Death In Elderly Patients Research Articles

COVID-19 IN CHRONIC MYELOID LEUKEMIA PATIENTS – BRAZILIAN EXPERIENCE

AimsTo collect data about COVID-19 in CML patients from Brazilian centers and their outcomes.MethodsObservational, multicentric, ongoing register study. Hematologists from private and public CML reference centers from different regions of Brazil were invited to report their cases of COVID-19 in CML patients. Those centers are responsible for the care of approximately 3030 CML patients.ResultsBetween March 2020 and July 2021, 16 institutions contributed to this analysis, and reported 73 COVID-19 cases in CML patients (pts). Eight-five % were from the South and Southeast regions, 11% from Northeast. The median age was 50 years (22-79), with 33% of the pts older than 60. Male patients were predominant (60%). The median time of CML diagnosis was 9 years (0-29). Most of the pts were in first line therapy (57.5%), 27% in second line and 11% in third line. Current CML treatment at COVID-19 was: imatinib (46,5%), nilotinib (22%), dasatinib (16%), post-transplant (4%), asciminib (1%), ponatinib (1%), treatment-free remission (2%), no treatment (7%). COVID-19 grade: asymptomatic (4%), mild (66%), moderate (12%), severe/critical (16%). CML status at COVID: AP/BC (3%), CP (12,4%), hematologic response (11%), complete cytogenetic response (4%), MMR (34%), MR4.0 (8%), MR4.5 (27%). Eleven patients interrupted treatment temporarily during COVID. COVID-19 was confirmed by RT-PCR of oral and nasal swab collection (68%) or rapid/serologic test (32%). Comorbidities were present in 34 pts, most common were: hypertension (33%), diabetes (14%), chronic renal failure (4%), chronic obstructive pulmonary disease/emphysema (5.5%), pulmonary hypertension (1). Hospitalization occurred in 30% of the cases, 18% in an intensive care unit, 8% with mechanical ventilation. Treatment received for COVID-19: antibiotics (31%), steroids (16%), chloroquine (5.5%), oseltamivir (4%); ivermectin (8%): heparin (3%). Sixty-nine patients recovered, 4 died from COVID-19 (5,4%): one 42 year old newly diagnosed male patient with high leukocytes counts and with a simultaneous bacterial infection, two 70-year old patients treated with imatinib, both in MR4.5, and one 31-year old male patient treated with nilotinib, after imatinib and dasatinib failure, with hematologic response. A fifth patient in the accelerated phase died 2 months after discharge, from disease progression and pulmonary infection. All cases occurred before vaccination. There was one case of re-infection, in a patient treated with imatinib.Discussion:Conclusionsthe majority of COVID-19 cases in the CML population was mild, but there were 2 deaths of young patients with active disease and two deaths in elderly patients, one of them with comorbidities. The mortality in CML was lower than observed in other hematologic cancers.

Hospitalization burden and end-of-life (EOL) care in elderly patients with glioblastoma (GBM).

