Age-adjusted Charlson Comorbidity Index Research Articles

Surgical and oncological results after rectal resections with or without previous treatment for prostate cancer.

Previous treatment for prostate cancer (PC) may potentially affect the surgical and oncological outcomes of subsequent rectal cancer surgery, but there are only a few studies regarding this particular group. In this study, we present the 3-year surgical and oncological results of rectal cancer patients who had received previous treatment for PC at a single Finnish tertiary referral centre. Data regarding all male patients diagnosed with rectal cancer and treated at Tampere University Hospital (TAUH) between 1997 and 2016 were gathered from medical records. In total, this study included 553 rectal cancer patients who underwent curative surgery, and 54 of them (9.8%) had a prior history of treatment for prostate cancer. Patients in the PC group were older and had more comorbidities compared with those in the non-PC group. The PC patients had a significantly higher risk of permanent stoma compared with the non-PC patients (61.5% vs. 45.2%, respectively, p = 0.025). The PC patients seemed to have lower tumours than the non-PC patients (87% vs. 75%, respectively, p = 0.05). Overall, the 3-year overall survival (OS) for the PC and non-PC patients was 74.1% and 80.6%, respectively. No significant differences were observed between the study groups even in the age-adjusted comparison [hazard ratio (HR): 1.07, confidence interval (CI) 95%: 0.60-1.89]. In the univariable analysis, radically operated patients without a history of PC exhibited an improved overall survival, (HR: 2.46, 95% CI: 1.34-4.53, p = 0.004). However, only a higher age-adjusted Charlson comorbidity index (CCI) and a low tumour location (<10 cm) were found to have an independent prognostic impact on worse OS in the multivariable analysis (HR: 1.57, 95% CI: 1.36-1.82, p < 0.001 and HR: 2.74, 95% CI: 1.32-5.70, p = 0.007, respectively). No significant differences were observed between the groups in terms of disease-free or local recurrence-free survival. Rectal cancer is more frequently found in the middle or lower part of the rectum in patients who have previously received treatment for prostate cancer. These patients also have a higher likelihood of requiring a permanent stoma. In radically operated rectal cancer, the PC group had a worse OS rate, according to the univariable analysis. However, the only independent prognostic factors for a worse OS that were highlighted in the multivariable analysis included a higher CCI and a low tumour location.

Multivariate analysis of prognostic factors in patients with lip squamous cell carcinoma after surgery

BackgroundLip squamous cell carcinoma (LSCC) was one of the most common cancer types of head and neck tumors. This study aimed to find more predictors of the prognosis in postoperative LSCC patients.MethodsA total of 147 LSCC patients between June 2012 and June 2018 were collected from two tertiary care institutions. There were 21 clinicopathological factors included and analyzed in our study. The univariate and multivariate Cox regression analyses were performed to find the independent prognostic factors for predicting progression-free survival (PFS) and overall survival (OS) in postoperative LSCC patients. The role of adjuvant radiotherapy in various subgroups was displayed by Kaplan–Meier plots.ResultsThe 1-, 3-, and 5-year PFS of postoperative LSCC patients were 88.4%, 70.1%, and 57.8%, respectively. Similarly, the 1-, 3-, and 5-year OS of postoperative LSCC patients were 94.6%, 76.9%, and 69.4%, respectively. The results suggested that postoperative LSCC patients with age at diagnosis ≥ 70 years, grade with moderate or poor differentiate, the American Joint Committee on Cancer (AJCC) stage IV, higher systemic immune-inflammation index (SII), surgical margin < 5, and age-adjusted Charlson Comorbidity Index (ACCI) ≥ 5 tend to have a poorer PFS (all P < 0.05). Besides, postoperative LSCC patients with age at diagnosis ≥ 70 years, AJCC stage IV, higher GPS, higher SII, and ACCI ≥ 5 tend to have a worse OS (all P < 0.05). Additionally, postoperative patients with LSCC in the subgroup of ACCI < 5 and AJCC III–IV stage was more likely to benefit from adjuvant radiotherapy, but not for the other subgroups.ConclusionWe identified a series of significant immune-inflammation-related and comorbidity-related clinicopathological factors associated with the prognosis of postoperative LSCC patients by local data from two tertiary care institutions in China, which can be helpful for patients and surgeons to pay more attention to nutrition, inflammation, and complications and finally obtained a better prognosis.

Angiotensin receptor blockers and severe diarrhea and/or enterocolitis induced by CAPOX in patients with colorectal cancer: A multicentric cohort.

