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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">El 31 de diciembre de 2019 las autoridades sanitarias de China informaron a la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41; de la aparici&#243;n de una serie de casos de neumon&#237;a relacionados con un mercado de animales vivos de la ciudad de Wuhan&#46; Tras la diseminaci&#243;n mundial de esta infecci&#243;n&#44; producida por el coronavirus SARS-CoV-2&#44; la OMS la declar&#243; pandemia COVID-19 el 11 de marzo de 2020<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Desde entonces&#44; se ha observado que existe una amplia variedad de manifestaciones cl&#237;nicas&#44; y de severidad de los pacientes&#44; desde positivos asintom&#225;ticos o paucisintom&#225;ticos hasta aquellos casos con riesgo vital con afectaci&#243;n respiratoria grave<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a>&#46; El da&#241;o pulmonar severo podr&#237;a deberse a la activaci&#243;n de una tormenta de citoquinas que producen una hiperinflamaci&#243;n y que son responsables&#44; por otro lado&#44; de la actividad inflamatoria de las enfermedades inflamatorias inmunomediadas &#40;IMID&#41;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;6&#44;7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Conocemos que la propia fisiopatolog&#237;a de la IMID predispone a un aumento del riesgo infeccioso al modificar la respuesta inmune del hu&#233;sped&#44; la cual resulta crucial para la resoluci&#243;n de la infecci&#243;n por SARS-CoV-2<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; En las IMID se han utilizado como tratamiento diversas terapias a lo largo de los a&#241;os&#44; si bien los f&#225;rmacos modificadores de la enfermedad biol&#243;gicos y peque&#241;as mol&#233;culas inhibidoras de la janus-kinasas &#40;JAK&#41;&#44; que act&#250;an bloqueando la expresi&#243;n de citoquinas proinflamatorias como la interleucina IL-1&#44; IL-6&#44; factor de necrosis tumoral TNF&#945;&#44; que utilizan las v&#237;as JAK para transmitir se&#241;ales intracelulares&#44; han supuesto una revoluci&#243;n en el manejo y control de los brotes en las &#250;ltimas d&#233;cadas<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;5&#44;8</span></a>&#46; Por todo ello&#44; con el objetivo de mejorar el pron&#243;stico de aquellos pacientes m&#225;s graves&#44; se han introducido en los protocolos de tratamiento de SARS-CoV-2 estos agentes biol&#243;gicos y peque&#241;as mol&#233;culas<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a>&#44; como tocilizumab&#44; anakinra o baricitinib&#44; que&#44; desde un punto de vista m&#225;s te&#243;rico&#44; pueden modificar la evoluci&#243;n de la enfermedad y mejorar el pron&#243;stico vital de los pacientes afectados por el SARS-CoV-2&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las evidencias que existen sobre el riesgo de contraer la infecci&#243;n por SARS-CoV-2 y el pron&#243;stico en los pacientes que padecen IMID son limitadas&#46; Hasta el momento se ha publicado que tanto la prevalencia como el comportamiento de estas enfermedades inflamatorias no difieren en este grupo poblacional<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">9&#8211;13</span></a>&#44; y que los tratamientos de base empleados para su tratamiento no empeoran el pron&#243;stico de la infecci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">11&#8211;13</span></a>&#46; Sin embargo&#44; en una reciente publicaci&#243;n realizada con poblaci&#243;n espa&#241;ola&#44; se ha observado cierto impacto de padecer una IMID&#44; y las diferentes terapias de las mismas&#44; en la infecci&#243;n por SARS-CoV-2<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a>&#46; Adem&#225;s&#44; la r&#225;pida expansi&#243;n de la infecci&#243;n por COVID-19 mundialmente hace cuestionarnos el impacto que pueda tener el virus sobre las pacientes embarazadas&#46; Recientemente&#44; el Centro para la Prevenci&#243;n y el Control de Enfermedades &#40;CDC&#44; por sus siglas en ingl&#233;s&#41;&#44; en funci&#243;n de las evidencias actuales&#44; ha determinado que las mujeres embarazadas tienen un riesgo incrementado de padecer la infecci&#243;n COVID-19 respecto a la poblaci&#243;n general y mayor riesgo de parto pret&#233;rmino<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a>&#46; Como agravante&#44; las pacientes embarazadas diagnosticadas de enfermedades reum&#225;ticas presentan un estatus inmunocomprometido&#44; que a&#241;adido al uso de tratamientos modificadores de la enfermedad&#44; puede representar para este grupo de pacientes una mayor susceptibilidad a contraer la infecci&#243;n por coronavirus<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a>&#46; Sin embargo&#44; el n&#250;mero de casos reportados de pacientes embarazadas con enfermedades inflamatorias es limitado y se desconoce el impacto del coronavirus sobre las mismas&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nuestro estudio analiza&#44; dentro de una cohorte de pacientes hospitalizados en nuestro centro por infecci&#243;n por SARS-CoV-2&#44; las caracter&#237;sticas