31 Background: GBM is associated with a poor prognosis and early death in elderly patients. Prior studies have demonstrated a high burden of hospitalization in this population. We sought to evaluate and examine trends in hospitalizations and EOL care in GBM survivors. Methods: Using SEER-Medicare linked data, we performed a retrospective observational cohort study of patients aged ≥ 65 years diagnosed with GBM from 2005-2017 who lived at least 6 months from the time of diagnosis. Aggressive EOL care was defined as: chemotherapy or radiotherapy within 14 days of death (DOD), surgery within 30 DOD, > 1 emergency department visit, ≥ 1 hospitalization or intensive care unit admission within 30 DOD; in-hospital death; or hospice enrollment ≤ 3 DOD. We evaluated age, race, ethnicity, marital status, gender, socioeconomic status, comorbidities, prior treatment and percentage of time hospitalized. Multivariable logistic regression was performed to determine factors associated with aggressive end of life care. Results: Of 5827 patients, 2269 (38.9%) survived at least 6 months. Among these, 1106 (48.7%) survived 6-12 months, 558 (24.6%) survived 12-18 months, and 605 (26.7%) survived > 18 months. Patients who survived 6-12 months had the highest burden of hospitalization and spent a median of 10.6% of their remaining life in the hospital compared to those surviving 12-18 months (5.4%) and > 18 months (3%) (P < 0.001). 10.1% of the cohort had claims for palliative care services; 49.8% of initial palliative care consults occurred in the last 30 days of life. Hospice claims existed in 83% with a median length of stay 33 days (IQR 12, 79 days). 30.1% of subjects received aggressive EOL care. Receiving chemo at any time (OR 1.510, 95% CI 1.221-1.867) and spending ≥ 20% of life in the hospital after diagnosis (OR 3.331, 95% CI 2.567-4.324) were associated with aggressive EOL care. Women (OR 0.759, 95% CI 0.624-0.922), patients with higher socioeconomic status (OR 0.533, 95% CI 0.342-0.829), and those diagnosed ≥ age 80 (OR 0.723, 95% CI 0.528-0.991) were less likely to receive aggressive EOL care. Race, ethnicity, marital status, and extent of initial resection were not associated with aggressive EOL care. Conclusions: A minority of elderly patients with GBM in the SEER-Medicare database survived ≥ 6 months; hospitalizations were common and patients spent a significant proportion of their remaining life hospitalized. Although hospice utilization was high in this cohort, 30% of patients received aggressive EOL care. Despite the aggressive nature of GBM, few patients had palliative care consults during their illness. Increased utilization of palliative care services may help reduce hospitalization burden and aggressive EOL care in this population.

Early multidrug treatment of SARS-CoV-2 infection (COVID-19) and reduced mortality among nursing home (or outpatient/ambulatory) residents

The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including initial viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic anti-blood clotting agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found hydroxychloroquine-based multidrug regimens were associated with a statistically significant > 60% reduction in mortality. Going forward, we conclude that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients e.g. LTF or ALF) has a reasonable probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus prior to symptoms worsening. Given the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of acute COVID-19 patients is a reasonable strategy to reduce the risks of hospitalization and death. If elderly high-risk patients in such congregated nursing home type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. The issue is timing of therapeutics, and we argue that early treatment before hospitalization, is the right time and can potentially save lives, especially among our higher-risk elderly populations hit hardest by severe illness and death from COVID-19. We must reiterate, we are talking about ‘early’ treatment before the disease is far along in the disease sequelae where the patient then needs hospitalization and aggressive interventions. We are referring to the initial days e.g. day one, post infection when symptoms emerge or there is strong clinical suspicion. This early therapeutic option deserves serious and urgent consideration by the medical establishment and respective decision-makers. Doctors must be allowed their clinical discretion in how they optimally treat their patients. Doctors must be brave and trust their skilled judgements and do all to save the lives of their patients.We therefore hypothesize that early outpatient ambulatory treatment, once initiated as soon as symptoms begin in high-risk positive persons, would significantly reduce hospitalizations and prevent deaths. Specifically, the provision of early multi-drug sequenced therapy with repurposed drugs will reduce hospitalization and death in elderly patients being cared for in long-term-care facilities.The most important implications of our hypothesis are: 1) hospitalizations and deaths would be reduced 2) transmission would be reduced due to the mitigation of symptoms and 3) recovery following infection and treatment provides for natural exposure immunity that is broad based, durable, and robust (helping towards natural immunity within the population). The end result is reduced strain on hospitals and systems that would allow for other non-COVID illnesses to receive care.

An Evaluation of Tp-e Interval and its Associations with Electrolyte Imbalances in the Electrocardiography of Elderly Patients on Hemodialysis