88 Background: While patients (pts) with colorectal cancer (CRC) treated with CAPOX (capecitabine and oxaliplatin) may experience severe diarrhea, risk factors for this toxicity remain undetermined. We have previously shown that concurrent use of angiotensin receptors blockers (ARB), a known inhibitor of TGF-B which is important for gut mucosa proliferation, significantly increased the risk of severe diarrhea and/or enterocolitis. Here we conducted a larger and multicenter study to validate this finding, adjusting for other risk factors. Methods: Multicenter retrospective cohort of CRC pts who received ≥ 1 cycle of CAPOX. The primary endpoint was grade (G) ≥ 3 diarrhea and/or enterocolitis as described by Common Terminology Criteria for Adverse Events version 5.0. Clinical data were retrieved from medical charts. Unadjusted logistic regression was used to evaluate risk factors for ≥ G3 diarrhea/enterocolitis (use of ARBs or angiotensin-converting enzyme inhibitors [ACEi], age, ECOG, Age-adjusted Charlson Comorbidity Index [A-CCI], sidedness, presence of ileostomy, treatment intent [curative vs palliative], use of proton pump inhibitors or antiacid, and center). A multivariable analysis was performed with variables with P &lt; 0.05 deemed significant. Results: From April/2010 to December/2023, 348 pts were included: 175 (50.3%) were female, median age was 61 years (28 - 87), 259 (74.4%) had stage III and 76 pts (21.9%), stage IV. 58 pts (16%) had G3 ≥ diarrhea/ enterocolitis, mostly before 3rd cycle. Age ≥ 65 years (Odds ratio [OR] 3.18; P &lt; 0,0001; 95% CI, 1.78 to 5.68 ); right-sided tumors (OR 1.73; P=0.075; 95% CI, 0.95 to 3.17); use of ARBs or ACEi (OR 1.57; P=0.127; 95% CI, 0.88 to 2.79); A-CCI (OR 1.12; P=0.042; 95% CI, 1.004 to 1.23) were associated with ≥ G3 diarrhea/enterocolitis in univariate analyses. In the multivariable analysis, age ≥ 65 years was significant (OR 3.13; P=0.001; 95% CI, 1.58 to 6.20), but use of ARBs or ACEi was not significant (OR 1.16; P=0.635; 95% CI, 0.62 to 2.13). Five out of 9 pts who used Olmesartan had ≥ G3 diarrhea/enterocolitis. Conclusions: Among pts treated with CAPOX, ≥ 65 years, but not use of ARBs or ACEi, was an independent risk factor for ≥ G3 diarrhea/enterocolitis. Concurrent Olmesartan and CAPOX should be used with caution.

Towards a better detection of patients at-risk of linezolid toxicity in clinical practice: a prospective study in three Belgian hospital centers.

Introduction: Linezolid is a last-resort antibiotic for infections caused by multidrug-resistant microorganisms. It is widely used for off-label indications and for longer than recommended treatment durations, exposing patients at higher risk of adverse drug reactions (ADRs), notably thrombocytopenia. This study aimed to investigate ADR incidence and risk factors, identify thrombocytopenia-related trough levels based on treatment duration, and evaluate the performance of predictive scores for ADR development. Methods: Adult in- and outpatients undergoing linezolid therapy were enrolled in three hospitals and ADRs and linezolid trough levels prospectively monitored over time. A population pharmacokinetic (pop-PK model) was used to estimate trough levels for blood samples collected at varying times. Results: A multivariate analysis based on 63 treatments identified treatment duration ≥10days and trough levels >8mg/L as independent risk factors of developing thrombocytopenia, with high trough values correlated with impaired renal function. Five patients treated for >28days did not develop thrombocytopenia but maintained trough values in the target range (<8mg/L). The Buzelé predictive score, which combines an age-adjusted Charlson comorbidity index with treatment duration, demonstrated 77% specificity and 67% sensitivity to predict the risk of ADR. Conclusion: Our work supports the necessity of establishing guidelines for dose adjustment in patients with renal insufficiency and the systematic use of TDM in patients at-risk in order to keep trough values ≤8mg/L. The Buzelé predictive score (if ≥7) may help to detect these at-risk patients, and pop-PK models can estimate trough levels based on plasma samples collected at varying times, reducing the logistical burden of TDM in clinical practice.