demogr&#225;ficas&#44; cl&#237;nicas y el pron&#243;stico vital de aquellos pacientes que presentaban una IMID&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Realizamos un estudio observacional de cohortes retrospectivo&#44; llevado a cabo en un hospital universitario espa&#241;ol que dispone de 258 camas de hospitalizaci&#243;n&#44; incluyendo 12 en Unidad de Cuidados Intensivos &#40;UCI&#41;&#44; y atiende a una poblaci&#243;n de alrededor de 190&#46;000 habitantes&#46; Se incluyeron pacientes de 18 a&#241;os o mayores ingresados en un hospital universitario de manera consecutiva&#44; con infecci&#243;n por el virus SARS-CoV-2&#44; del 26 de febrero al 20 de mayo 2020&#44; ambas fechas inclusive&#46; La infecci&#243;n por el virus SARS-CoV-2 fue confirmada mediante test diagn&#243;stico de reacci&#243;n en cadena de la polimerasa &#40;PCR&#41; en una muestra de exudado nasofar&#237;ngeo o de esputo&#46; En caso de resultado negativo&#44; se realizaba un segundo test si la cl&#237;nica del paciente era altamente sugestiva y&#47;o presentaba criterios anal&#237;ticos o radiol&#243;gicos sugestivos de la infecci&#243;n<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a>&#46; Se excluyeron los pacientes que denegaron su consentimiento informado a los tratamientos para infecci&#243;n por SARS-CoV-2 aprobados en el protocolo del hospital&#44; as&#237; como los reingresos de un mismo paciente teni&#233;ndose en cuenta &#250;nicamente el primer episodio de ingreso hospitalario&#46; Se incluyeron mujeres embarazadas o en periodo de lactancia&#46; Los pacientes fueron tratados siguiendo el criterio m&#233;dico y los protocolos locales de tratamiento&#44; elaborados seg&#250;n las recomendaciones de las autoridades sanitarias&#44; basadas en la evidencia cient&#237;fica disponible en cada momento<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los datos demogr&#225;ficos&#44; comorbilidades&#44; s&#237;ntomas cl&#237;nicos&#44; resultados de laboratorio&#44; pruebas radiol&#243;gicas y tratamiento de cada paciente fueron obtenidos de la historia cl&#237;nica electr&#243;nica del hospital&#46; Las IMID que se incluyeron fueron artritis reumatoide &#40;AR&#41;&#44; artritis psori&#225;sica &#40;APs&#41;&#44; espondilitis anquilosante &#40;SpA&#41;&#44; lupus eritematoso sist&#233;mico &#40;LES&#41;&#44; polimialgia reum&#225;tica &#40;PMR&#41;&#44; arteritis de c&#233;lulas gigantes &#40;ACG&#41;&#44; s&#237;ndrome de Sj&#246;gren &#40;SS&#41;&#44; vasculitis&#44; esclerodermia sist&#233;mica &#40;ES&#41;&#44; psoriasis &#40;Pso&#41;&#44; enfermedad de Crohn &#40;EC&#41;&#44; colitis ulcerosa &#40;CU&#41; y otras enfermedades autoinmunes &#40;incluyendo enfermedad de Beh&#231;et y miopat&#237;as inflamatorias&#41;&#46; La APs y la Pso se englobaron dentro del concepto de enfermedad psori&#225;sica &#40;EPs&#41;&#46; Tambi&#233;n se recogieron los datos de pacientes que recib&#237;an tratamiento de la enfermedad inflamatoria en forma de variable dicot&#243;mica s&#237;&#47;no&#44; incluyendo los tratamientos biol&#243;gicos y los inhibidores de JAK&#46; Los datos cl&#237;nicos fueron recogidos por descarga directa o mediante revisi&#243;n manual individualizada de la historia cl&#237;nica electr&#243;nica&#46; Se dise&#241;&#243; un formulario seguro de recogida de datos en el programa corporativo de historia cl&#237;nica para el resto de los datos demogr&#225;ficos&#44; comorbilidades&#44; s&#237;ntomas cl&#237;nicos y pruebas radiol&#243;gicas&#46; Para asegurar la correcta recogida&#44; estos formularios fueron validados por los investigadores principales&#44; MRV y DEQ&#44; antes de incorporarlos a la base de datos&#44; con el objetivo de mejorar la calidad de los datos recogidos y disminuir en lo posible los datos perdidos&#46; Los datos de car&#225;cter personal eran disociados y pseudoanonimizados en la base de datos para su posterior an&#225;lisis estad&#237;stico por un experto independiente&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0035" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis estad&#237;stico&#44; las variables cuantitativas se expresan mediante medianas y rango intercuart&#237;lico &#40;RIQ&#41;&#46; En el an&#225;lisis de diferencias de medias se utiliz&#243; la prueba T de Student para las variables con distribuci&#243;n normal y la U de Mann-Whitney para variables con distribuci&#243;n no normal&#46; Las variables categ&#243;ricas se representan como frecuencias absolutas y porcentajes&#46; Para contrastar las variables categ&#243;ricas se utiliz&#243; la prueba de &#967;<span class="elsevierStyleSup">2</span> Pearson o la prueba exacta de Fisher&#44; y en caso necesario&#44; la prueba de tendencia de Mantel-Haenszel&#46; El nivel de significaci&#243;n estad&#237;stica adoptado para todas las pruebas de contraste fue de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; El an&#225;lisis y tratamiento estad&#237;stico de los datos se realiz&#243; mediante el paquete estad&#237;stico SPSS &#40;IBM Corp&#46; Released 2010&#46; IBM SPSS Statistics for Windows&#44; Version 19&#46;0&#46; Armonk&#44; NY&#58; IBM Corp&#46;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El