Aim: Sudden cardiac death (SCD) due to arrhythmias is a major cause of death in elderly patients on hemodialysis (HD). It has been found that prolonged Tp-e interval (Tpe) on electrocardiography (ECG) and increased Tpe/QTc ratio are strongly associated with SCD. In this study, we aimed to inves¬tigate the effects of changes in serum electrolyte levels on the pre- and post-HD ECG parameters, particularly Tpe. Methods: The study included 160 HD patients (with no disease or medication known to affect the QT interval) and 80 age- and sex-matched controls with normal kidney functions. All participants were aged 55 years or older. Pre- and post-HD serum electrolyte values and ECG re¬cordings were obtained. The heart rate, QRS interval, QTc, Tpe, and Tpe/QTc values were calculated. The pre-HD data were compared with the post-HD data as well as with controls. Results: The pre- and post-HD Tpe (p<0.001 for both comparisons) and Tpe/QTc (p=0.024 and p<0.001, respectively) values were significantly higher in the HD group than in the control group. The post-HD Tpe and Tpe/QTc values were significantly increased compared to the pre-HD values (p<0.001 for each comparison). The pre-HD Tpe was longer in patients with hypocalcemia or hy¬perphosphatemia than in normocalcemic and normophosphatemic patients (p=0.04 for both data¬sets). ΔTpe was significantly correlated with Δcalcium (r=-0.19, p=0.02) and Δphosphorus (r=-0.23, p=0.004). Conclusion: In the elderly patients on HD, Tpe, which was prolonged before HD, was even more prolonged after HD. Hypocalcemia and hyperphosphatemia may be among the un¬derlying factors.

Quick Sequential Organ Failure Assessment, Sequential Organ Failure Assessment, and Procalcitonin for Early Diagnosis and Prediction of Death in Elderly Patients with Suspicion of Sepsis in the Emergency Department, Based on Sepsis-3 Definition

Background: Sepsis is a disease with a high mortality rate without prompt treatment. However, this entity is difficult to diagnose in the elderly population in the emergency room; for this reason, it is necessary to have diagnostic tools for early detection. Objective: The aim of the study was to determine the highest diagnostic yield of procalcitonin (PCT), Quick Sequential Organ Failure Assessment (qSOFA), and Sequential Organ Failure Assessment (SOFA) for sepsis (based on the sepsis-3 consensus), on admission at the emergency department, in those older than 65 years. Methods: This is a diagnostic test study of a historical cohort of 65-year-old patients with suspected sepsis. Results: In the sample of 179 patients, 53.6% had confirmed sepsis. Significant differences were found (p < 0.0001), with a greater diagnostic and predictive capacity of PCT for the diagnosis of sepsis (receiver operating characteristics curve area [area under the curve (AUC) = 0.883, 95% CI: 0.835–0.931] than qSOFA (AUC = 0.559, 95% CI: 0.485–0.663) and SOFA (AUC = 0.662, 95% CI: 0.584–0.739); these results were similar in the cohort of patients ≥75 years. In positive PCT(≥0.5 ng/mL), the sensitivity was 71.8% (95% CI: 62.36–81.39), specificity of 89.1% (95% CI: 81.87–96.45%), V+ 88.4% (95% CI: 80.73–96.19%), V− of 73.2% (95% CI: 64.14–82.39%), positive likelihood ratio of 6.63 (95% CI: 3.53–12.44), and negative likelihood ratio of 0.32 (95% CI: 0.23–0.44); these results were similar in the cohort of patients ≥75 years. Lactate ≥2 mmol/L (RR = 1.659 [95% CI: 1.002–2.747]) and PCT ≥0.5 ng/mL (RR = 1.942 [95% CI: 1.157–3.261]) showed a significant association with in-hospital mortality. Conclusion: In the elderly population with suspicion of infection on admission to the emergency department, qSOFA presents a low diagnostic performance of confirmed sepsis and in-hospital mortality, for which other tools with higher diagnostic and prognostic performance should be added, such as PCT and lactate.

A narrative review on the interaction between genes and the treatment of hypertension and breast cancer.

