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Galardo G, Crisanti L, Gentile A, Cornacchia M, Iatomasi F, Egiddi I, Puscio E, Menichelli D, Pugliese F, Pastori D. Neutrophil to lymphocyte ratio (NLR) and short-term mortality risk in elderly acute medical patients admitted to a University Hospital Emergency Department. Intern Emerg Med 2024:10.1007/s11739-024-03683-8. [PMID: 38918300 DOI: 10.1007/s11739-024-03683-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
Early identification of patients with a poorer prognosis in the Emergency Department (ED) is crucial for prompt treatment and resource allocation. We investigated the relationship between the Neutrophil to Lymphocyte Ratio (NLR) and 30-day mortality in elderly acute medical patients. Prospective single-center cohort study including consecutive patients admitted to the ED. Inclusion criteria were age > 65 years and medical condition as the cause of ED access. Exclusion criteria were patients admitted for traumatic injuries or non-traumatic surgical diseases. ROC analysis was used to set the best cut-off of the NLR for mortality. 953 patients were included and 142 (14.9%) died during follow-up. ROC analysis showed a good predictive value of the NLR with an AUC 0.70, 95%CI 0.67-0.73 (p < 0.001) and identified a NLR > 8 as the best cut-off. Patients with NLR > 8 had a more serious triage code (72.6% had a triage code ≤ 2) and an increased heart rate and body temperature. They more often presented with dyspnea, abdominal pain, falls and vomiting. They also were characterized by an increase in urea, creatinine, white blood cells, neutrophils, fibrinogen, D-dimer, glycemia, CRP, LDH and transaminases and by a decrease in eGFR, of lymphocytes and monocytes. Multivariable logistic regression analysis demonstrated that the NLR remained associated with mortality after adjustment for confounders (Odds ratio 2.563, 95%CI 1.595-4.118, p < 0.001). Patients with NLR > 8 showed a higher mortality rate. NLR is an easy and inexpensive tool that may be used for risk stratification in the ED. The results of this study need to be validated in larger external cohorts.
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Affiliation(s)
- Gioacchino Galardo
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
- Medical Emergency Unit, Policlinico Umberto I, Rome, Italy
| | - Luca Crisanti
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00189, Rome, Italy
| | - Andrea Gentile
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Marco Cornacchia
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Francesca Iatomasi
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Iacopo Egiddi
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Emanuele Puscio
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Danilo Menichelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Francesco Pugliese
- Department of General Surgery and Surgical Specialties Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
- IRCCS Neuromed, Località Camerelle, 86077, Pozzilli, IS, Italy.
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Marlor DR, Taghlabi KM, Hierl AN, Braasch MC, Winfield RD. In-hospital, 30- and 90-day mortality in elderly trauma patients with operative feeding tubes. Am J Surg 2023; 225:758-763. [PMID: 36404168 DOI: 10.1016/j.amjsurg.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nutrition is essential in the treatment of elderly trauma patients (ETP). ETP experience dysphagia at rates six times higher than the non-trauma elderly population (NTEP) and are at increased risk for malnutrition. Operative feeding tube (OFT) placement is often used to aid with the nutritional management of ETP. Elderly patients experience higher rates of morbidity and mortality when compared to the general population, especially in the traumatic setting, with some data suggesting in-hospital mortality as high as 10%. However, the mortality rates and associated comorbidities associated with OFT in ETP are unknown. The purposes of this study were to establish the mortality rate in hospital as well as 30- and 90-days following discharge among elderly trauma patients (ETP) receiving OFT, and to assess factors associated with mortality within this population. METHODS A retrospective review of all trauma patients from a single Level I Trauma Center from 01/2010-09/2020 was conducted. Exclusion criteria were patients under 65 years of age or those with previously placed OFT. Demographics, comorbidities, injury mechanisms, injury severity scores (ISS), and OFT data were collected from the institutional trauma registry. Mortality data were obtained using the Social Security Death Index. Mortality at discharge, 30 days, and 90 days following discharge were the primary outcomes. Bivariate analysis was conducted to compare characteristics and comorbidities of patients alive and dead at the time points of interest. RESULTS There were 151 ETP who received OFT. Patients were largely male (67.5%), severely injured via a blunt mechanism (95%), and had a median age of 76 years. 11 (7.3%) experienced in-hospital mortality following feeding tube placement, 21 (13.9%) died within 30 days, and 31 (20.5%) within 90 days. Bivariate analysis demonstrated that ETP who died were more likely to have a history of dementia (p = 0.004), congestive heart failure (p = 0.014), and end-stage liver disease (p = 0.034). No other patient or injury factors were associated with mortality after OFT placement. CONCLUSION Mortality rates for ETP with OFT were higher than anticipated, yet favorable compared to recently reported data. Patients who died were more likely to have dementia, CHF, or ESLD than those who survived. The few comorbidities associated with mortality suggest that nearly all ETP who undergo OFT placement are at risk for mortality. Additionally, the data highlights the importance of early goals of care discussions for ETP and their loved ones when operative feeding tubes are being considered. LEVEL OF EVIDENCE Level III. STUDY TYPE Prognostic/Therapeutic/Diagnostic Test/Economic/Decision.
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Affiliation(s)
- Derek R Marlor
- University of Kansas Medical Center, Trauma, Surgical Critical Care and Acute Care Surgery, Kansas City, KS, USA.
| | - Khaled M Taghlabi
- University of Kansas Medical Center, Trauma, Surgical Critical Care and Acute Care Surgery, Kansas City, KS, USA.
| | | | | | - Robert D Winfield
- University of Kansas Medical Center, Trauma, Surgical Critical Care and Acute Care Surgery, Kansas City, KS, USA.