protocolo del estudio fue aprobado el 22 de junio por el Comit&#233; &#201;tico de Investigaci&#243;n con medicamentos &#40;CEIm&#41; previo a su realizaci&#243;n y clasificado por la Agencia Espa&#241;ola de Medicamentos y Productos Sanitarios &#40;AEMPS&#41;&#46; Se obtuvo la exenci&#243;n de solicitar el consentimiento informado por escrito a los pacientes&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0045" class="elsevierStylePara elsevierViewall">De los 612 pacientes con sospecha de infecci&#243;n por SARS-CoV-2 al inicio del ingreso&#44; 246 tuvieron PCR positiva&#44; y 23 padec&#237;an una IMID&#44; de los cuales en 9 pacientes se confirm&#243; la enfermedad infecciosa por PCR &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Las IMID m&#225;s frecuentes fueron las siguientes por este orden&#58; enfermedad psori&#225;sica &#40;43&#44;5&#37;&#41;&#44; colitis ulcerosa &#40;26&#44;1&#37;&#41;&#44; Crohn &#40;17&#44;4&#37;&#41; y enteritis &#40;13&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">De entre los pacientes ingresados con sospecha de infecci&#243;n por SARS-CoV-2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>612&#41;&#44; 23 presentaban una IMID&#44; 12 mujeres &#40;44&#44;7&#37;&#41; y 11 hombres &#40;55&#44;3&#37;&#41;&#44; y no se registraron mujeres embarazadas&#46; De los 23 pacientes con IMID&#44; 9 de ellos fueron diagnosticados de infecci&#243;n por SARS-CoV-2&#44; frente a 14 pacientes en los que se descart&#243; esta infecci&#243;n&#46; No se observ&#243; correlaci&#243;n entre infecci&#243;n por SARS-CoV-2 e IMID &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;55&#41;&#46; Asimismo&#44; no se observaron diferencias estad&#237;sticas ni por edad ni por sexo entre los pacientes ingresados con IMID&#44; infectados y no infectados&#58; 5 mujeres infectadas &#40;55&#44;6&#37;&#41; vs&#46; 7 mujeres no infectadas &#40;50&#37;&#41;&#44; 4 hombres infectados &#40;36&#44;4&#37;&#41; vs&#46; 7 hombres no infectados &#40;50&#37;&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La IMID m&#225;s prevalente entre los infectados fue la EPs sin observarse&#44; igualmente&#44; diferencias estad&#237;sticamente significativas con respecto al resto de IMID detectadas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Los s&#237;ntomas de inicio de la infecci&#243;n que presentaron los pacientes con enfermedades inflamatorias fueron similares en frecuencia a los del resto de pacientes estudiados&#58; la fiebre fue el s&#237;ntoma m&#225;s frecuente observado al ingreso &#40;78&#44;3&#37;&#41;&#44; seguido por disnea &#40;43&#44;5&#37;&#41; y tos seca &#40;43&#44;5&#37;&#41; &#40;datos pendientes de publicaci&#243;n&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Al analizar las comorbilidades que presentaron los pacientes con IMID&#44; no se observaron diferencias respecto al resto de pacientes ingresados en relaci&#243;n con caracter&#237;sticas demogr&#225;ficas&#44; los factores de riesgo cardiovascular o neumopat&#237;as cr&#243;nicas&#46; Sin embargo&#44; se observ&#243; una tendencia a presentar mayor porcentaje de obesidad &#40;38&#44;5&#37; vs&#46; 22&#44;7&#37;&#41; y tratamientos con inhibidores de la enzima convertidora de angiotensina &#40;IECA&#41; o antagonistas de los receptores de angiotensina II &#40;ARAII&#41; &#40;65&#44;4&#37; vs&#46; 42&#44;8&#37;&#41;&#44; respecto al resto de los pacientes que ingresaron por sospecha de infecci&#243;n por SARS-CoV-2&#44; por lo que&#44; a pesar de que las diferencias no fueron estad&#237;sticamente significativas&#44; los pacientes con IMID presentaban con mayor frecuencia factores de riesgo cardiovascular&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Al analizar los 23 pacientes con IMID&#44; se observaron diferencias que no alcanzaron la significaci&#243;n estad&#237;stica entre los infectados y los no infectados&#44; en relaci&#243;n con la enfermedad cardiovascular &#40;44&#44;4&#37; en infectados vs&#46; 7&#44;1&#37; en no infectados&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41;&#44; y en obesidad &#40;55&#44;6&#37; en infectados vs&#46; 14&#44;3&#37; en no infectados p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#41;&#46; Respecto a la presencia de enfermedad tromboemb&#243;lica&#44; hipertensi&#243;n arterial &#40;HTA&#41;&#44; diabetes mellitus &#40;DM&#41; o cardiopat&#237;a isqu&#233;mica&#44; tampoco se observaron diferencias entre los infectados y los no infectados&#46; Tampoco en el uso de tratamientos domiciliarios con IECA&#44; anticoagulantes&#44; glucocorticoides &#40;GC&#41;&#44; f&#225;rmacos modificadores de la enfermedad o tratamientos biol&#243;gicos&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Entre los pacientes con IMID&#44; no se registr&#243; ning&#250;n brote de la enfermedad de base durante la estancia hospitalaria&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En nuestra cohorte se recogieron datos sobre el n&#250;mero de d&#237;as con s&#237;ntomas que presentaron los pacientes previamente al ingreso hospitalario&#44; y el n&#250;mero de d&#237;as de estancia hospitalaria&#46; Al analizar esta informaci&#243;n&#44; no se