ObjectiveThe aim to discuss the close relationship between the common biological mechanisms of breast cancer and hypertension, inflammation and oxidative stress, breast cancer gene mutations breast cancer susceptibility gene (BRCA), G protein-coupled receptor kinase (GRK4), etc. and breast cancer treatment includes chemotherapy, Endocrine therapy, Targeted therapy and anti-angiogenesis drugs. In anti-angiogenesis drugs focusing on the mechanism of tyrosine kinase inhibitors (TKI) that may activate the rhoa/rock pathway to cause hypertension, as well as the relationship between breast cancer and antihypertensive drugs includes angiotensin-converting enzyme inhibitors (ACEIs), Calcium channel blockers (CCBs) and β-blockers (BBs)will be explored.BackgroundCardiovascular diseases (CVD) and tumors are the two major types of diseases with the highest mortality rates, while hypertension accounts for the largest proportion of CVDs. A large number of the same or similar risk factors are shared between hypertension and tumors, and they influence each other. Many patients, particularly elderly patients, often present with the coexistence of the two diseases. As medical advances have enabled clinicians to cure tumors, many patients with cancer live longer, leading to a gradual increase in the incidence of CVDs, including hypertension. With the second highest incidence among tumors, breast cancer has gradually attracted widespread attention and has been the topic of numerous studies. Studies have confirmed that CVD is one of the causes of death in elderly patients with breast cancer.MethodsPublications from 1985 to 2020 were retrieved from the Web Of Science, Cochrane Library, PubMed, EMBASE and MEDLINE database. We used a mix of MeSH and keywords.ConclusionsHypertension and cancer may share a common mechanism. The screening and risk assessment of breast cancer in patients with hypertension must be strengthened. Breast cancer cardiology is the interdisciplinary study of oncology and cardiology, and in-depth research in this field may result in long-term improvements in the survival and prognosis of patients with both clinical hypertension and breast cancer.

Prognostic value of prealbumin, N-terminal pro-B-type natriuretic peptide, heart type fatty acid binding protein, and cardiac troponin I in elderly patients for heart failure and poor outcomes.

ObjectivesThis study aimed to investigate the prognostic value of serum prealbumin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), heart type fatty acid binding protein (hFABP), and cardiac troponin I (cTnI) for heart failure and cardiac death in elderly patients.MethodsWe studied 426 consecutive patients with New York Heart Association classes I to IV who were recruited between February 2014 and 2018. Cardiac mortality was the primary end point. Receiver operator characteristic curves were created to analyze predictive values.ResultsWhen prealbumin, NT-proBNP, hFABP, and cTnI were combined, the areas under the receiver operator characteristic curve reached 0.930 and 0.903 for heart failure and cardiac death, respectively. Prealbumin, NT-proBNP, hFABP, and cTnI levels changed differently during therapy in patients in different prognosis groups. These parameters improved in patients who did not develop major adverse cardiovascular events (MACEs), but were unchanged or deteriorated in patients with MACEs. Multivariate Cox regression analysis showed that these parameters were significant independent risk factors for MACEs and cardiac death.ConclusionsOur study shows that serum prealbumin, NT-proBNP, hFABP, and cTnI levels are significant prognostic factors for elderly patients with poor cardiac function. These parameters are more accurate for prognosis when used together.

The clinical practice of ulcerative colitis in elderly patients: An investigation using a nationwide database in Japan.

Background and AimThe number of elderly patients with ulcerative colitis (UC) is increasing worldwide. The clinical practice of associated treatment is still unclear. Therefore, we aimed to analyze clinical treatment realities and mortality in elderly and non‐elderly patients with UC.MethodsWe collected UC patients' data using the diagnosis procedure combination (DPC) database system and divided eligible patients into elderly (≥65 years) and non‐elderly (≤64 years) groups. We investigated and compared their therapeutic histories (medical treatments vs. surgery). Logistic regression analysis was conducted to identify clinical factors affecting surgery and in‐hospital death in each group.ResultsThe rates of systemic steroid injection, molecular targeting drug usage, and surgery were not different between the two age groups. Meanwhile, the rate of in‐hospital death in elderly patients was higher than that in non‐elderly patients (2.7% vs. 0.19%, P < 0.0001). Multivariate analysis revealed that lower body mass index, treatment at an academic hospital, smoking history, molecular targeting drug use, and treatment with systemic steroid injection affected the rate of surgery in the elderly group. Multivariate analysis also revealed that male and older age affected the rate of in‐hospital death in the elderly group. Similar tendencies were also recognized in the non‐elderly group.ConclusionsThe clinical practice of treating elderly patients with UC is overall not different from treating non‐elderly patients with UC. Although the form of medical treatment and surgery rate for elderly patients with UC may not be significantly different from non‐elderly patients, the rate of in‐hospital death for elderly patients is higher.

