Publications by authors named "B Gracia-Tello"

19 Publications

Coexistence of immune-mediated diseases in sarcoidosis. Frequency and clinical significance in 1737 patients.

Joint Bone Spine 2021 Jun 8;88(6):105236. Epub 2021 Jun 8.

Department of Medicine, Universitat de Barcelona, Barcelona, Spain; Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain. Electronic address:

Objective: To analyze whether immune-mediated diseases (IMDs) occurs in sarcoidosis more commonly than expected in the general population, and how concomitant IMDs influence the clinical presentation of the disease.

Methods: We searched for coexisting IMDs in patients included in the SARCOGEAS-cohort, a multicenter nationwide database of consecutive patients diagnosed according to the ATS/ESC/WASOG criteria. Comparisons were made considering the presence or absence of IMD clustering, and odds ratios (OR) and their 95% confidence intervals (CI) were calculated as the ratio of observed cases of every IMD in the sarcoidosis cohort to the observed cases in the general population.

Results: Among 1737 patients with sarcoidosis, 283 (16%) patients presented at least one associated IMD. These patients were more commonly female (OR: 1.98, 95% CI: 1.49-2.62) and were diagnosed with sarcoidosis at an older age (49.6 vs. 47.5years, P<0.05). The frequency of IMDs in patients with sarcoidosis was nearly 2-fold higher than the frequency observed in the general population (OR: 1.64, 95% CI: 1.44-1.86). Significant associations were identified in 17 individual IMDs. In comparison with the general population, the IMDs with the strongest strength of association with sarcoidosis (OR>5) were common variable immunodeficiency (CVID) (OR: 431.8), familial Mediterranean fever (OR 33.9), primary biliary cholangitis (OR: 16.57), haemolytic anemia (OR: 12.17), autoimmune hepatitis (OR: 9.01), antiphospholipid syndrome (OR: 8.70), immune thrombocytopenia (OR: 8.43), Sjögren syndrome (OR: 6.98), systemic sclerosis (OR: 5.71), ankylosing spondylitis (OR: 5.49), IgA deficiency (OR: 5.07) and psoriatic arthritis (OR: 5.06). Sex-adjusted ORs were considerably higher than crude ORs for eosinophilic digestive disease in women, and for immune thrombocytopenia, systemic sclerosis and autoimmune hepatitis in men.

Conclusion: We found coexisting IMDs in 1 out of 6 patients with sarcoidosis. The strongest associations were found for immunodeficiencies and some systemic, rheumatic, hepatic and hematological autoimmune diseases.
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June 2021

Characterization and Outcomes of SARS-CoV-2 Infection in Patients with Sarcoidosis.

Viruses 2021 05 27;13(6). Epub 2021 May 27.

Department of Autoimmune Diseases, ICMiD, Hospital Clinic, 08036 Barcelona, Spain.

To analyze the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with sarcoidosis from a large multicenter cohort from Southern Europe and to identify the risk factors associated with a more complicated infection. We searched for patients with sarcoidosis presenting with SARS-CoV-2 infection (defined according to the European Centre for Disease Prevention and Control guidelines) among those included in the SarcoGEAS Registry, a nationwide, multicenter registry of patients fulfilling the American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous Disorders 1999 classification criteria for sarcoidosis. A 2:1 age-sex-matched subset of patients with sarcoidosis without SARS-CoV-2 infection was selected as control population. Forty-five patients with SARS-CoV-2 infection were identified (28 women, mean age 55 years). Thirty-six patients presented a symptomatic SARS-CoV-2 infection and 14 were hospitalized (12 required supplemental oxygen, 2 intensive care unit admission and 1 mechanical ventilation). Four patients died due to progressive respiratory failure. Patients who required hospital admission had an older mean age (64.9 vs. 51.0 years, = 0.006), a higher frequency of baseline comorbidities including cardiovascular disease (64% vs. 23%, = 0.016), diabetes mellitus (43% vs. 13%, = 0.049) and chronic liver/kidney diseases (36% vs. 0%, = 0.002) and presented more frequently fever (79% vs. 35%, = 0.011) and dyspnea (50% vs. 3%, = 0.001) in comparison with patients managed at home. Age- and sex-adjusted multivariate analysis identified the age at diagnosis of SARS-Cov-2 infection as the only independent variable associated with hospitalization (adjusted 1.18, 95% conficence interval 1.04-1.35). A baseline moderate/severe pulmonary impairment in function tests was associated with a higher rate of hospitalization but the difference was not statistically significant (50% vs. 23%, = 0.219). A close monitoring of SARS-CoV-2 infection in elderly patients with sarcoidosis, especially in those with baseline cardiopulmonary diseases and chronic liver or renal failure, is recommended. The low frequency of severe pulmonary involvement in patients with sarcoidosis from Southern Europe may explain the weak prognostic role of baseline lung impairment in our study, in contrast to studies from other geographical areas.
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May 2021