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Tsekoura V, Roupa Z, Noula M, Yamasaki EN. Postoperative Analgesia Management Evaluation in the Postanesthesia Unit: An Exploratory Analysis Based on Patient and Surgery Characteristics. J Perianesth Nurs 2023; 38:219-223. [PMID: 36156269 DOI: 10.1016/j.jopan.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Several methods have been proposed for postoperative pain management, including administration of opioid analgesics, epidural analgesia, and perineural and infiltrative techniques; however, data are lacking on the relationship between pain intensity, patients' age and gender, and surgery duration. DESIGN Prospective, observational, single-center study. METHODS The study included patients greater than or equal to 18 years old who underwent surgery with different anesthesia types, grouped according to the American Society of Anesthesiologists' physical status classification score. The McGill Pain Questionnaire was used to assess postoperative pain intensity. The postoperative pain evaluation was performed in the first 5 minutes on entering the postanesthesia care unit (PACU), and at 30 minutes and 24 hours after the operation. RESULTS Our results showed a significant negative relationship between pain intensity as assessed at 5 and 30 minutes postoperatively and age. Postoperative pain intensity at 24 hours was significantly lower after low-risk surgeries lasting up to 1 hour; pain intensity was also significantly lower at 30 minutes following epidural anesthesia. When nonsteroidal anti-inflammatory drugs were not administered in the PACU, pain intensity was significantly lower at 5 minutes, 30 minutes, and 3 hours. CONCLUSIONS Postoperative analgesic administration should be conducted in accordance with age and surgery type. Additionally, epidural anesthesia can reduce the immediate postoperative pain intensity.
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Affiliation(s)
- Vasiliki Tsekoura
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus; Department of Anesthesiology and Critical Care Medicine, University General Hospital of Patras, Patras, Greece.
| | - Zoe Roupa
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus
| | - Maria Noula
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus
| | - Edna N Yamasaki
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus
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Walicka M, Puzianowska-Kuznicka M, Chlebus M, Śliwczyński A, Brzozowska M, Rutkowski D, Kania L, Czech M, Jacyna A, Franek E. Relationship between age and in-hospital mortality during 15,345,025 non-surgical hospitalizations. Arch Med Sci 2021; 17:40-46. [PMID: 33488854 PMCID: PMC7811322 DOI: 10.5114/aoms/89768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/06/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mortality, whether in or out of hospital, increases with age. However, studies evaluating in-hospital mortality in large populations did not distinguish between surgical and non-surgical causes of death, either in young or in elderly patients. The aim of the study was to assess in-hospital non-surgical mortality in a large group of patients, with a special focus on the elderly. MATERIAL AND METHODS Data from the database of the Polish National Health Fund (NHF) regarding hospitalizations of adult (≥ 18 years) patients not related to surgical procedures in the years 2009-2013 were used to assess in-hospital mortality. RESULTS 15,345,025 hospitalizations were assessed. The mean in-hospital non-surgery-related mortality rate was 3.96 ±0.17%, and increased from 3.79% to 4.2% between 2009 and 2013. The mean odds ratio for in-hospital death increased with the age of patients, reaching a 229-fold higher rate in the ≥ 95 years age group as compared to the 18-24 age group. The highest mean mortality was associated with respiratory diseases (6.91 ±0.20%), followed by heart and vascular diseases, nervous system diseases, as well as combined gastrointestinal tract, liver, biliary tract, pancreas and spleen diseases (5.65 ±0.27%, 5.46 ±0.05% and 4.01 ±0.13%, respectively). CONCLUSIONS The in-hospital non-surgery-related mortality rate was approximately 4%. It significantly increased with age and, regardless of age, was highest in patients suffering from respiratory diseases.
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Affiliation(s)
- Magdalena Walicka
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Monika Puzianowska-Kuznicka
- Department of Human Epigenetics, Mossakowski Medical Research Centre, Warsaw, Poland
- Department of Geriatrics and Gerontology, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Marcin Chlebus
- Department of Quantitative Finance, Faculty of Economic Sciences, University of Warsaw, Warsaw, Poland
| | | | | | | | - Lidia Kania
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
- Department of Human Epigenetics, Mossakowski Medical Research Centre, Warsaw, Poland
| | - Marcin Czech
- Warsaw University of Technology Business School, Warsaw, Poland
| | | | - Edward Franek
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
- Department of Human Epigenetics, Mossakowski Medical Research Centre, Warsaw, Poland
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Gbeasor-Komlanvi FA, Tchankoni MK, Bakoubayi AW, Lokossou MY, Sadio A, Zida-Compaore WIC, Djibril M, Belo M, Agbonon A, Ekouevi DK. Predictors of three-month mortality among hospitalized older adults in Togo. BMC Geriatr 2020; 20:507. [PMID: 33243161 PMCID: PMC7690011 DOI: 10.1186/s12877-020-01907-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background Assessing hospital mortality and its predictors is important as some of these can be prevented through appropriate interventions. Few studies have reported hospital mortality data among older adults in sub-Saharan Africa. The objective of this study was to assess the mortality and associated factors among hospitalized older adults in Togo. Methods We conducted a prospective cohort study from February 2018 to September 2019 among patients ≥50 years admitted in medical and surgical services of six hospitals in Togo. Data were recorded during hospitalization and through telephone follow-up survey within 90 days after admission. The main outcome was all-cause mortality at 3 months. Survival curves were estimated using the Kaplan-Meier method and Cox regression analyses were performed to assess predictors of mortality. Results The median age of the 650 older adults included in the study period was 61 years, IQR: [55–70] and at least one comorbidity was identified in 59.7% of them. The all-cause mortality rate of 17.2% (95%CI: 14.4–20.4) and the majority of death (93.7%) occurred in hospital. Overall survival rate was 85.5 and 82.8% after 30 and 90 days of follow-up, respectively. Factors associated with 3-month mortality were the hospital level in the health pyramid, hospitalization service, length of stay, functional impairment, depression and malignant diseases. Conclusion Togolese health system needs to adjust its response to an aging population in order to provide the most effective care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01907-y.