STATIN TREATMENT REDUCES THE RISK OF DEATH AMONG ELDERLY FRAIL PATIENTS. EVIDENCE FROM A LARGE POPULATION-BASED COHORT

Objective: Randomized controlled trials show that statin treatment is associated with a reduction of cardiovascular outcomes and mortality. Evidence is limited, however, on whether these drugs are protective in frail patients. Aim of our study was to assess the protective effect of these drugs in a large and unselected cohort of frail elderly subjects. Protection was inferred from the reduction of mortality associated with adherence to treatment because of the evidence that adherence to statin is closely related with outcomes. Design and method: The target population included Lombardy residents (Italy), aged 65 years or older, who received at least three consecutive prescriptions of a statin during 2011–2012. A case-control study was performed, the cases being the cohort members who died until 2018. Logistic regression was used to model the outcome risk associated with statin adherence. Adherence was measured by the proportion of the follow-up covered by prescriptions. The analysis was stratified according to four clinical categories (good, medium, poor, and very poor clinical status), based on different life expectancies, as assessed by a prognostic score (i.e., the Multisource Comorbidity Score) which had been found to sensitively predict the risk of death. From the good to the very poor clinical status, the 7-year death probability increased from 11% to 52%. Results: In each clinical status, there was a significant reduction of all-cause mortality as adherence to statin treatment increased. The reduction in the adjusted risk of mortality from the lowest to the highest adherence level was greatest among patients with a good clinical status (-56%) and less among other cohort members (i.e., -48%, -44% and -47% in medium, poor and very poor groups, respectively). Similar findings were obtained for the risk of cardiovascular mortality. Conclusions: In a real-life setting, adherence to statin treatment reduced the risk of death in elderly patients regardless their clinical conditions. The reduction extended to patients with a high risk of mortality, suggesting that also frail patients are protected by lipid-lowering treatment. However, in these patients the benefit from the treatment seems lower than those in good clinical conditions.

Clinical Findings and Risk Factors of COVID-19 Infection and Death in Elderly patients Admitted to Medical Centers of Mazandaran University of Medical Sciences During 1 Year

Objectives: The elderly are at higher risks for developing Coronavirus Disease 2019 (COVID-19). Besides, when generating the illness, they have a higher risk of death. Recognizing clinical characteristics and risk factors associated with morbidity and mortality in the elderly is necessary to prevent mortality in similar infectious diseases. Methods &amp; Materials: This descriptive research explored the data of all geriatrics admitted following COVID-19 in the medical centers affiliated with Mazandaran University of Medical Sciences. These data were collected from February 20, 2020, to February 20, 2021. Data analysis was performed by SPSS using logistic regression analysis. P&lt;0.05 was considered significant. Results: Of the total 54523 patients admitted to the medical centers in the 12 months, 25218 patients were elderlies. In total, 51.05% and 12343 of the patients were female and male, respectively. In total, 3512 elderlies were expired. The death cases included 1814 (51.65%) males and the rest were females. Moreover, 16203 patients were in the age group of youngest-old, aged 60-75 years; 8270 patients were middle-old, 76-90 years; and the oldest-old category included 745 patients in the age group of ≥90 years. There was a significant relationship between age, gender, and COVID-19-induced death in the elderly (P&lt;0.05). Older adults presented the highest death rate due to this disease Men were 10% more prone to die from COVID-19 than women. Major comorbidities recorded in this population were kidney diseases (92%), cancer (76%), diabetes (32%), and cardiovascular diseases (17%). Conclusion: Preventive measures to support the elderly are essential to combat the COVID-19 pandemic. Furthermore, it is essential to focus on the specific health needs of the elderly, such as proper nutrition, wellbeing, and mental health promotion.

