) were neurological. The worst results were found in trauma patients with an AUC of not greater than 0.75 in all the models. In respiratory patients, the ANN achieved the best AUC = 0.87 (0.78-0.91). Conclusions: The ANN was able to stratify hospital mortality risk by using the APACHE II system variables. The ANN tended to achieve better results than LR, since, in order to work, it does not require lineal restrictions or independent variables. Allocation of individual probability differed in each model.
Research Interests:
Research Interests:
Research Interests:
ABSTRACT
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
de hepatotoxicidad asociados principalmente con fluvoxamina, fluoxetina, paroxetina y sertralina. En una revisión a través de MEDLINE desde 1966 hasta marzo 2007 sobre daño hepático inducido por antidepresivos, se publicó que la mayorı́a... more
de hepatotoxicidad asociados principalmente con fluvoxamina, fluoxetina, paroxetina y sertralina. En una revisión a través de MEDLINE desde 1966 hasta marzo 2007 sobre daño hepático inducido por antidepresivos, se publicó que la mayorı́a de los antidepresivos tenı́an el potencial de producir daño hepático idiopático y, por definición, éstos no podı́an predecirse sobre la base de la dosis o los factores de riesgo especı́fico. Fluoxetina y paroxetina presentaron el mayor número de casos entre los ISRS. Nefazodona, un inhibidor de la recaptación de norepinefrina y serotonina, parece tener los casos más graves y es el único antidepresivo que tiene un black box warning de la FDA en relación con la hepatoxicidad. Los antidepresivos tricı́clicos y los inhibidores de la monoaminooxidasa (IMAO) pueden también producir hepatoxicidad, pero se han reportado pocos casos en los últimos 15 años, posiblemente por la disminución en su utilización. Esta supuesta mayor seguridad de los ISRS podrı́a explicar, en parte, el considerable incremento que su consumo ha experimentado en nuestro paı́s. Entre los ISRS se encuentra el citalopram, que está prácticamente desprovisto de efecto sobre la recaptación de noradrenalina, dopamina y ácido gammaminobutı́rico. Esta selectividad podrı́a explicar la baja incidencia de sus efectos adversos. Está indicado en el tratamiento de episodios depresivos mayores, el tratamiento preventivo de recaı́das y recurrencias, el trastorno de angustia con o sin agorafobia y el trastorno obsesivo compulsivo. Se elimina principalmente por vı́a hepática (85%) y el 15% restante se elimina por vı́a renal. Interacciona con IMAO no selectivos, IMAO selectivos A y B, pimozida, carbamacepina e imipramina. Aunque se han descrito casos excepcionales de incremento de valores de aminotransferasas, es muy rara la hepatitis. Presentamos el caso de un paciente de 83 años con antecedentes de diabetes mellitus de tipo 2, insuficiencia renal crónica, adenocarcinoma de próstata tratado con quimioterapia y radioterapia, con colitis actı́nica, infartos lacunares, insuficiencia cardı́aca y probable hidrocefalia normotensiva, que recibı́a tratamiento con furosemida, bisoprolol, ácido acetilsalicı́lico, clorpromazina e insulina glargina. Todo esto desde hacı́a varios meses, sin que hubiera presentado alteraciones analı́ticas. A raı́z de un cuadro de postración y adinamia, se habı́a iniciado tratamiento con 20 mg diarios de citalopram, 4 dı́as antes, por sospecha de sı́ndrome depresivo. En el ingreso presentó analı́tica con glucosa de 307 mg/dl; urea de 137 mg/dl; creatinina de 2,75 mg/dl; (AST) de 1.516 U/l; (ALT) de 1.155 U/l; GGT de 111 U/l; fosfatasa alcalina de 222 U/l, y LDH de 2.324 U/l (VN: 5 – 41). La serologı́a para los virus de hepatitis A, B y C fue negativa, ası́ como la serologı́a para el herpes virus. El estudio inmunológico con ANA, AMA, ASMA, antiLKM y anticitosol hepático resultó negativo. La ecografı́a abdominal no mostró alteraciones hepáticas. Se retiró el citalopram al
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
ABSTRACT
Research Interests:
Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient... more
Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient characteristics, disease severity, nutritional status, type of nutritional therapy and outcomes, and laboratory parameters were collected in a database. Statistical differences were analyzed according to the administration of IMN or other types of enteral formulas. Results: In total, 406 patients were included in the analysis, of whom 15.02% (61) received IMN. Univariate analysis showed that patients treated with IMN formulas received higher mean caloric and protein intake, and better 28-day survival (85.2% vs. 73.3%; p = 0.014. Unadjusted Hazard Ratio (HR): 0.15; 95% CI (Confidence Interval): 0.06–0.36; p < 0.001). Once adjusted for confounding factors, multivariate analysis showed a lower need for vasopressor support (OR: 0.49; 95% CI: 0.26–0.91...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Background Severity scores are commonly used for outcome adjustment and benchmarking of trauma care provided. No specific models performed only with critically ill patients are available. Our objective was to develop a new score for early... more
Background Severity scores are commonly used for outcome adjustment and benchmarking of trauma care provided. No specific models performed only with critically ill patients are available. Our objective was to develop a new score for early mortality prediction in trauma ICU patients. Methods This is a retrospective study using the Spanish Trauma ICU registry (RETRAUCI) 2015–2019. Patients were divided and analysed into the derivation (2015–2017) and validation sets (2018–2019). We used as candidate variables to be associated with mortality those available in RETRAUCI that could be collected in the first 24 h after ICU admission. Using logistic regression methodology, a simple score (RETRASCORE) was created with points assigned to each selected variable. The performance of the model was carried out according to global measures, discrimination and calibration. Results The analysis included 9465 patients: derivation set 5976 and validation set 3489. Thirty-day mortality was 12.2%. The p...