observaron diferencias significativas entre pacientes que presentaban IMID y los que no&#46; Tampoco se observaron diferencias en los ingresos en UCI entre los pacientes con IMID y sin ella &#40;3&#44;8&#37; vs&#46; 3&#44;9&#37;&#41;&#46; En cuanto al resultado de fallecimiento&#44; que ocurri&#243; en 43 pacientes infectados &#40;16&#44;9&#37;&#41;&#44; tampoco se observaron diferencias entre los pacientes con o sin IMID &#40;19&#44;2&#37; vs&#46; 16&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;73&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">A diferencia de los estudios publicados hasta la fecha&#44; en nuestra cohorte se evaluaron las caracter&#237;sticas epidemiol&#243;gicas y cl&#237;nicas de los pacientes con IMID&#44; que&#44; por la gravedad a su llegada al servicio de urgencias del hospital&#44; requirieron hospitalizaci&#243;n por sospecha de infecci&#243;n por SARS-CoV-2&#46; Hasta el momento se han publicado art&#237;culos de prevalencia de infecci&#243;n por SARS-CoV-2 en pacientes con IMID en diferentes zonas geogr&#225;ficas&#44; principalmente europeas<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">9&#44;13&#44;19</span></a>&#46; Adem&#225;s&#44; se han descrito las caracter&#237;sticas de pacientes con antecedentes de IMID y el impacto de la propia enfermedad o los tratamientos relacionados con la morbimortalidad de la enfermedad por SARS-CoV-2<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12&#44;14</span></a>&#44; que no demuestra una asociaci&#243;n entre los tratamientos inmunosupresores con las complicaciones respiratorias asociadas a la infecci&#243;n por COVID-19<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a>&#46; Nuestro estudio no permite establecer la prevalencia poblacional de la enfermedad por SARS-CoV-2 entre los pacientes que presentan una IMID en nuestra &#225;rea&#44; pero s&#237; permite describir la prevalencia de infecci&#243;n por SARS-CoV-2 entre los pacientes con IMID hospitalizados por sospecha de la infecci&#243;n&#44; as&#237; como la evoluci&#243;n cl&#237;nica de los mismos&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Seg&#250;n la distribuci&#243;n por patolog&#237;as observada en nuestra poblaci&#243;n de estudio&#44; 23 pacientes presentaban enfermedades incluidas dentro del espectro de las IMID&#46; Las patolog&#237;as que se identificaron entre los pacientes que ingresaron con una IMID fueron la APs&#44; Pso&#44; EC y CU&#46; No se recogieron ingresos de pacientes con AR&#44; SpA&#44; LES&#44; u otras conectivopat&#237;as&#46; Estos resultados est&#225;n alineados con los de otros grupos de trabajo<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8&#44;14&#44;19</span></a>&#44; donde los datos agregados de los pacientes con IMID presentaron m&#225;s casos de infecci&#243;n por SARS-CoV-2 respecto al de otras patolog&#237;as autoinmunes&#46; No se registraron pacientes con PMR&#44; a pesar de que es una patolog&#237;a t&#237;pica de edades avanzadas&#44; factor asociado a mayor gravedad de la infecci&#243;n v&#237;rica&#44; cuyo tratamiento de base son los GC&#46; Podr&#237;a ser que los pacientes acudieron menos al hospital siguiendo las recomendaciones sanitarias o por dificultades en la movilidad&#46; Cabe destacar que la prevalencia de la infecci&#243;n en LES fue menor que otras enfermedades&#44; tal vez porque el uso de GC en pacientes con LES se comporte como un factor protector frente a la enfermedad grave por COVID-19&#44; ya que el tratamiento con GC en casos severos por COVID-19 ha demostrado ser beneficioso sobre el desenlace de la infecci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">21&#44;22</span></a>&#46; Sin embargo&#44; la hidroxicloroquina&#44; que representa el tratamiento de base para el LES&#44; no ha demostrado mejorar el curso cl&#237;nico del SARS-CoV2<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a>&#44; a pesar de que al inicio de la pandemia se administr&#243; a pacientes infectados bajo la hip&#243;tesis de mejorar el pron&#243;stico de la enfermedad&#46; El n&#250;mero reducido de pacientes con IMID en nuestra cohorte no permite extraer unas conclusiones firmes sobre el efecto que tiene la enfermedad inflamatoria o los tratamientos inmunosupresores de base sobre la evoluci&#243;n de la infecci&#243;n por COVID-19&#46; Sin embargo&#44; impresiona que los pacientes inmunocomprometidos no presentan mayor morbilidad o mortalidad por SARS-CoV-2 respecto a otros pacientes&#44; tal como se ha descrito en otras series<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8&#44;12</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En nuestra cohorte no se registraron pacientes embarazadas con enfermedades reum&#225;ticas que requirieran ingreso por infecci&#243;n por SARS-CoV-2&#44; de la misma manera que no se registraron en otros grupos europeos<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a>&#44; pese a la mayor predisposici&#243;n a la infecci&#243;n que presentan por la asociaci&#243;n entre embarazo&#44; IMID y tratamientos inmunosupresores&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La presentaci&#243;n cl&#237;nica de los pacientes que