Prognostic significance of cardiac amyloidosis in patients with aortic stenosis: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac amyloidosis (CA) has been increasingly recognized in elderly patients with aortic stenosis (AS), but with uncertain prognostic significance. Objectives We performed a systematic review and meta-analysis to clarify whether concurrent CA portends excess mortality in patients with aortic stenosis AS. Methods Our systematic review of the literature published through June 2020, sought observational studies reporting summary-level outcome data of all-cause mortality in AS patients with or without concurrent CA. Pooled estimate of Mantel-Haenszel odds ratio (OR) and 95% confidence intervals (CIs) for all-cause death was assessed as the primary endpoint. We performed subgroup analysis stratified by severity of left ventricular hypertrophy (LVH) and study-level meta-regression analysis to explore the effect of covariates on summary effect size and to address statistical heterogeneity. Results We identified 4 studies including 609 AS patients (9% AS-CA; 69% men; age, 84 ± 5 years). The average follow-up was 20 ± 5 months. Compared with lone AS, AS-CA was associated with 2-fold increase in all-cause mortality (pooled OR: 2.30; 95% CI: 1.02-5.18; I2 = 62%). When analysed according to LVH severity, pooled ORs (95% CI) for all-cause mortality were 1.29 (0.65-2.22) for mild LVH (≤16 mm), and 4.81 (2.19-10.56) for moderate/severe LVH (&amp;gt;16 mm). Meta-regression analysis confirmed a stronger relationship proportional to the degree of LVH, regardless of age and aortic valve replacement, explaining between-study heterogeneity variance. Conclusions CA heralds significantly higher risk of all-cause death in elderly patients with AS. Severity of LVH appears to be a major prognostic determinant in patients with dual AS-CA pathology. Abstract Figure.

Population-based Analysis for Risk of Suicide Death in Elderly Patients after Osteoporotic Fracture: a Nested Case-Control Study.

BackgroundThe purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture.MethodsWe used the National Health Insurance Service-Senior cohort of South Korea. Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death.ResultsThree thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57–4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04–2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74–2.77; P = 0.282).ConclusionThere were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.

Dementia and the risk of death in elderly patients with COVID‐19 infection: Systematic review and meta‐analysis

AbstractObjectivesThe COVID‐19 infection represents a global public health emergency worldwide. Several risk factors have been associated with a poor prognosis among COVID‐19 patients. We aimed to perform a systemic review and meta‐analysis to evaluate the mortality risk in elderly patients with dementia and COVID‐19 infection.MethodsLiterature search was based on Cochrane Library, Embase, PubMed, and Google Scholar to locate articles published between December 2019 and July 2020, presenting the number of survived versus deceased patients with dementia and COVID‐19 infection.ResultsA total of 233 articles were retrieved: 158 were excluded for not meeting the inclusion criteria, leaving 75 articles to assess for eligibility. After evaluation of the full‐text articles, eight met the inclusion criteria and were thus included into the final analysis (6493 patients – mean age: 69.6 years). Among COVID‐19 patients, the prevalence of dementia was higher in non‐survivors compared with survivors (17.5% vs. 5.4%, p &lt; 0.001). The pooled analysis performed using a random‐effect model showed an increase in the risk of death in COVID‐19 patients with dementia (odds ratio: 3.75; 95% confidence interval: 2.54–5.54, p &lt; 0.0001, I 2 = 49.5%). The Egger's regression test confirmed that there were not statistically evidences of publication bias (t = 0.059; p = 0.954).ConclusionsOur preliminary results suggest that patients with COVID‐19 infection and dementia have a higher mortality risk in the short‐term period compared with infected non‐demented individuals. Due to their intrinsic frailty, dementia patients may require a more aggressive treatment and prompt isolation to improve their short‐term outcome.

Journal Digest: Tic Disorders; Infrared Therapy; SGA; Weight Stigma; TBT

Journal Digest: Tic Disorders; Infrared Therapy; SGA; Weight Stigma; TBT

Ten-year all-cause death in elderly patients undergoing percutaneous coronary intervention or coronary artery bypass grafting: a prespecified subgroup analysis of the SYNTAX Extended Survival study