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Affiliation(s)
- Fifonsi Adjidossi Gbeasor-Komlanvi
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo. .,Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo.
| | | | | | | | - Arnold Sadio
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.,Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo
| | | | - Mohaman Djibril
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.,Centre Hospitalier Universitaire Sylvanus Olympio, Pavillon Militaire, Lomé, Togo
| | - Mofou Belo
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.,Programme National de Lutte contre les Maladies Chroniques, Lomé, Togo
| | - Amegnona Agbonon
- Université de Lomé, Laboratoire de Physiologie-Pharmacologie, Lomé, Togo
| | - Didier Koumavi Ekouevi
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.,Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo
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Hernández-Rubio A, Sanvisens A, Bolao F, Pérez-Mañá C, García-Marchena N, Fernández-Prendes C, Muñoz A, Muga R. Association of hyperuricemia and gamma glutamyl transferase as a marker of metabolic risk in alcohol use disorder. Sci Rep 2020; 10:20060. [PMID: 33208850 PMCID: PMC7674473 DOI: 10.1038/s41598-020-77013-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022] Open
Abstract
Excessive alcohol consumption leads to overproduction of urates and renal function plays a critical role in serum uric acid levels. We aimed to assess associations of hyperuricemia in patients with alcohol use disorder (AUD) and comparable Glomerular Filtration Rate (GFR). A total of 686 patients undergoing treatment for AUD between 2013 and 2017 were eligible (77% men); age at admission was 47 years [interquartile range (IQR), 40-53 years], age of onset of alcohol consumption was 16 years [IQR, 16-18 years] and the amount of alcohol consumed was 160 g/day [IQR, 120-240 g/day]. Body Mass Index was 24.7 kg/m2 [IQR, 21.9-28.4 kg/m2], eGFR was 105 mL/min/1.73 m2 [IQR, 95.7-113.0 mL], 9.7% had metabolic syndrome and 23% had advanced liver fibrosis (FIB-4 > 3.25). Prevalence of hyperuricemia was 12.5%. The eGFR-adjusted multivariate analysis showed that relative to patients with GGT ≤ 50, those with GGT between 51 and 300 U/L and those with GGT > 300 U/L were 4.31 (95% CI 1.62-11.46) and 10.3 (95% CI 3.50-29.90) times more likely to have hyperuricemia, respectively. Our data shows that hyperuricemia in the context of AUD is strongly associated with serum GGT levels and suggest an increased cardio-metabolic risk in this population.
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Affiliation(s)
- Anna Hernández-Rubio
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, 08916, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain
| | - Arantza Sanvisens
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, 08916, Badalona, Spain
| | - Ferran Bolao
- Department of Internal Medicine, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Clara Pérez-Mañá
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Nuria García-Marchena
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, 08916, Badalona, Spain
| | - Carla Fernández-Prendes
- Department of Clinical Analysis and Biochemistry, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Alvaro Muñoz
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roberto Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, 08916, Badalona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain.
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Clinical Conditions of Hospitalized Older Adult Patients and Their Outcomes in a Regional Referral Hospital in Southwestern Uganda. J Aging Res 2020; 2020:6830495. [PMID: 32676210 PMCID: PMC7341388 DOI: 10.1155/2020/6830495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background Recent advances in medicine have caused positive impact on the life expectancy of most countries, resulting in increased older adult population. Aging comes with a number of health challenges. This study investigated health conditions of older adults at admission and clinical outcomes in a regional referral hospital in southwestern Uganda. Methods A retrospective study reviewed clinical data of older adult patients admitted between January 2016 and December 2017. Demographic data, cause of admission, length, and outcomes of hospitalization are described. Results Up to 813 patient files were reviewed. The patients had been hospitalized to emergency, 371 (45.6%); medical, 355 (43.7%); surgical, 84 (10.3%); psychiatry, 2 (0.3%); and obstetrics and gynecology, 1 (0.1%) wards. The majority, 427 (52.5%), of the patients were females. Cancer was the most common reason for hospitalization, 130/889 (14.6%), followed by stroke, 94/889 (10.6%); heart failure, 76/889 (8.6%); chronic obstructive pulmonary disease, 56/889 (6.3%); pneumonia, 47/889 (5.3%); and head injury, 45/889 (5.1%), whilst 560 (68.9%) of the hospitalized patients were discharged, 197 (24.2%) died, 18 (2.2%) were referred for advanced care, and 38 (4.7%) escaped from the facility. The emergency ward had the highest deaths, 101 (51.3%), then medical, 56 (28.4%), and surgical, 39 (19.8%), wards. Mortality of those who died was admitted with stroke, 30 (15.2%), cancer, 21 (10.7%), head injury, 16 (8.1%), heart failure, 14 (7.1%), sepsis, 14 (7.1%), and renal disease, 12 (6.1%). On average, patients were admitted for 5 days (IQR: 3-8). Conclusions The high proportion of mortality in this group is worrying and requires further investigations.