padec&#237;an una IMID&#44; as&#237; como la gravedad al ingreso&#44; son similares a las del resto de pacientes de nuestra cohorte de estudio&#46; De forma similar&#44; los pacientes con enfermedades reumatol&#243;gicas de otras series presentaron m&#225;s frecuentemente tos seca&#44; disnea y fiebre<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8&#44;12&#44;19</span></a>&#46; Sin embargo&#44; como se ha comentado en otras series de pacientes con enfermedades inflamatorias cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a>&#44; en nuestra poblaci&#243;n los pacientes con IMID presentan m&#225;s comorbilidades&#44; y concretamente un porcentaje de obesidad mayor&#46; La obesidad es un factor determinante en la enfermedad cardiovascular de las enfermedades IMID&#44; y ha sido reconocida como una importante causa de morbimortalidad de estas&#46; Asimismo&#44; la obesidad se comporta como factor de riesgo de infecci&#243;n m&#225;s grave por SARS-CoV-2<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a> y por ende&#44; peor evoluci&#243;n cl&#237;nica&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">De los pacientes que ingresaron con IMID&#44; se suspendi&#243; el tratamiento inmunosupresor de base seg&#250;n las recomendaciones de las sociedades cient&#237;ficas<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">26&#44;27</span></a>&#46; A pesar de todo&#44; no se describi&#243; ninguna reagudizaci&#243;n de la enfermedad de base&#46; El tratamiento que recibieron los pacientes fue id&#233;ntico al del resto de hospitalizados por la infecci&#243;n&#44; siguiendo las recomendaciones de las gu&#237;as nacionales y el protocolo de nuestro hospital&#46; La media de d&#237;as de ingreso hospitalario&#44; de estancia en UCI&#44; o letalidad tampoco difirieron respecto al resto de pacientes infectados &#40;datos pendientes de publicaci&#243;n&#41;&#46; Estos resultados nos hacen reflexionar acerca de lo determinante que son las IMID y los tratamientos inmunomoduladores o inmunosupresores que recib&#237;an previamente estos pacientes&#44; en el manejo de la infecci&#243;n por SARS-CoV-2 y en la evoluci&#243;n de dichos pacientes&#46; La mayor&#237;a de f&#225;rmacos inmunosupresores empleados en las IMID presentan una vida media larga&#44; por lo que su retirada tras el diagn&#243;stico de la infecci&#243;n no garantiza la eliminaci&#243;n inmediata del f&#225;rmaco en sangre&#46; Pese a ello&#44; la mayor&#237;a de pacientes afectados por SARS-CoV-2 presentaron una buena evoluci&#243;n cl&#237;nica&#44; tal como se ha demostrado en otras series<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a>&#44; sin observarse diferencias de desenlace final de la enfermedad por SARS-CoV-2 entre pacientes que presentaban IMID y los que no&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Entre las limitaciones de nuestro estudio&#44; cabe destacar que solo se han podido identificar los casos de pacientes con IMID cl&#237;nicamente m&#225;s graves ya que&#44; por recomendaciones de las autoridades sanitarias&#44; se indic&#243; a los pacientes que presentaban s&#237;ntomas m&#225;s leves permanecer en sus casas y solo a los pacientes que consultaron en el servicio de urgencias del hospital con criterio de ingreso se realiz&#243; la determinaci&#243;n de la PCR&#44; por lo que no se ha podido establecer la prevalencia real de la infecci&#243;n en nuestra poblaci&#243;n de inter&#233;s&#44; ni realizar asociaciones m&#225;s reales&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Al tratarse de un estudio retrospectivo no se pueden extraer relaciones de causalidad&#46; Adem&#225;s&#44; al realizarse en un &#250;nico centro hospitalario&#44; nuestros resultados no son extrapolables directamente a otros &#225;mbitos sanitarios&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Este estudio permite concluir que las enfermedades inmunomediadas y los tratamientos de las mismas no parecen ser determinantes en el desenlace cl&#237;nico del ingreso hospitalario de pacientes infectados por SARS-CoV-2&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudio ha contado con la financiaci&#243;n de una &#171;Beca de Ayuda a la Investigaci&#243;n en Reumatolog&#237;a 2020&#187;&#44; otorgada por la Fundaci&#243;n Valenciana de Reumatolog&#237;a&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los autores no tienen nada que declarar&#46;</p></span></span>"