Abstract Background Coronary artery disease is the leading cause of death among elderly men and women worldwide. The aging society worldwide will lead to increasing numbers of elderly patients with multivessel coronary artery disease. Although age is recognized as one of the most important factors in a decision-making for revascularization of multivessel coronary artery disease, the very long-term outcomes in patients undergoing revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is still unclear. Objectives The aim of the present study was to investigate the association between revascularization strategies and 10-year outcomes in elderly patients. Methods The SYNTAX Extended Survival (SYNTAXES) study (NCT 03417050) is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries, enrolling 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to revascularization strategy with CABG versus PCI in the SYNTAX trial. Patients were divided into two groups according to the prespecified threshold of 70 years old; elderly patients (&amp;gt;70 years) and non-elderly patients (≤70 years). The primary endpoint of this study was all-cause death at 10 years. Results Out of 1,800 patients, 575 patients (31.9%) were classified as elderly (&amp;gt;70 years). The mean age ± standard deviation (SD) of the elderly patients and the non-elderly patients was 75.8±3.6 years and 60.1±7.4 years, respectively. Of note, elderly patients were more frequently female than non-elderly patients (33.6% vs. 17.1%, p&amp;lt;0.001). As expected, the elderly patients had higher prevalence of chronic kidney disease (43.4% vs. 7.9%, p&amp;lt;0.001), had higher anatomical SYNTAX score (30.2±11.8 vs 28.0±11.2 p&amp;lt;0.001) when compared to those of the non-elderly patients. Up to 10 years, all-cause death occurred in 42.7% and 18.9% in the elderly and non-elderly patients, respectively (Log-rank p&amp;lt;0.001). The cubic spline curve showed an exponentially increase in all-cause death at 10 years according to the increase of age both in the PCI arm and the CABG arm. At 10 years, there was no significant difference in the risk of all-cause death between CABG vs. PCI either in elderly patients (41.5% vs. 44.0%; Log-rank p=0.53) or non-elderly patients (16.6% vs. 21.1%; Log-rank p=0.051). Conclusion CABG and PCI were equipoise in terms of risk of all-cause death at 10 years in patients with de novo 3VD and/or LMCAD irrespective of their age when stratified according to the prespecified threshold of 70 years old. Kaplan-Meier curves Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): German Foundation of Heart Research

A Prognostic Model for Non-Lung Cancer Death in Elderly Patients Treated with Stereotactic Body Radiotherapy for Localized Non-Small Cell Lung Cancer

A Prognostic Model for Non-Lung Cancer Death in Elderly Patients Treated with Stereotactic Body Radiotherapy for Localized Non-Small Cell Lung Cancer

Nomogram for Predicting Breast Cancer-Specific Mortality of Elderly Women with Breast Cancer.

BackgroundThe objectives of this study were to evaluate the cumulative incidence of breast cancer-specific death (BCSD) and other cause-specific death in elderly patients with breast cancer (BC) and to develop an individualized nomogram for estimating BCSD.Material/MethodsData were retrieved from the Surveillance, Epidemiology, and End Results program. A total of 25 241 patients older than 65 years with stage I–III BC diagnosed between 2004 and 2008 was included in the study cohort. We used the cumulative incidence function (CIF) to describe the cause-specific mortality and Gray’s test to compare the differences in CIF among the groups. Fine and Gray’s proportional subdistribution hazard model was applied to validate the independent prognostic factors, upon which the competing-risks nomogram and web-based calculator was built. The performance of the nomogram was assessed with the C-indexes and calibration plot diagrams.ResultsAfter data screening, 25 241 cases were included for statistical analysis. In the training cohort, the 5-, 8-, and 10-year cumulative incidence of BCSD was 5.7, 8.1, and 9.1%, respectively. Ten independent prognostic factors associated with BCSD were identified. The C-index of the nomogram was 0.818 (0.804–0.831) in the training cohort and 0.808 (0.783–0.833) in the validation cohort. Calibration plot diagrams showed near-ideal consistency between the predicted probabilities and actual observations.ConclusionsWe built a reliable dynamic nomogram for predicting BCSD in elderly patients, and this individualized predictive tool is favorable for risk classification and complex personalized treatment decision making in clinical practice.

Predictors of medium- and long-term mortality in elderly patients with acute pulmonary embolism