Charlson Comorbidity Index and Frailty as Predictors of Resolution Following Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Research on variables associated with chronic subdural hematoma (cSDH) resolution following middle meningeal artery embolization (MMAE) is limited. This study investigated the clinical utility of age-adjusted Charlson Comorbidity Index (ACCI) and modified 5-item Frailty Index (mFI-5) for predicting cSDH resolution following MMAE. We identified patients who underwent MMAE at our institution between January 2018, and December 2022, with at least 20 days of follow-up and one radiographic follow-up study. Patient demographics, characteristics, and outcomes were collected. Complete resolution was defined as absence of subdural collections on CT-scan at last follow-up. Non-age adjusted CCI (CCI), ACCI, and mFI-5 scores were calculated. Univariate and multivariable logistic regression analyzed the relationship between cSDH resolution and variables. A receiver operating characteristic (ROC) curve established the utility of ACCI and mFI-5 in predicting hematoma resolution. The study included 85 MMAE procedures. In univariate analysis, patients without resolution were older, had higher CCI, higher ACCI, higher mFI-5, and were more likely to have diabetes mellitus. In multivarible analysis, CCI (OR: 0.66, 95% CI: 0.48, 0.91) was independently associated with resolution controlling for age and antithrombotic resumption. The area under the ROC (AUROC) curve was 0.75 (95% CI: 0.65 - 0.85) for ACCI and 0.64 (95% CI: 0.52 - 0.76) for mFI-5. The optimal cutoffs for predicting resolution were ACCI ≥ 5 (sensitivity = 0.63, specificity = 0.77), and mFI-5 > 0 (sensitivity = 0.84, specificity = 0.43). ACCI and mFI-5 moderately predict MMAE resolution and may aid in medical decision-making.

Influencing factors on the quality of recovery after total knee arthroplasty: development of a predictive model.

Total Knee Arthroplasty (TKA) is a widely performed procedure that significantly benefits patients with severe knee degeneration. However, the recovery outcomes post-surgery can vary significantly among patients. Identifying the factors influencing these outcomes is crucial for improving patient care and satisfaction. In this retrospective study, we analyzed 362 TKA cases performed between January 1, 2018, and July 1, 2022. Multivariate logistic regression was employed to identify key predictors of recovery within the first year after surgery. The analysis revealed that Body Mass Index (BMI), age-adjusted Charlson Comorbidity Index (aCCI), sleep quality, Bone Mineral Density (BMD), and analgesic efficacy were significant predictors of poor recovery (p < 0.05). These predictors were used to develop a clinical prediction model, which demonstrated strong predictive ability with an Area Under the Receiver Operating Characteristic (AUC) curve of 0.802. The model was internally validated. The findings suggest that personalized postoperative care and tailored rehabilitation programs based on these predictors could enhance recovery outcomes and increase patient satisfaction following TKA.

Predictors of Return to Emergency Department and Readmission Following Primary Elective Total Shoulder Arthroplasty.

Returns to the Emergency Department (ED) and unplanned readmissions within 90 days of shoulder arthroplasty represent a significant financial burden to healthcare systems. Identifying the reasons and risk factors could potentially reduce their prevalence. A retrospective review of primary anatomic (aTSA) and reverse shoulder arthroplasty (rTSA) cases from January 2016 through August 2023 was performed. Demographic patient and surgical data, including age, diagnosis of anxiety or depression, body mass index (BMI), smoking status, age-adjusted Charlson Comorbidity Index (ACCI), modified 5-item fragility index (mFI-5), and hospital length of stay (LOS) was collected. Patient visits to the ED within 12 months prior to surgery were recorded. Predictors for return to the ED within 90 days postoperatively and any readmissions were determined. There were 338 cases (167 aTSA and 171 rTSA), of which 225 (67%) were women. Patients with anxiety (OR=2.44, 95% CI 1.11-5.33; P=0.026), surgical postoperative complications (OR=3.22, 95% CI 1.36-7.58; P=0.008), ED visit within 3 months prior to surgery (OR=3.80, 95% CI 1.71-8.45; P=0.001), ED visit 3 to 6 months prior to surgery (OR=2.60, 95% CI 1.12-6.05; P=0.027), and ED visit 6 to 12 months prior to surgery (OR=2.12, 95% CI 1.02-4.41; P=0.045) were more likely to have ED visit within 90 days postoperatively. Patients with prior ipsilateral shoulder surgery (OR=3.32, 95% CI 1.21-9.09; P=0.02), surgical postoperative complications (OR=13.92, 95% CI 5.04-38.42; P<0.001), an ED visit within 3 to 6 months preoperatively (OR=8.47, 95% CI 2.84-25.27; P<0.001), and an mFI-5 ≥2 (OR=3.66, 95% CI 1.35-9.91; P=0.011) were more likely to be readmitted within 90 days. Patients who present to the ED within 12 months prior to shoulder arthroplasty, those with anxiety, those with surgical complications and those with higher fragility should be monitored closely during the early postoperative period to minimize returns to the ED and/or unplanned readmissions.

Impact of blood transfusion on mortality and rebleeding in gastrointestinal bleeding: an 8-year cohort from a tertiary care center.