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    "fechaRecibido" => "2020-12-19"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las enfermedades inflamatorias inmunomediadas &#40;IMID&#41; predisponen a un aumento del riesgo infeccioso al modificar la respuesta inmune del hu&#233;sped&#44; que resulta crucial para la resoluci&#243;n de la infecci&#243;n por SARS-CoV-2&#46; Las &#250;ltimas publicaciones indican que los pacientes con IMID y sus tratamientos de base no empeoran el pron&#243;stico de la infecci&#243;n por SARS-CoV-2&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas cl&#237;nicas y la evoluci&#243;n de pacientes con IMID que requirieron ingreso hospitalario por infecci&#243;n por SARS-CoV-2&#46; En segundo lugar&#44; comparar las caracter&#237;sticas cl&#237;nicas y la evoluci&#243;n entre pacientes que requirieron ingreso hospitalario por infecci&#243;n por SARS-CoV-2 con IMID y aquellos que no la presentaban&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional de cohortes retrospectivo&#44; que incluy&#243; pacientes ingresados por sospecha de SARS-CoV-2&#44; tratados seg&#250;n el criterio m&#233;dico y los protocolos basados en la evidencia cient&#237;fica&#46; La recogida de datos cl&#237;nicos se realiz&#243; por descarga directa o mediante revisi&#243;n manual de la historia cl&#237;nica electr&#243;nica&#46; El an&#225;lisis estad&#237;stico determin&#243; las diferencias de caracter&#237;sticas y evoluci&#243;n cl&#237;nica de la infecci&#243;n en pacientes con IMID&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">De los 612 pacientes revisados&#44; 23 padec&#237;an IMID y 9 de ellos fueron diagnosticados de infecci&#243;n por SARS-CoV-2&#46; No se observ&#243; correlaci&#243;n entre infecci&#243;n por SARS-CoV-2 e IMID&#46; Los pacientes con IMID presentaban mayor prevalencia de enfermedad cardiovascular y obesidad&#44; aunque no significativamente&#46; Asimismo&#44; los pacientes con IMID no presentaron una evoluci&#243;n cl&#237;nica durante el ingreso hospitalario diferente respecto al resto de pacientes&#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 IMID y los tratamientos de las mismas no determinan el pron&#243;stico del ingreso hospitalario de la infecci&#243;n por SARS-CoV-2&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Immune-mediated inflammatory diseases &#40;IMID&#41; predispose to a higher infection risk by modifying the host&#39;s immune response&#44; which acts as a key factor in SARS-CoV-2 infection resolution&#46; Recent publications show that IMID patients and its treatments do not worsen the outcome of SARS-CoV-2 infection&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To describe the clinical characteristics and outcomes of patients with IMID who required hospital admission due to SARS-CoV-2 infection&#46; Secondly&#44; to compare clinical characteristics and outcomes between patients who required hospital admission due to SARS-CoV-2 infection with IMID and those who were not affected&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We performed an observational retrospective cohort study&#44; including admitted patients with suspected SARS-CoV-2 infection&#44; treated according to medical criteria and local protocols based on the best available scientific evidence&#46; Clinical data were collected from their electronical clinical history&#46; Statistical analysis determined the differences in the characteristics and clinical outcome of the infection in IMID patients&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Of a total number of 612 revised patients&#44; 23 had an IMID and 9 of them were positive for the SARS-CoV-2 infection&#46; We did not observe a correlation between these two disorders&#46; There was a higher frequency of obesity and cardiovascular disease among IMID patients&#44; but without statistical significance&#46; The clinical outcomes were no different between hospitalized IMID and non IMID patients&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">IMID and its treatments do not determine the outcome of patients admitted with SARS-CoV-2 infection&#46;</p></span>"
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                  \t\t\t\t">2 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colitis ulcerosa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad psori&#225;sica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Obesidad &#40;IMC</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">30</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;22&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Otras enfermedades pulmonares cr&#243;nicas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;21&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;61&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">Embolia pulmonar o trombosis venosa profunda</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#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">NA&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">Neoplasia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;13&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;21&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;25&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">VIH</span>&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 &#40;0&#44;0&#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 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="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="elsevierStyleItalic">Tratamiento domiciliario</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>Anticoagulante&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">1 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;00&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>IECA o ARAII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;39&#44;1&#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">5 &#40;35&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;00&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>F&#225;rmacos biol&#243;gicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;56&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;42&#44;9&#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">7 &#40;77&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;10&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><span class="elsevierStyleHsp" style=""></span>Metotrexato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;17&#44;4&#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">3 &#40;21&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;63&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><span class="elsevierStyleHsp" style=""></span>Leflunomida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;4&#44;3&#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">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;39&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><span class="elsevierStyleHsp" style=""></span>Azatioprina&nbsp;\t\t\t\t\t\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;13&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;14&#44;3&#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 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00&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><span class="elsevierStyleHsp" style=""></span>Mesalazina&nbsp;\t\t\t\t\t\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;21&#44;7&#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 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;44&#44;4&#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;06&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>Glucocorticoides sist&#233;micos&nbsp;\t\t\t\t\t\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;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Cirrosis</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neoplasia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;12&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedad cardiovascular</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67 &#40;27&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedad cerebrovascular</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dislipemia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">105 &#40;42&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Fumador</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Obesidad &#40;IMC</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">30</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&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">57 &#40;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;55&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">VIH</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Demencia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 &#40;11&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Embolia pulmonar o trombosis venosa profunda</span>Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anticoagulante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#40;12&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IECA o ARAII&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">111 &#40;45&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;00&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>F&#225;rmacos biol&#243;gicos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;11&#44;1&#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;07&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
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;ntomas</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>Fiebre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">181 &#40;73&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;12&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">126 &#40;51&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;75&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>Tos seca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">150 &#40;61&#44;0&#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">6 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;00&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>Expectoraci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;14&#44;2&#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 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00&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>Dolor de garganta&nbsp;\t\t\t\t\t\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">18 &#40;7&#44;3&#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 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;51&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>Mialgias&nbsp;\t\t\t\t\t\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;21&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;69&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>Cefalea&nbsp;\t\t\t\t\t\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">27 &#40;11&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00&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>Mareo&nbsp;\t\t\t\t\t\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">18 &#40;7&#44;3&#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 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;51&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>Diarrea&nbsp;\t\t\t\t\t\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">56 &#40;22&#44;8&#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;22&#44;2&#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;00&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>Malestar general&nbsp;\t\t\t\t\t\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">128 &#40;52&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;44&#44;4&#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;74&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>Anosmia&nbsp;\t\t\t\t\t\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">17 &#40;6&#44;9&#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 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;49&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>Ageusia&nbsp;\t\t\t\t\t\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">18 &#40;7&#44;3&#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 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;51&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>Dolor tor&#225;cico&nbsp;\t\t\t\t\t\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">16 &#40;6&#44;5&#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;22&#44;2&#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;13&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
                  \t\t\t\t"><span class="elsevierStyleItalic">Variable resultado</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>Alta hospitalaria&nbsp;\t\t\t\t\t\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">192 &#40;78&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;66&#44;7&#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;42&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>Fallecidos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;16&#44;7&#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;22&#44;2&#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&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>D&#237;as ingreso&#44; mediana &#40;RIQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;0 &#40;4&#44;0-15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0 &#40;6&#44;0-13&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas y comorbilidades de los pacientes ingresados por COVID-19 confirmado en el hospital de la Plana</p>"
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        0 => array:2 [
          "identificador" => "bibs0015"
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                      "titulo" => "Implications of COVID-19 for the management of patients with inflammatory rheumatic diseases"
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                          "etal" => false
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                            0 => "C&#46; Richez"
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                            2 => "M&#46; Lemoine"
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                            4 => "T&#46; Schaeverbeke"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jbspin.2020.03.010"
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                        "tituloSerie" => "Joint Bone Spine&#46;"
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                        "volumen" => "87"
                        "paginaInicial" => "187"
                        "paginaFinal" => "189"
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                          0 => array:2 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19 infection and rheumatoid arthritis&#58; Faraway&#44; so close&#33;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;G&#46; Favalli"
                            1 => "F&#46; Ingegnoli"
                            2 => "O&#46; De Lucia"
                            3 => "G&#46; Cincinelli"
                            4 => "R&#46; Cimaz"
                            5 => "R&#46; Caporali"
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                    0 => array:2 [
                      "doi" => "10.1016/j.autrev.2020.102523"
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                        "tituloSerie" => "Autoimmun Rev&#46;"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32205186"
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                          "etal" => true
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                            0 => "R&#46; He"
                            1 => "Z&#46; Lu"
                            2 => "L&#46; Zhang"
                            3 => "T&#46; Fan"
                            4 => "R&#46; Xiong"
                            5 => "X&#46; Shen"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jcv.2020.104361"
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                          0 => array:2 [
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