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Dülger D, Albuz Ö. Risk indices that predict in-hospital mortality of elderly patients. Turk J Med Sci 2020; 50:969-977. [PMID: 32490649 PMCID: PMC7379462 DOI: 10.3906/sag-2005-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background/aim Mortality in the elderly population tends to be higher than in all other age groups; the risk factors that predict mortality among those in this age cohort are not fully understood. This large-scale clinical study aimed to identify effective risk factors that predict mortality in the elderly population with a particular focus on age and hospitalization status. Material and methods We retrospectively analyzed outcomes from patients with clinical follow-up between July 2015 and January 2020 at 29 Mayıs State Hospital, Ankara, Turkey. Patient records with missing or ambiguous data were excluded. Age, sex, length of hospital stay, comorbidities, consultation requests and diagnoses that include infectious diseases were evaluated for their role in predicting in-hospital mortality using binary logistic regression analysis. Primary outcomes focused on factors that had an impact on overall in-hospital mortality in the elderly population. Results Our study included 11,430 patients; of this group, 39.9% were elderly, which we defined as 65 years of age or older. Risk factors for in-hospital mortality in this cohort included consultation requests (AOR = 1.95, CI (1.53–2.49), P < 0.001) and length of hospital stay of ≥4 days (AOR = 2.49, CI (1.90–3.26), P < 0.001). Conclusion Elderly patients are at significantly higher risk for in-hospital mortality than are younger patients. Among the factors that may be used to predict the risk of in-hospital mortality in the elderly patient cohort, the most important factor is the length of hospital stay.
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Affiliation(s)
- Dilek Dülger
- Department of Microbiology, Faculty of Medicine, Karabük University, Karabük, Turkey
| | - Özgür Albuz
- Deparment of General Surgery, Keçiören Training and Research Hospital,Ankara,Turkey
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Brucato A, Ferrari A, Tiraboschi M, Zucchi A, Cogliati C, Torzillo D, Dentali F, Tavecchia L, Gessi V, Squizzato A, Moretti S, Permunian ET, Carobbio A, Pasina L, De Stefano F, Tombetti E, Cumetti D, Tognoni G, Barbui T. Three-month mortality in permanently bedridden medical non-oncologic patients. The BECLAP study (permanently BEdridden, creatinine CLearance, albumin, previous hospital admissions study). Eur J Intern Med 2020; 72:60-66. [PMID: 31757579 DOI: 10.1016/j.ejim.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/18/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To predict the 3-months mortality in permanently bedridden medical non-oncologic inpatients. PATIENTS AND METHODS 2788 consecutive patients admitted in 5 Italian Internal Medicine units from January 2016 through January 2017 were prospectively screened; 644 oncologic patients were excluded; 2144 non-oncologic patients (1021 female) were followed-up for mortality for 6 months. Main outcome was 3-months mortality in permanently bedridden inpatients with at least 2 of: creatinine clearance <35 ml/min; albumin < 2.5 g/dl; at least 2 hospital admissions in the previous 6 months. Advanced dementia and dysphagia were also recorded. RESULTS Mean age of the 2144 patients was 73.9 (SD, 14.9) years; 374 (17%) were permanently bedridden, 435 (20%) had a creatinine clearance <35 ml/min, 217 (10%) albumin <2,5 g/dl, 112 (5%) at least 2 hospital admissions in the previous 6 months. Seventy-seven (4%) patients were permanently bedridden with at least 2 of the above mentioned items, and 48 of them died within 3 months (62%) (p < 0.001;95% CI 51-73%). Regression coefficients of the variables associated with 3-months mortality in multivariate analysis in 998 patients of unit 1 (training cohort) were used to create a simple score, which was validated in the 1146 patients of the other units (validation cohort) and performed well in predicting the 3-months mortality (https://www.ejcrim.com/beclap/). CONCLUSIONS Approximately two out of three non-oncologic medical patients permanently bedridden having 2 of the abovementioned items are dead 3 months after index admission; a simple score including bedridden status, creatinine clearance, albumin, dysphagia, age and sex may help discuss management priorities.
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Affiliation(s)
- Antonio Brucato
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy; Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| | - Alberto Ferrari
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Mara Tiraboschi
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Health Protection Agency, Bergamo, Italy
| | - Chiara Cogliati
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Daniela Torzillo
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luca Tavecchia
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Vera Gessi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Sara Moretti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio De Stefano
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | | | - Davide Cumetti
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Gianni Tognoni
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziano Barbui
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
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Rosenfarb J, Sforza N, Rujelman R, Morosan Allo Y, Parisi C, Blanc E, Frigerio C, Fossati P, Caruso D, Faingold C, Meroño T, Brenta G. Relevance of TSH evaluation in elderly in-patients with non-thyroidal illness. J Endocrinol Invest 2019; 42:667-671. [PMID: 30367433 DOI: 10.1007/s40618-018-0967-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/13/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Non-thyroidal illness (NTI) is frequent in hospitalized patients. Its recovery is characterized by a raise in TSH levels. However, the clinical significance of high TSH levels at admission in hospitalized elderly patients with NTI remains uncertain. AIM To explore the relevance of baseline TSH evaluation in hospitalized elderly patients with NTI. METHODS We examined the participants with NTI (n = 123) from our previous study (Sforza, 2017). NTI was defined as: low T3 (< 80 ng/dL) and normal or low total T4 in the presence of TSH values between 0.1 and 6.0 mU/L. Thyroid function tests were performed on day 1 and day 8 of the hospital stay. Positive TSH changes (+ ΔTSH) were considered when the day-8 TSH value increased more than the reference change value for TSH (+ 78%). Multiple logistic regression was used to evaluate the independent association of baseline TSH, sex, clinical comorbidities (by ACE-27) and medications with + ΔTSH. RESULTS Out of 123 patients (77 ± 8 years, 52% female), 34 showed a + ΔTSH. These patients had a lower TSH at admission (p < 0.001) and intra-hospital mortality (p = 0.003) than the others. In multiple logistic regression, TSH > 2.11 mU/L at baseline was associated with reduced odds to show + ΔTSH [odds ratio (95 CI) 0.29 (0.11-0.75); p = 0.011] in a model adjusted by age, sex and ACE-27. DISCUSSION Inappropriately higher TSH levels at admission in hospitalized elderly patients were associated with a reduced ability to raise their TSH levels later on. The present results confront the idea that TSH levels at admission are irrelevant in this clinical context.