The aim of this study was to investigate the impact of blood transfusion (BT) on mortality and rebleeding in patients with gastrointestinal bleeding (GIB) and whether BT at a threshold of ≤7 g/dL may improve these outcomes. A prospective study was conducted in patients admitted with GIB between 2013 and 2021. Antithrombotic (AT) use and clinical outcomes were compared between transfused and non-transfused patients, and between those transfused at a threshold of ≤7 vs. >7 g/dL. Multivariate analysis was performed to identify predictors of mortality and rebleeding. A total of 667 patients, including 383 transfused, were followed up for a median of 56 months. Predictors of end-of-follow-up mortality included: age-adjusted Charlson Comorbidity Index, stigmata of recent hemorrhage (SRH), and being on anticoagulants only upon presentation (P=0.026). SRH was a predictor of end-of-follow-up rebleeding, while having been on only antiplatelet therapy (AP) upon presentation was protective (P<0.001). BT was not associated with mortality or rebleeding at 1 month or end of follow up. Among transfused patients, being discharged only on AP protected against mortality (P=0.044). BT at >7 g/dL did not affect the risk of short or long-term rebleeding or mortality compared to BT at ≤7 g/dL. Short- and long-term mortality and rebleeding in GIB were not affected by BT, nor by a transfusion threshold of ≤7 vs. >7 g/dL, but were affected by the use of AT. Further studies that account for AT use are needed to determine the best transfusion strategy in GIB.

Geriatric nutritional risk index has a prognostic value for recovery outcomes in elderly patients with brain abscess.

The Geriatric Nutritional Risk Index (GNRI) is a straightforward and objective tool for nutritional screening in older patients and has been demonstrated to possess prognostic predictive value in several diseases. Nonetheless, there is a lack of research on the nutritional risk associated with brain abscess in the older. This study aimed to evaluate the prevalence of nutritional risk among these patients by GNRI and to investigate its potential prognostic value for clinical outcomes. From August 2019 to April 2023, 100 older patients diagnosed with brain abscess were enrolled in this single-center prospective cohort study, which evaluated the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in elderly brain abscess patients. Data collected included demographic, and clinical characteristics at admission and calculated the GNRI, and the Glasgow Outcome Scale (GOS) score 6 months post-discharge. A GOS score of 5 was considered indicative of a good recovery, whereas scores ranging from 1 to 4 were classified as poor recovery. The results revealed that 48% of older brain abscess patients were at risk of malnutrition according to the GNRI. These patients had significantly higher post-admission C-reactive protein (CRP) levels (p = 0.017), more comorbidities (p < 0.001), and higher age-adjusted Charlson Comorbidity Index (aCCI) scores (p < 0.001) compared to those without nutritional risk. Spearman correlation analysis showed that GNRI scores were negatively correlated with CRP levels, comorbidities, and aCCI scores, and positively correlated with Glasgow Outcome Scale (GOS) scores (Spearman's ρ = 0.624, p < 0.001). Multivariate logistic regression revealed that lower GNRI values were linked to reduced GOS levels (OR = 0.826, 95% CI: 0.775-0.880). ROC analysis determined a GNRI threshold of 97.50 for predicting poor recovery, with 90.57% sensitivity and 87.23% specificity. The older brain abscess patients exhibited a high malnutrition risk. GNRI showed an important predictive value for recovery in older patients, which could be helpful in clinical intervention and rehabilitation.

The prognostic significance of the age-adjusted Charlson comorbidity index in the prediction of postoperative outcome after liver resection for colorectal cancer metastases

The prognostic significance of the age-adjusted Charlson comorbidity index in the prediction of postoperative outcome after liver resection for colorectal cancer metastases

Long-term risk of death in patients with infection attended by prehospital emergency services.

To develop and validate a risk model for 1-year mortality based on variables available from early prehospital emergency attendance of patients with infection. Prospective, observational, noninterventional multicenter study in adults with suspected infection transferred to 4 Spanish hospitals by advanced life-support ambulances from June 1, 2020, through June 30, 2022. We collected demographic, physiological, clinical, and analytical data. Cox regression analysis was used to develop and validate a risk model for 1-year mortality. Four hundred ten patients were enrolled (development cohort, 287; validation cohort, 123). Cumulative mortality was 49% overall. Sepsis (infection plus a Sepsis-related Organ Failure Assessment score of 2 or higher) was diagnosed in 29.2% of survivors vs 56.7% of nonsurvivors. The risk model achieved an area under the receiver operating characteristic curve of 0.89 for 1-year mortality. The following predictors were included in the model: age; institutionalization; age-adjusted Charlson comorbidity index; PaCO2; potassium, lactate, urea nitrogen, and creatinine levels; fraction of inspired oxygen; and diagnosed sepsis. The model showed excellent ability to predict 1-year mortality based on epidemiological, analytical, and clinical variables, identifying patients at high risk of death soon after their first contact with the health care system.

