Diagnostic gap; Early diagnosis; Population ; Brecha de diagnóstico; Diagnóstico precoz; Población ; Bretxa de diagnòstic; Diagnòstic precoç; Població ; Introduction: The Models of Patient Engagement for Alzheimer's Disease (MOPEAD) project was conceived to explore innovative complementary strategies to uncover hidden prodromal and mild Alzheimer's disease (AD) dementia cases and to raise awareness both in the general public and among health professionals about the importance of early diagnosis. Methods: Four different strategies or RUNs were used: (a) a web-based (WB) prescreening tool, (2) an open house initiative (OHI), (3) a primary care-based protocol for early detection of cognitive decline (PC), and (4) a tertiary care-based pre-screening at diabetologist clinics (DC). Results: A total of 1129 patients at high risk of having prodromal AD or dementia were identified of 2847 pre-screened individuals (39.7%). The corresponding proportion for the different initiatives were 36.8% (WB), 35.6% (OHI), 44.4% (PC), and 58.3% (DC). Conclusion: These four complementary pre-screening strategies were useful for identifying individuals at high risk of having prodromal or mild AD. ; This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under Grant Agreement No 115985. This Joint Undertaking receives support from the European Union's Horizon 2020 Research and Innovation program and the European Federation of Pharmaceutical Industries and Associations. www.imi.europa.eu/. All participants provided informed consent.
Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Paràmetre d'atenuació controlat; Lesió hepàtica ; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Parámetro de atenuación controlado; Daño hepático ; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Controlled attenuation parameter; Liver injury ; Liver injury has been widely described in patients with Coronavirus disease 2019 (COVID-19). We aimed to study the effect of liver biochemistry alterations, previous liver disease, and the value of liver elastography on hard clinical outcomes in COVID-19 patients. We conducted a single-center prospective observational study in 370 consecutive patients admitted for polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data were collected at baseline and liver parameters and clinical events recorded during follow-up. Transient elastography [with Controlled Attenuation Parameter (CAP) measurements] was performed at admission in 98 patients. All patients were followed up until day 28 or death. The two main outcomes of the study were 28-day mortality and the occurrence of the composite endpoint intensive care unit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated at admission in 130 patients (35%) and 167 (45%) patients, respectively. Overall, 14.6% of patients presented the composite endpoint ICU and/or death. Neither ALT elevations, prior liver disease, liver stiffness nor liver steatosis (assessed with CAP) had any effect on outcomes. However, patients with abnormal baseline AST had a higher occurrence of the composite ICU/death (21% versus 9.5%, p = 0.002). Patients ⩾65 years and with an AST level > 50 U/ml at admission had a significantly higher risk of ICU and/or death than those with AST ⩽ 50 U/ml (50% versus 13.3%, p < 0.001). In conclusion, mild liver damage is prevalent in COVID-19 patients, but neither ALT elevation nor liver steatosis influenced hard clinical outcomes. Elevated baseline AST is a strong predictor of hard outcomes, especially in patients ⩾65 years. ; The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: JG is a recipient of a Research Intensification grant from the Instituto de Salud Carlos III, Spain. MST and MVC are recipients of a Juan Rodés grant from the Instituto de Salud Carlos III. The work was partially funded by grants PI17/00310, PI18/00947, PI18/00961, and PI19/00330 from Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF, "Investing in your future" – Una manera de hacer Europa). CIBERehd is supported by Instituto de Salud Carlos III. The work was independent of all funding.