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Affiliation(s)
- J Rosenfarb
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - N Sforza
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - R Rujelman
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - Y Morosan Allo
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - C Parisi
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - E Blanc
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - C Frigerio
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - P Fossati
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - D Caruso
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - C Faingold
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina
| | - T Meroño
- Depto. de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - G Brenta
- Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina.
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11
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Ostuni M, Musso CG. Usefulness of frailty evaluation for handling chronic kidney disease elderly patients: a review and original proposal. Int Urol Nephrol 2019; 51:461-465. [PMID: 30604227 DOI: 10.1007/s11255-018-2061-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 12/12/2018] [Indexed: 12/16/2022]
Abstract
There is interdependence between chronic kidney disease (CKD) and ageing whereby CKD makes ageing more accelerated and pronounced, whereas ageing accelerates chronic nephropathy's progression. Frailty status catalyzes this spiral, with renal and systemic negative consequences, and this condition can currently be documented by applying already validated clinical scores (frailty phenotype) or physical test (gate speed). Although, nephroprevention strategies are similar between young adult and senior CKD patients, standard targets should be adequate to very old and frail elderly individuals. For this purpose, an original algorithm is here proposed to adjust the conventional nephroprevention strategies to the condition of CKD frail patient (more relaxed targets and tighter control), as well as to prescribe anti-frailty interventions to slow patient's functional decline, hospitalization and mortality.
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Affiliation(s)
- Marco Ostuni
- Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carlos G Musso
- Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. .,Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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12
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Peel A, Gutmanis I, Bon T. Disparities in health outcomes among seniors without a family physician in the North West Local Health Integration Network: a retrospective cohort study. CMAJ Open 2019; 7:E94-E100. [PMID: 30782772 PMCID: PMC6380899 DOI: 10.9778/cmajo.20180004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The relationship between having a family physician and in-hospital and postdischarge health outcomes among older adults is unclear. We ascertained the proportion of seniors who did not have a family physician and were admitted to an Ontario tertiary care centre, and we determined the association between having/not having a family physician and in-hospital mortality, 1-year mortality and readmission after live discharge. METHODS This was a retrospective cohort study of community-dwelling seniors who were admitted to a medical service at Thunder Bay Regional Health Sciences Centre. We conducted regression analyses adjusted for demographic factors, prior health care utilization, and factors associated with the index admission to determine the association between family physician status and the study outcomes. RESULTS Among the 12 033 seniors admitted to hospital between Apr. 1, 2004, and Mar. 31, 2013, 40.7% lacked a family physician. Among those without a family physician, 8.0% (390/4899) died during the index admission and 15.8% (714/4509) died in the subsequent year. Adjusted regression models showed that not having a family physician was significantly associated with in-hospital mortality (odds ratio 1.56, 95% confidence interval [CI] 1.33-1.83). Regression models of all-cause 1-year mortality and readmission also suggested that lack of a family physician was associated with detrimental health outcomes (hazard ratio 1.14, 95% CI 1.04-1.26; subdistribution hazard ratio 1.17, 95% CI 1.10-1.24, respectively). INTERPRETATION Elders without family physicians were disadvantaged during their hospital admission as well as in the subsequent year. Additional interventions aimed at increasing the proportion of seniors admitted to hospital who are connected with a family physician are warranted.
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Affiliation(s)
- Alexandrea Peel
- Division of Geriatric Medicine (Peel), Department of Medicine, Schulich School of Medicine & Dentistry; Lawson Health Research Institute (Gutmanis), London, Ont.; Northern Ontario School of Medicine (Bon); Thunder Bay Regional Health Sciences Centre and St. Joseph's Care Group (Bon), Thunder Bay, Ont.