Oncological and functional outcomes of patients who underwent open partial nephrectomy for kidney tumor.

To report long-term functional and oncological outcomes of OPN Methods: We enrolled 182 patients who underwent consecutive OPN with a diagnosis of kidney tumor in our clinic between April 2002 and February 2020 and were selected from our prospective OPN database. Preoperative demographic and clinical characteristics, intraoperative and pathological results, and patients' postoperative functional and oncological follow-up data were retrospectively analyzed. Overall survival (OS) and disease- free survival (DFS) were evaluated using Kaplan-Meier survival analysis. The time-dependent variation between preoperative and postoperative functional results was statistically analyzed and presented in a graph. The mean age was 54.4 ± 10.8 yr, and the median age-adjusted Charlson comorbidity index (ACCI) was 1 (interquartile range [IQR] 0-1). The mean tumor size was 3.1 ± 1.2 cm, and the median RENAL score was 6 (IQR 5-8). The most common malign histopathological subtype was clear cell carcinoma with 76.6%, and five cases (3.4%) had positive surgical margins (PSMs). The most common surgical techniques were the retroperitoneal approach (98.9%) and cold ischemia (88.5%). Estimated glomerular filtration rate (eGFR) preservation was 92% (80.8-99.3, IQR), which translates to 32% chronic kidney disease (CKD) upstaging. Acute kidney injury (AKI) was detected in 27 (14.8%) patients according to RIFLE criteria. The intraoperative complication rate was 5.5%, and the postoperative overall complication rate (Clavien-Dindo 1-5) was 30.2%. Major complications (Clavien-Dindo 3-5) were observed in 13 (7.1%) patients. The median oncological follow-up was 42 mo (21.3- 84.6, IQR), and the 5- and 10-yr OS were 90.1% and 78.6%, 5 and 10-yr DFS were 99.4% and 92.1%, respectively. No local recurrence was observed in 5 (3.4%) patients with PSMs; only one had distant metastasis in the 8th postoperative month. The retrospective design, the small number of patients who underwent PN based on mandatory indication, and one type of surgical approach may limit the generalizability of our findings. This study confirms excellent long-term oncologic and functional outcomes after OPN in a cohort of patients selected from a single institution. In light of the information provided by the literature and our study, our recommendation is to push the limits of PN under every technically feasible condition in the treatment of kidney tumors to protect the kidney reserve and achieve near-perfect oncological results.

PROFILES OF TWO COHORTS OF NEAR-CENTENARIANS AND CENTENARIANS: FINDINGS FROM HONG KONG CENTENARIAN STUDY 1 AND 2

Abstract Hong Kong launched its first centenarian study in 2011 when there were just over 3,600 centenarians, and subsequently, the second phase in 2021/22 when the population of centenarians tripled. Both studies investigated the multidimensional well-being of local older adults of Chinese ethnicity aged 95 or above (near centenarians and centenarians, NCCs). A comparison of the two cohorts of community dwelling NCCs who lived with their family (2011: N=77; 2021/22: N=151) indicates a substantial drop in sensory functions (2011 vs 2021/22: intact vision: 94.8% vs 40.4%; intact hearing: 93.5% vs 53.6%), social activities (weekly or more: 48.1% vs 40.4%), outdoor activities (weekly or more: 75.3% vs 45.3%), and independence in activities of daily living (ADL) (no. of dependent task: 0.79 vs 2.79). Although the prevalence of comorbidities was comparable (Charlson age-adjusted comorbidity index: Mean = 2.7 vs 3.5), the frailty and pre-frailty was considerably more common in the 2021/22 cohort (55.3%; 39.0%) than the 2011 cohort (50.6%; 23.4%). We also found disparate predictors for health evaluations. Among the 2011 cohort, being male and having better psychological well-being were related to more favorable assessments of health compared to their peers. Among the 2021/22 cohort, favorable peer-compared health assessments were related to fewer ADL dependent tasks, better psychological well-being, higher age and being female. Despite the impact by COVID on the 2021/22 cohort, our findings alert policy makers and practitioners worldwide to the growing number of community-dwelling adults of advanced age with considerable personal care and health needs.