Point-of-care lung ultrasound assessment for risk stratification and therapy guiding in COVID-19 patients. A prospective non-interventional study.

Eur Respir J 2021 Feb 25. Epub 2021 Feb 25.

Internal Medicine department, Clinical Hospital "Lozano Blesa", Zaragoza, Spain.

Background: Lung ultrasound (LUS) is feasible for assessing lung injury caused by COVID-19. However, the prognostic meaning and time-line changes of lung injury assessed by LUS in COVID-19 hospitalised patients, is unknown.

Methods: Prospective cohort study designed to analyse prognostic value of LUS in COVID-19 patients by using a quantitative scale (LUZ-score) during the first 72 h after admission. Primary endpoint was in-hospital death and/or admission to the intensive care unit. Total length of hospital stay, increase of oxygen flow or escalate medical treatment during the first 72 h, were secondary endpoints.

Results: 130 patients were included in the final analysis; mean age was 56.7±13.5 years. Time since the beginning of symptoms until admission was 6 days (4-9). Lung injury assessed by LUZ-score did not differ during the first 72 h (21 points [16-26] at admission 20 points [16-27] at 72 h; p=0.183). In univariable logistic regression analysis estimated PaO2/FiO2 (HR 0.99 [0.98-0.99]; p=0.027) and LUZ-score>22 points (5.45 (1.42-20.90); p=0.013) were predictors for the primary endpoint.

Conclusions: LUZ-score is an easy, simple and fast point of care ultrasound tool to identify patients with severe lung injury due to COVID-19, upon admission. Baseline score is predictive of severity along the whole period of hospitalisation. The score facilitates early implementation or intensification of treatment for COVID-19 infection. LUZ-score may be combined with clinical variables (as estimated PAFI) to further refine risk stratification.
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February 2021

Nailfold capillaroscopy in the Spanish Group of Systemic Autoimmune Diseases (GEAS). Results of an electronic survey.

Med Clin (Barc) 2020 12 5;155(11):509-510. Epub 2019 Oct 5.

Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa , Zaragoza, España.

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December 2020

External validation of the PALIAR index for patients with advanced, nononcologic chronic diseases.

Aging Clin Exp Res 2019 Mar 6;31(3):393-402. Epub 2018 Jun 6.

Research Group on Comorbidity and Polyphatology in Aragón, Aragón Health Sciences Institute, Avda San Juan Bosco 13 (CIBA), 50009, Zaragoza, Spain.

Objective: To externally validate the PALIAR index for patients with advanced, nononcologic chronic diseases.

Methods: We performed a prospective, multicenter cohort study that included patients with advanced, nononcologic chronic diseases hospitalized in internal medicine departments and treated consecutively by the researchers between July 1st and December 31st, 2014. Data were collected from each patient on age, sex, advanced disease, Charlson index, comorbidities, Barthel index, terminal illness symptoms, need for caregiver, hospitalization in the past 3 and 12 months and number of drugs. We calculated the PALIAR index and conducted a 6-month follow-up. To analyze the association between the variables and mortality, we constructed several multivariate logistic regression models.

Results: The study included 295 patients with a mean age of 82.7 (8.6) years, 148 (50.2%) of whom were women. Mortality at 6 months was associated with the albumin level (OR 0.52, 95% CI 0.30-0.85, p = 0.011), and the terminal illness (OR 2.75, 95% CI 1.55-4.89, p = 0.001). The PALIAR index showed good discrimination for predicting mortality (statistical C, 0.728, 95% CI 0.670-0.787). A reduced version of the PALIAR index showed similar mortality discriminatory power.

Conclusions: The PALIAR index is a reliable tool for predicting mortality in patients with advanced, nononcologic chronic diseases.
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March 2019