| | - Iris Gutmanis
- Division of Geriatric Medicine (Peel), Department of Medicine, Schulich School of Medicine & Dentistry; Lawson Health Research Institute (Gutmanis), London, Ont.; Northern Ontario School of Medicine (Bon); Thunder Bay Regional Health Sciences Centre and St. Joseph's Care Group (Bon), Thunder Bay, Ont
| | - Trevor Bon
- Division of Geriatric Medicine (Peel), Department of Medicine, Schulich School of Medicine & Dentistry; Lawson Health Research Institute (Gutmanis), London, Ont.; Northern Ontario School of Medicine (Bon); Thunder Bay Regional Health Sciences Centre and St. Joseph's Care Group (Bon), Thunder Bay, Ont
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13
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Advanced Data Analytics for Improved Decision-Making at a Veterans Affairs Medical Center. J Healthc Manag 2019; 64:54-62. [DOI: 10.1097/jhm-d-17-00164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Corsi N, Roberto A, Cortesi L, Nobili A, Mannucci PM, Corli O. Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards. Eur J Intern Med 2018; 55:35-39. [PMID: 29853269 DOI: 10.1016/j.ejim.2018.05.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic pain is a frequent characteristic of elderly people and represents an actual and still poorly debated topic. OBJECTIVE We investigated pain prevalence and intensity, and its pharmacological therapy in elderly patients hospitalized in 101 internal medicine wards. METHODS Taking advantage of the "REgistro POliterapie Società Italiana Medicina Interna" (REPOSI), we collected 2535 patients of whom almost a quarter was older than 85 years old. Among them, 582 patients were affected by pain (either chronic or acute) and 296 were diagnosed with chronic pain. RESULTS Patients with pain showed worse cognitive status, higher depression and comorbidities, and a longer duration of hospital stay compared to those without pain (all p < .0366). Patients with chronic pain revealed lower level of independency in their daily life, worse cognitive status and higher level of depression compared to acute pain patients (all p < .0156). Moreover, most of them were not treated for pain at admission (73.4%) and half of them was not treated with any analgesic drug at discharge (50.5%). This difference affected also the reported levels of pain intensity. Patients who received analgesics at both admission and discharge remained stable (p = .172). Conversely, those not treated at admission who received an analgesic treatment during the hospital stay decreased their perceived pain (p < .0001). CONCLUSIONS Our results show the need to focus more attention on the pharmacological treatment of chronic pain, especially in hospitalized elderly patients, in order to support them and facilitate their daily life after hospital discharge.
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Affiliation(s)
- Nicole Corsi
- Pain and Palliative Care Research Unit, Oncology Department, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy.
| | - Anna Roberto
- Pain and Palliative Care Research Unit, Oncology Department, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Laura Cortesi
- Quality Assessment of Geriatric Therapies and Services Laboratory, Neuroscience Department, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Alessandro Nobili
- Quality Assessment of Geriatric Therapies and Services Laboratory, Neuroscience Department, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Oscar Corli
- Pain and Palliative Care Research Unit, Oncology Department, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy
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Vilpert S, Monod S, Jaccard Ruedin H, Maurer J, Trueb L, Yersin B, Büla C. Differences in triage category, priority level and hospitalization rate between young-old and old-old patients visiting the emergency department. BMC Health Serv Res 2018; 18:456. [PMID: 29907110 PMCID: PMC6003168 DOI: 10.1186/s12913-018-3257-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 05/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Emergency Department (ED) are challenged by the increasing number of visits made by the heterogeneous population of elderly persons. This study aims to 1) compare chief complaints (triage categories) and level of priority; 2) to investigate their association with hospitalization after an ED visit; 3) to explore factors explaining the difference in hospitalization rates among community-dwelling older adults aged 65–84 vs 85+ years. Methods All ED visits of patients age 65 and over that occurred between 2005 and 2010 to the University of Lausanne Medical Center were analyzed. Associations of hospitalization with triage categories and level of priority using regressions were compared between the two age groups. Blinder-Oaxaca decomposition was performed to explore how much age-related differences in prevalence of priority level and triage categories contributed to predicted difference in hospitalization rates across the two age groups. Results Among 39′178 ED visits, 8′812 (22.5%) occurred in 85+ patients. This group had fewer high priority and more low priority conditions than the younger group. Older patients were more frequently triaged in “Trauma” (20.9 vs 15.0%) and “Home care impossible” (10.1% vs 4.2%) categories, and were more frequently hospitalized after their ED visit (69.1% vs 58.5%). Differences in prevalence of triage categories between the two age groups explained a quarter (26%) of the total age-related difference in hospitalization rates, whereas priority level did not play a role. Conclusions Prevalence of priority level and in triage categories differed across the two age groups but only triage categories contributed moderately to explaining the age-related difference in hospitalization rates after the ED visit. Indeed, most of this difference remained unexplained, suggesting that age itself, besides other unmeasured factors, may play a role in explaining the higher hospitalization rate in patients aged 85+ years. Electronic supplementary material The online version of this article (10.1186/s12913-018-3257-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Vilpert
- FORS Swiss Centre of Expertise in Social Sciences, University of Lausanne, Géopolis, 1015, Lausanne, Switzerland.