Adherence to lifestyle therapy in patients with chronic heart failure and comorbidity

Background: Influence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet. The aim of this study was to investigate awareness and adherence to lifestyle therapy in patients with CHF and comorbidity.Мethods: Two hundred and three patients with CHF (130 males and 73 females, mean age was 61.8±9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, in 2016. Age-adjusted Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life was estimated using SF-36 Health Status Survey. Psychological state and attitude to condition were estimated using Minnesota Multiphasic Personality Inventory, the Personal Questionnaire of Behterevsk’ Institute, characterological questionnaire by K. Leonhard. Follow-up period was 1 year.Results: The awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (limited salt intake). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (limited salt intake). Age-adjusted Charlson comorbidity index was 5.0±2.1 points. Patients with high comorbidity (Charlson comorbidity index &gt;6 points) had decreased of quality of life, both in the physical and the psychological aspects. There were no differences in adherence to lifestyle therapy in patients with CHF, depending on comorbidity. Nonadherent patients were characterized by sensitive type of attitude to their condition, emotional lability, exclusion as a type of defense mechanism and negative coping strategies.Сonclusions: Nonadherence to lifestyle therapy in patients with CHF was associated with maladaptive type of attitude to their condition, which was more common in patients with high comorbidity.

Adherence to lifestyle therapy in patients with chronic heart failure and comorbidity

Background: Influence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet. The aim of this study was to investigate awareness and adherence to lifestyle therapy in patients with CHF and comorbidity.Мethods: Two hundred and three patients with CHF (130 males and 73 females, mean age was 61.8±9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, in 2016. Age-adjusted Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life was estimated using SF-36 Health Status Survey. Psychological state and attitude to condition were estimated using Minnesota Multiphasic Personality Inventory, the Personal Questionnaire of Behterevsk’ Institute, characterological questionnaire by K. Leonhard. Follow-up period was 1 year.Results: The awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (limited salt intake). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (limited salt intake). Age-adjusted Charlson comorbidity index was 5.0±2.1 points. Patients with high comorbidity (Charlson comorbidity index &gt;6 points) had decreased of quality of life, both in the physical and the psychological aspects. There were no differences in adherence to lifestyle therapy in patients with CHF, depending on comorbidity. Nonadherent patients were characterized by sensitive type of attitude to their condition, emotional lability, exclusion as a type of defense mechanism and negative coping strategies.Сonclusions: Nonadherence to lifestyle therapy in patients with CHF was associated with maladaptive type of attitude to their condition, which was more common in patients with high comorbidity.

Adherence to lifestyle therapy in patients with chronic heart failure and comorbidity

Background: Influence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet. The aim of this study was to investigate awareness and adherence to lifestyle therapy in patients with CHF and comorbidity.Мethods: Two hundred and three patients with CHF (130 males and 73 females, mean age was 61.8±9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, in 2016. Age-adjusted Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life was estimated using SF-36 Health Status Survey. Psychological state and attitude to condition were estimated using Minnesota Multiphasic Personality Inventory, the Personal Questionnaire of Behterevsk’ Institute, characterological questionnaire by K. Leonhard. Follow-up period was 1 year.Results: The awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (limited salt intake). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (limited salt intake). Age-adjusted Charlson comorbidity index was 5.0±2.1 points. Patients with high comorbidity (Charlson comorbidity index &gt;6 points) had decreased of quality of life, both in the physical and the psychological aspects. There were no differences in adherence to lifestyle therapy in patients with CHF, depending on comorbidity. Nonadherent patients were characterized by sensitive type of attitude to their condition, emotional lability, exclusion as a type of defense mechanism and negative coping strategies.Сonclusions: Nonadherence to lifestyle therapy in patients with CHF was associated with maladaptive type of attitude to their condition, which was more common in patients with high comorbidity.

Optimal postoperative delirium prediction after coronary artery bypass grafting surgery: a prospective cohort study.

Postoperative delirium (POD) presents as a serious neuropsychiatric syndrome in patients undergoing off-pump coronary artery bypass grafting (OPCABG) surgery. This is correlated with higher mortality, cognitive decline, and increased costs. The Age-adjusted Charlson Comorbidity Index (ACCI) is recognized as an independent predictor for mortality and survival rate. The purpose of our study is to estimate the predictive value of the ACCI on the POD in patients undergoing OPCABG surgery. This prospective cohort study enrolled patients undergoing OPCABG surgery between December 2020 and May 2021 in Qilu Hospital. Patients were divided into the low-ACCI group (score, 0-3) and the high-ACCI group (score ≥4) according to their ACCI scores. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and CAM were used to diagnose POD within 7 days after surgery. The general, laboratory, and clinical data of the patients were recorded and collected. The characteristic ROC curve was applied to further assess the predictive value of the ACCI for POD in patients following OPCABG surgery. A total of 89 patients were enrolled, including 45 patients in the low-ACCI group and 44 patients in the high-ACCI group. The incidence of POD was higher in the high-ACCI group than in the low-ACCI group (45.5% vs. 15.6%, P = 0.003). Multivariate logistic regression analyses showed that the ACCI (OR, 2.433; 95% CI, 1.468-4.032; P = 0.001) was an independent risk factor for POD. The ACCI accurately predicted POD in patients following OPCABG surgery with an AUC of 0.738, and the Hosmer-Lemeshow goodness of fit test yielded X2 = 5.391 (P = 0.145). The high-ACCI group showed a high incidence of POD. The ACCI was an independent factor associated with POD in patients following OPCABG surgery. In addition, the ACCI could accurately predict POD in patients following OPCABG surgery. ClinicalTrials.gov, identifier CHiCTR2100052811.