Research Interests:
Extensive dataset accounting for mortality studies in an Intensive Care Unit
Table S1. Differential metabolites according mortality (full list). Figure S1. Clinical specificity for metabolomics signature. A. PLS-DA analyses shows that metabolome is able to discriminate between those patients who survive and those... more
Table S1. Differential metabolites according mortality (full list). Figure S1. Clinical specificity for metabolomics signature. A. PLS-DA analyses shows that metabolome is able to discriminate between those patients who survive and those patients who do not survive. Although the metabolomic profile of survived patients is homogenous, one of the non-surviving patients had a specific metabolomic profile (black arrow). B. Heatmap hierarchical clustering analyses using the 25 metabolites with the lowest p value (T-Student test) confirms that one patient has a specific metabolomic profile (black arrow). PLS-DA cross-validation details (4 components): Accuracy: 0.91, R2: 0.96, Q2: -0.141. The negative value of Q2 means that the model is not all predictive or is overfitted, probably because the low number of not surviving patients. (DOCX 239 kb)
Research Interests:
Research Interests:
Palliative Performance Scale (PPS) is a reliable tool to assess performance status in cancer patients receiving palliative care. Spanish validated and culturally adapted tools are needed. To develop PPS translation and cross-cultural... more
Palliative Performance Scale (PPS) is a reliable tool to assess performance status in cancer patients receiving palliative care. Spanish validated and culturally adapted tools are needed. To develop PPS translation and cross-cultural adaptation into Spanish. To assess its psychometric properties. Translation process with cross-cultural adaptation to produce Spanish Palliative Performance Scale (PPS-SPANISH). Palliative Care Team at one University hospital in Spain. 15 advanced cancer patients (60 assessments) were included for PPS translation and validation and 250 patients for cross-sectional analysis. All participants were recruited at oncology ward, emergency area and outpatient clinic by palliative care team professionals. Informed consent was given. Average age was 66.4 ± 13 (60% men). Process designed in three steps. Step 1, PPS translation and reverse translation into Spanish (3 bilingual speakers). Linguistic complexity measurement. Step 2, readability and intelligibility as...
Research Interests:
Research Interests:
Risk factors for the deterioration of quality of life in critical trauma patients. Assessment at 6 and 12 months after discharge from the intensive care unit | Factores de riesgo de deterioro de calidad de vida en pacientes traumáticos críticos. Valoración a los 6 y 12 meses del alta de la unidad...more
To evaluate factors influencing the deterioration of health-related quality of life (HRQoL) in trauma patients admitted to an ICU. A prospective observational study was carried out. The combined medical/surgical ICU in a university... more
To evaluate factors influencing the deterioration of health-related quality of life (HRQoL) in trauma patients admitted to an ICU. A prospective observational study was carried out. The combined medical/surgical ICU in a university secondary hospital with 24-hour neurosurgery service. Trauma patients admitted to the ICU during a two-year period. HRQoL assessment prior to admission to the ICU, and at 6 and 12 months after discharge. Demographic variables, type and severity of injury (AIS), severity (APACHE II, ISS, TRISS), length of stay, procedures, mortality and HRQoL according to the SF-36 and EQ-5D. We completed the monitoring of 110 patients that showed significant impairment of their HRQoL in all the dimensions assessed. According to the SF-36, physical role was more deteriorated at 12 months, but the mental component decreased more than the physical component after 6 months. The VAS scale of the EQ-5D decreased to 55 at 6 months (19) and increased to 66 at 12 months (17). In the multiple logistic regression analysis, the variables associated with poorer HRQoL were age &amp;amp;amp;amp;gt; 45 years, TRISS &amp;amp;amp;amp;gt; 10, previous porer quality of life, and serious injuries in the extremities. Patients showed marked deterioration of their HRQoL at 6 months, followed by overall improvement at 12 months, though without reaching their previous state. The factors that determine poorer quality of life include age, severity, previous HRQoL, and severe injuries in the extremities.