| | - Stéfanie Monod
- Public Health Department of the Canton of Vaud, Av. des Casernes 2, Lausanne, 1014, Switzerland
| | - Hélène Jaccard Ruedin
- Réseau Santé Nord Broye, Center for Community Geriatrics, Av. des Sciences 1, 1400, Yverdon-les-Bains, Switzerland
| | - Jürgen Maurer
- Department of Economics, University of Lausanne, Internef, 1015, Lausanne, Switzerland
| | - Lionel Trueb
- Service of Emergency Medicine, University of Lausanne Medical Center (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bertrand Yersin
- Service of Emergency Medicine, University of Lausanne Medical Center (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Medical Center (CHUV), Mont-Paisible 16, 1011, Lausanne, Switzerland
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Pasina L, Cortesi L, Tiraboschi M, Nobili A, Lanzo G, Tettamanti M, Franchi C, Mannucci PM, Ghidoni S, Assolari A, Brucato A. Risk factors for three-month mortality after discharge in a cohort of non-oncologic hospitalized elderly patients: Results from the REPOSI study. Arch Gerontol Geriatr 2018; 74:169-173. [PMID: 29121542 DOI: 10.1016/j.archger.2017.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 10/09/2017] [Accepted: 10/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Short-term prognosis, e.g. mortality at three months, has many important implications in planning the overall management of patients, particularly non-oncologic patients in order to avoid futile practices. The aims of this study were: i) to investigate the risk of three-month mortality after discharge from internal medicine and geriatric wards of non-oncologic patients with at least one of the following conditions: permanent bedridden status during the hospital stay; severely reduced kidney function; hypoalbuminemia; hospital admissions in the previous six months; severe dementia; ii) to establish the absolute risk difference of three-month mortality of bedridden compared to non-bedridden patients. METHODS This prospective cohort study was run in 102 Italian internal medicine and geriatric hospital wards. The sample included all patients with three-months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during the whole hospital stay. The following parameters were also recorded: estimated GFR≤29mL/min/1.73m2; severe dementia; albuminemia ≪2.5g/dL; hospital admissions in the six months before the index admission. RESULTS Of 3915 patients eligible for the analysis, three-month follow-up were available for 2058, who were included in the study. Bedridden patients were 112 and the absolute risk difference of mortality at three months was 0.13 (CI 95% 0.08-0.19, p≪0.0001). Logistic regression analysis also adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition (OR 2.10, CI 95% 1.12-3.94), severely reduced kidney function (OR 2.27, CI 95% 1.22-4.21), hospital admission in the previous six months (OR 1.96, CI 95% 1.22-3.14), severe dementia (with total or severe physical dependence) (OR 4.16, CI 95% 2.39-7.25) and hypoalbuminemia (OR 2.47, CI 95% 1.12-5.44) were significantly associated with higher risk of three-month mortality. CONCLUSIONS Bedridden status, severely reduced kidney function, recent hospital admissions, severe dementia and hypoalbuminemia were associated with higher risk of three-month mortality in non-oncologic patients after discharge from internal medicine and geriatric hospital wards.
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Affiliation(s)
- Luca Pasina
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Laura Cortesi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Alessandro Nobili
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Giovanna Lanzo
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mauro Tettamanti
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Carlotta Franchi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Ca' Granda Maggiore Hospital Foundation and University of Milan, Italy
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Breuer GS, Schwartz Y, Freier-Dror Y, Nesher G. Uric acid level as predictor of mortality in the acute care setting of advanced age population. Eur J Intern Med 2017; 44:74-76. [PMID: 28739350 DOI: 10.1016/j.ejim.2017.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Gabriel S Breuer
- Department of Internal Medicine and the Rheumatology Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Hebrew University Medical School, Jerusalem, Israel.
| | - Yuval Schwartz
- Department of Internal Medicine, Shaare-Zedek Medical center, Jerusalem, Israel
| | | | - Gideon Nesher
- Department of Internal Medicine and the Rheumatology Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Hebrew University Medical School, Jerusalem, Israel
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Harrison SJ, Messner J, Leeder DJ, Stephenson J, Sidhom SA. Are Albumin Levels a Good Predictor of Mortality in Elderly Patients with Neck of Femur Fractures? J Nutr Health Aging 2017; 21:699-703. [PMID: 28537335 DOI: 10.1007/s12603-016-0799-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (<35g/dl) has been highlighted as being a good biochemical predictor of short-term mortality (<12 months). Our aims were to assess whether there was an association between low albumin levels and mortality and whether the severity adversely affects outcomes. MATERIALS AND METHODS Patients admitted to our large district hospital between January 2011 and December 2012 who had sustained a NOF fracture, were over 65 years old and had a pre-operative albumin level were included. This retrospective, longitudinal, observational study concluded in July 2014. Demographic and pre-operative function and albumin data was collated retrospectively. An association with mortality was made. RESULTS 471 patients had usable data. Mean pre-operative albumin level was 29.5g/dl (SD 6.22g/dl) in patients who died and 32.8g/dl (SD 6.43g/dl) in patients who survived during the study period. Pre-operative albumin level was significantly associated with survival (hazard ratio 0.957: 95% CI (0.937, 0.978); p<0.001). Thus, a reduction of 1g/dl in pre-operative albumin is associated with an increased hazard of death of 4.3%. CONCLUSIONS Early identification of patients with hypoalbuminaemia on admission with a venous blood sample and timely input from orthogeriatrians could optimise these patients pre- and post-operatively. This may enable rates of morbidity and mortality to fall. Hypoalbuminaemia may be a reasonable predictor of shorter-term mortality in this patient subgroup. However, this may reflect existing co-morbidities rather than an isolated cause. This study supports an association between hypoalbuminaemia and poorer outcome for patients with NOF fractures.