Standardized community management on the diagnosis, treatment, and risk factors control for non-valvular atrial fibrillation in elderly patients

BackgroundBy investigating the knowledge, medication, occurrence of complications, and risks among elderly non-valvular atrial fibrillation (NVAF) patients in Shanghai communities, and providing standardized comprehensive management and follow-up, we aim to explore the impact of standardized community management on improving disease awareness, standardizing atrial fibrillation (AF) treatment, reducing the risk of complications occurrence, and addressing risk factors for AF patients.MethodsThis research selected elderly atrial fibrillation patients from Zhuanqiao Community Health Service Center, Minhang District, Shanghai from July 2020 to October 2022. Their personal health records and examination results were reviewed, and the incidence of AF, awareness, medication, and complications were investigated. Age-adjusted Charlson Comorbidity Index (aCCI), CHA2DS2-VASc score, and HAS-BLED score were used to evaluate disease burden, thromboembolic risk, and bleeding risk, respectively. The patients were subjected to standardized community management, and the compliance rate of disease awareness, treatment, resting heart rate, blood pressure, fasting blood glucose, and body mass index (BMI) were assessed at the baseline, 6 months and 1 year after management.ResultsA total of 243 NVAF patients were included, with an average aCCI score of (4.5 ± 1.1). Among them, 28% of the patients were aware of their AF, and 18.1% of the patients were aware of the hazards of AF. Of the patients, 11.9% used anticoagulant drugs, including 6.6% and 5.3% for warfarin and non-vitamin K antagonist oral anticoagulants (NOACs), respectively. 7% of patients used antiplatelet drugs. 26.7% of the patients used heart rate control drugs. 10.3% of the patients experienced thromboembolic events, and 0.8% of the patients experienced bleeding events. 93.0% of the patients were at high risk of thromboembolism, and 24.7% of the patients were at high risk of bleeding. Compared with the baseline, there were significant statistical differences (P < 0.001) in disease awareness, awareness of the hazards of AF, use of anticoagulant drugs and heart rate control drugs, and control of risk factors among NVAF patients after standardized community management. Moreover, with the extension of management time, there was a linear increase in the awareness of NVAF, awareness of the hazards of AF, utilization rate of anticoagulant drugs, utilization rate of heart rate control drugs, blood pressure, blood glucose, and BMI compliance rate (P < 0.001).ConclusionCurrently, the awareness, treatment, and control of risk factors for AF in elderly NVAF patients in Shanghai community are not satisfactory. Standardized community management helps to improve the diagnosis, treatment, and control of risk factors in AF.

The prognostic value of age-adjusted Charlson comorbidity index in laparoscopic resection for hilar cholangiocarcinoma

The prognostic role of the Age-Adjusted Charlson Comorbidity Index (ACCI) in hilar cholangiocarcinoma patients undergoing laparoscopic resection is unclear. To evaluate ACCI's effect on overall survival (OS) and recurrence-free survival (RFS), we gathered data from 136 patients who underwent laparoscopic resection for hilar cholangiocarcinoma at Zhengzhou University People’s Hospital between 1 June 2018 and 1 June 2022. ACCI scores were categorized into high ACCI (ACCI > 4.0) and low ACCI (ACCI ≤ 4.0) groups. We examined ACCI's association with OS and RFS using Cox regression analyses and developed an ACCI-based nomogram for survival prediction. Our analysis revealed that higher ACCI scores (ACCI > 4.0) (HR = 2.14, 95%CI: 1.37–3.34) were identified as an independent risk factor significantly affecting both OS and RFS in postoperative patients with hilar cholangiocarcinoma (p < 0.05). TNM stage III-IV (HR = 7.42, 95%CI: 3.11–17.68), not undergoing R0 resection (HR = 1.58, 95%CI: 1.01–2.46), hemorrhage quantity > 350 mL (HR = 1.92, 95%CI: 1.24–2.97), and not receiving chemotherapy (HR = 1.89, 95%CI: 1.21–2.95) were also independent risk factors for OS. The ACCI-based nomogram accurately predicted the 1-, 2-, and 3-year OS rates, with Area Under the Curve (AUC) values of 0.818, 0.844, and 0.924, respectively. Calibration curves confirmed the nomogram’s accuracy, and decision curve analysis highlighted its superior predictive performance. These findings suggest that a higher ACCI is associated with a worse prognosis in patients undergoing laparoscopic resection for hilar cholangiocarcinoma. The ACCI-based nomogram could aid clinicians in making accurate predictions about patient survival and facilitate individualized treatment planning.

