Predicting mortality and length of stay of geriatric patients in an acute care general hospital

Three-hundred-eight geriatric patients (mean age = 76.7 yr, range = 70-94 yr) consecutively admitted to an acute care general hospital were followed up to identify the predictors of in-hospital mortality and long stay. Sociodemographic, medical, and functional data were collected within 24 hours from admission and their correlation with the outcomes assessed by logistic regression analysis. The following variables were shown to be independent predictors of death: use of more than 6 drugs (odds ratio = 3.04, confidence limits = 1.05-8.76); abnormal Mini-Mental State score (o.r. = 1.72, c.l. = 1.05-1.83); low ADL score (o.r. = 2.4, c.l. = 1.07-5.56). Extended stay was significantly and independently predicted by polypharmacy (o.r. = 1.94, c.l. = 1.18-3.2) and comorbidity (o.r. = 2.06, c.l. = 1.24-3.38). The mortality rates of patients with cognitive impairment and polypharmacy with or without functional impairment were 40% and 22%, respectively. The proposed method allows identification of high-risk geriatric inpatients by a simple medical and functional assessment on admission.

Surgical infections surveillance: results of a six-month incidence study in two Italian hospitals

In a six-month incidence study of surgical wound infections (SWI) in two Italian hospitals, 1,019 surgical patients, in three general surgery wards, and 433 surgical patients in one orthopedics ward were studied. For the SWI surveillance, the DANOP-DATA system was used: this microcomputer program was developed by Danish authors and tested in a European multicenter study coordinated by the World Health Organization in 1989. Two Italian hospitals participated in the multicenter study. The overall infection rate was 1.2 per 100 operations in orthopedics and 4.9/100 in general surgery. The risk of infection increased with age (RR = 2.06; 95% CL = 1.20-3.53), wound class (RR = 3.38; 95% CL = 1.97-5.8), length of pre-operative stay (RR = 2.71; 95% CL = 1.54-4.74), and duration of operation (RR = 2.59; 95% CL = 1.48-4.54). The infection rates ranged from 3.7 to 7.3/100 among the three general surgery wards; this variability by ward was only partially explained by differences in the age distribution of in-patients, wound class, duration of operation and length of pre-operative stay. When all these risk factors were simultaneously taken into account using a logistic regression model, the odds radio, comparing one of the three general surgical wards with the other two, was still 2.29 (95% CL = 1.23-4.26). The observed variability can be attributed to differences, among the participating wards, in the case-mix of patients treated and/or to differences in the quality of infection control programs implemented.

Radiological changes and circulating immune complexes in patients with urinary schistosomiasis

The degree of infection and the urographic picture was correlated to the presence and level of circulating immune complexes (CICs) in 69 patients affected by urinary schistosomiasis. Patients were divided into 2 groups: those eliminating less and those eliminating more than 25 eggs/10 ml of urine. Radiological changes in the urinary tract were present in 67% of patients, the most frequent finding being single or multiple filling defects in the bladder. CICs were present in 39 patients. A positive correlation was found between the presence and level of CICs and the output of Schistosoma haematobium eggs, as well as between the presence of CIC and single or multiple filling defects of the bladder. Our findings indicated that CICs were present in patients with urinary schistosomiasis, but the different incidence in patients with a large egg output and radiological filling defects suggests a possible pathogenic role only in the earlier phase of the infection.

Detection of parasite related antigens associated with conglutinin binding immune complexes in patients with Schistosoma haematobium

An ELISA assay was designed to detect the presence of parasite related antigens associated with circulating immune complexes in patients affected by urinary schistosomiasis. The assay makes use of bovine conglutinin as the immune complex recognition unit and of human anti-Schistosoma antibody as the antigen recognition unit. Using this method we showed that 10 of 15 (67%) patients with a positive polyethylene glycol assay had circulating immune complexes in which parasite antigens could be detected.