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Affiliation(s)
- S J Harrison
- Simon J Harrison, Huddersfield Royal Infirmary, Acre Street, Huddersfield, HD3 3EA, United Kingdom, , Tel: +44 07967 759035
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Barma M, Goodbrand JA, Donnan PT, McGilchrist MM, Frost H, McMurdo MET, Witham MD. Slower Decline in C-Reactive Protein after an Inflammatory Insult Is Associated with Longer Survival in Older Hospitalised Patients. PLoS One 2016; 11:e0159412. [PMID: 27467771 PMCID: PMC4965167 DOI: 10.1371/journal.pone.0159412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/02/2016] [Indexed: 12/29/2022] Open
Abstract
Background Enhancing biological resilience may offer a novel way to prevent and ameliorate disease in older patients. We investigated whether changes in C-reactive protein (CRP), as a dynamic marker of the acute inflammatory response to diverse stressors, may provide a way to operationalize the concept of resilience in older adults. We tested this hypothesis by examining whether such changes could predict prognosis by identifying which individuals are at greater risk of 6-month mortality. Methods Analysis of prospective, routinely collected datasets containing data on hospitalization, clinical chemistry and rehabilitation outcomes for rehabilitation inpatients between 1999 and 2011. Maximum CRP response during acute illness and CRP recovery indices (time and slope of CRP decay to half maximum, and to <50mg/L if peak values were greater than 50mg/L) was derived from biochemistry data. 6-month survival plots were conducted on quartiles of CRP recovery indices. Cox proportional hazards models were used to test univariate and multivariate predictors of 6-month mortality. Covariates included age, sex, number of medications, serum calcium, haemoglobin level, renal function, and the presence of previous myocardial infarction, stroke, chronic heart failure, COPD and diabetes. Results 3723 patients, mean age 84 years, were included. 1535 (41%) were male and 733 (20%) died during six-month follow-up. The lower an individual’s peak CRP reading, and the longer the time taken for their CRP to fall, the better their 6-month survival. The time for CRP to reach half of its maximum value was the best dynamic CRP index of survival (HR 0.93 per week, 95% CI 0.89 to 0.98; p = 0.004); this remained significant even after adjustment for maximum CRP level and covariates listed above. Conclusion CRP recovery indices are associated with survival in older people; further work is required to explain differences in physiology between patients with a fast and slow CRP recovery.
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Affiliation(s)
- Maryam Barma
- Ageing and Health, University of Dundee, Ninewells Hospital, Dundee, Scotland, United Kingdom
| | - James A. Goodbrand
- Ageing and Health, University of Dundee, Ninewells Hospital, Dundee, Scotland, United Kingdom
| | - Peter T. Donnan
- Dundee Epidemiology and Biostatistics Unit, Dundee University Medical Research Institute, University of Dundee, Dundee, Scotland, United Kingdom
| | - Mark M. McGilchrist
- Health Informatics Centre; Tayside Medical Science Centre, University of Dundee, Dundee, Scotland, United Kingdom
| | - Helen Frost
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, United Kingdom
| | - Marion E. T. McMurdo
- Ageing and Health, University of Dundee, Ninewells Hospital, Dundee, Scotland, United Kingdom
| | - Miles D. Witham
- Ageing and Health, University of Dundee, Ninewells Hospital, Dundee, Scotland, United Kingdom
- * E-mail:
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Frailty phenotype and chronic kidney disease: a review of the literature. Int Urol Nephrol 2015; 47:1801-7. [DOI: 10.1007/s11255-015-1112-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023]
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21
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Sekine K, Nagata N, Sakamoto K, Arai T, Shimbo T, Shinozaki M, Okubo H, Watanabe K, Imbe K, Mikami S, Nozaki Y, Sakurai T, Yokoi C, Kojima Y, Kobayakawa M, Yanase M, Akiyama J, Noda M, Uemura N. Abdominal visceral fat accumulation measured by computed tomography associated with an increased risk of gallstone disease. J Gastroenterol Hepatol 2015; 30:1325-31. [PMID: 25869941 DOI: 10.1111/jgh.12965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM Visceral adiposity is a strong determinant of insulin resistance, which decreases cholecystokinin response sensitivity, and increases cholesterol saturation in the gallbladder bile; thus, it potentially relates to gallstone disease development. We aimed to investigate whether visceral fat measured by computed tomography (CT) is a risk factor for gallstone disease. METHODS A cohort of 717 participants undergoing CT and ultrasonography was analyzed. The associations between body mass index (BMI), visceral adipose tissue (VAT) area, subcutaneous adipose tissue (SAT) area, and gallstone disease were analyzed adjusted for age, sex, hypertension, diabetes, and dyslipidemia. RESULTS In multivariate analysis, gallstone disease was significantly associated with VAT and SAT areas for both categorical data and trend (P for trend < 0.001, 0.009), but not body mass index (BMI). Among patients with BMI < 25, gallstone disease remained significantly associated with VAT area (P for trend 0.021) and SAT area (P for trend 0.005). Interactions between the obesity indices and being elderly on the risk of gallstone disease were found; specifically BMI (P = 0.005), SAT (P < 0.001), and VAT (P = 0.154). A significant association between all obesity indices and gallstone disease was seen in patients aged < 65 but not among those aged ≥ 65. However, no significant association was noted between the obesity indices and sex. CONCLUSIONS CT-measured adipose tissue, rather than BMI, was a better predictor for risk of gallstone disease. This finding applies to younger people or even those with normal body weight, suggesting the importance of abdominal visceral fat accumulation in the development of gallstone disease.
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Affiliation(s)
- Katsunori Sekine
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naoyoshi Nagata
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kayo Sakamoto
- Diagnostic Radiology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tomohiro Arai
- Diagnostic Radiology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takuro Shimbo
- Clinical Research and Informatics, International Clinical Research Center Research Institute, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masafumi Shinozaki
- Diagnostic Radiology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hidetaka Okubo
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Watanabe
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Koh Imbe
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shintaro Mikami
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuichi Nozaki
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toshiyuki Sakurai
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Chizu Yokoi
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yasushi Kojima
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masao Kobayakawa
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mikio Yanase
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Junichi Akiyama
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mitsuhiko Noda
- Diabetes Research Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan
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