Age-Adjusted Charlson Comorbidity Index Is a Significant Factor for Predicting Thrombosis Development and Survival in Polycythemia Vera

Background: The worldwide-recognized prognostic role of age and previous thrombosis as part of standard risk score in polycythemia vera (PV) deserves some deeper insight . Aimof our study was to identify prediction factors for thrombosis development and overall survival (OS) in PV patients. Methods: Study included 816 PV patients diagnosed according to WHO classification and treated between 2005-2022 at University center. The analysis included: demographic, clinical and laboratory parameters with neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), thrombosis data, age-adjusted Charlson comorbidity index (ACCI) and presence of cardiovascular (CV) risk factors (arterial hypertension, diabetes, smoking, hyperlipidaemia). JAK2 positivity had 97.8% of patients. During follow up 29.8% of patients died. Results: Mean age was 62 years (range 18-87), 51.7% male and 61.3% older &amp;gt;60 years. According to standard risk score, 26.5% of patients belonged to low-risk group while 73.5% to high-risk group. According to ACCI: 11.8% were without comorbidities, mild grade had 34.4%, moderate 36% and severe 17.8% of patients. Distribution according to CV risk factor presence: without 25.6%, one 38.8%, two 27.5%, three 7.5%, four 0.6% of patients with highest incidence of arterial hypertension&amp;gt;smoking&amp;gt;diabetes &amp;gt;hyperlipidaemia. Previous thrombosis was reported in 182 patients (22.3%) with 222 thrombosis (160 arterial, 62 venous). During follow up 111 patients (13.6%) had 120 thrombosis (82 arterial, 38 venous). Previous thrombosis (p=0.029), ACCI groups (p&amp;lt;0.001), presence of CV factor ≥1 (p=0.001) or secondary malignancy (p&amp;lt;0.001) predicted venous thrombosis development. In comparison, previous thrombosis (p = 0.03), male gender (p=0.006) standard risk score (p=0.001), ACCI (p&amp;lt;0.001), CV factor ≥1 (p&amp;lt;0.001), NLR ≥5 (p=0.008) and PLR ≥500 (p&amp;lt;0.001), were predictors of arterial thrombosis development. In multivariate analysis, risk of venous thrombosis development was independently associated with only ACCI (HR 3.75; p&amp;lt;0.001) while arterial thrombosis with ACCI (HR2 2.12; p&amp;lt;0.01) and PLR ≥500 (HR 1.886, p=0.028). Patients with thrombosis during the follow-up had significantly shorter survival (p=0.048). Patients in low risk standard group had median survival of 221 months v.s high risk group patients with 119months (p&amp;lt;0.001). Median survival of patients according ACCI groups: without comorbidities 233 months; mild grade 171 months; moderate grade 120 months and severe grade 84 months (p&amp;lt;0.001). Univariate analysis identified factors associated with shorter OS: age ≥65y(p&amp;lt;0.001), Le ≥15x10 9/L (p&amp;lt;0.001), ANC ≥10x10 9/L (p&amp;lt;0.001), Plt ≥1000x10 9/L (p=0.027), presence of secondary malignancy (p&amp;lt;0.001), previous thrombosis (p=0.03), development of arterial (p&amp;lt;0.001) and venous (p&amp;lt;0.001) thrombosis during follow up. Of CV factors only presence of arterial hypertension showed negative survival effect (p=0.003). Multivariate Cox regression model revealed age ≥65y (HR=3.3; p&amp;lt;0.001), ACCI group (HR=1.7; p&amp;lt;0.001) and ANC ≥10x10 9/L (HR=1.6; p=0.001) as most important survival predictors. Patients with ACCI score ≥4 significantly received hydroxyurea (p&amp;lt;0.001). The mean OS was 12.5 years while 5-years and 10-years OS was 81% and 62% respectively. The cause of death was as the follows: heart failure (37%), second malignancy (15.2%), thrombosis (14.8%), progression of disease (8.6%), COVID infection (4.2%) and unknown cause in 20.2% of patients. Conclusion: Age-adjusted CCI was found to be the most reliable predictor of thrombosis development in PV. The application of ACCI allows better PV survival assessment by delineating ACCI moderate grade as intermediate risk survival group and improves identification of high-risk PV patients incorporating ACCI severe grade group with survival less than 7 years.