IntroductionData on medium- and long-term prognostic factors for death in elderly patients with acute Pulmonary Embolism (APE) are lacking. The present study aimed to assess sPESI score and the Charlson Comorbidity Index (CCI) as medium- and long-term predictors of mortality in elderly patients with haemodinamically stable APE. MethodsAll consecutive patients aged≥65 years old, evaluated at the emergency department (ED) of our hospital from 2010 through 2014, with a final diagnosis of APE, were included in this retrospective cohort study. ResultsStudy population:162 patients, female:36.5%, median age:79 years old, 74% presented a sPESI score>0, and 61% a CCI≥ 1. All causes mortality: 19.8%, 23.5%, 26.5%, 32.1% and 48.2% at 3, 6 months, 1, 2 and 5 years after APE. Univariate regression analysis: CCI≥1 was associated with a higher mortality at 3, 6 months, 1, 2 and 5 years. Multivariate Cox analysis: CCI≥1 associated with increased mortality at 3 months (HR:4.29; IC95%:1.46–12.59), 6 months (HR:5.33; IC95%:1.84–15.44), 1 year (HR:4.87; IC95%:1.87–12.70), 2 years (HR:3.78; IC95%:1.74–8.25), and 5 years (HR:2.30; IC95%:1.33–3.99). sPESI score≥1 was not found to be related to an increased medium-or long-term mortality. Negative predictive values (IC95%) of CCI≥1 were 93.65% (87.61–99.69), 93.65% (87.61–99.69), 92.06% (85.37–98.76), 87.3% (79.05–95.55) and 71.61% (60.13–83.1) for mortality at 3, 6 months, 1, 2 and 5 years. ConclusionIn elderly patients with a confirmed normotensive APE, unlike sPESI score, CCI showed to be an independent prognostic factor for medium- and long-term mortality. In these patients, after the acute phase following a PE event, the assessment of the comorbidities burden represents the most appropriate approach for predicting medium- and long-term mortality.

Correlation Between Intestinal Microflora and Gastrointestinal Dysfunction in Elderly Patients with Sepsis

Multiple organ dysfunction syndrome (MODS) is a key factor that leads to death in elderly patients with sepsis. Therefore, early prevention and treatment of gastrointestinal dysfunction (GIDF) in elderly patients with sepsis is an important measure to prevent MODS occurrence. This research explores the correlation between intestinal microflora and GIDF in elderly patients with sepsis and provides ideas for the prevention and treatment of GIDF in elderly patients with sepsis. In this study, 152 patients with sepsis (122 patients with sepsis and GIDF) treated in the Third Affiliated Hospital of Yunnan University of Chinese Medicine from January to September 2019 were selected as the sepsis group and 100 elderly who had normal physical examination results were selected as the control group. The common intestinal microflora of the two groups was compared. Patients with sepsis and GIDF were treated as the GIDF group and the other patients with sepsis were treated as the non-GIDF group. The common intestinal microflora, gastrointestinal indicators, serum inflammatory factors, and immune function indices were compared between the two groups. Correlation analysis of the observed indices with statistical significance was carried out. The results showed 152 patients with sepsis and 122 patients with sepsis and GIDF; thus, the incidence of sepsis with GIDF was 80.26%. The total average score of sepsis with GIDF was 3.61±0.09. There was no statistically significant difference in GIDF scores of patients ages 65–75 and &gt; 75 years old. The number of Bifidobacterium and Lactobacillus in elderly patients with sepsis was lower and the number of Escherichia coli was higher than in the control group. In elderly patients with sepsis, the number of Bifidobacterium and Lactobacillus in the GIDF group was lower and the number of E. coli was higher than in the non-GIDF group. White blood cell (WBC) count, procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), gastrin (GAS), and diamine oxidase (DAO) in GIDF patients were higher and motilin (MOT), CIT (CIT), CD4+, and CD8+ were lower than in the non-GIDF group. WBC count, PCT, CRP, TNF-α, GAS, and DAO were negatively correlated with the number of Bifidobacterium and Lactobacillus but positively correlated with E. coli. MOT, CIT, CD4+, and CD8+ were positively correlated with the number of Bifidobacterium and Lactobacillus but negatively correlated with E. coli. There was a negative correlation between Bifidobacterium and Lactobacillus and GIDF score and a positive correlation between E. coli and GIDF score. Therefore, the change in the intestinal microflora in elderly patients with sepsis is related to GIDF.

Application of POSSUM and P-POSSUM in Surgical Risk Assessment of Elderly Patients Undergoing Hepatobiliary and Pancreatic Surgery.

PurposeTo investigate the efficacy and accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scoring systems in the risk assessment of postoperative complications and death in elderly patients undergoing hepatobiliary and pancreatic surgery.Patients and MethodsUsing POSSUM and P-POSSUM, 274 elderly patients undergoing hepatobiliary and pancreatic surgery were evaluated, and the complications and deaths predicted by the systems were compared with the actual situation. The accuracy and predictive ability of POSSUM and P-POSSUM were evaluated using chi-squared and t-tests, consistency of predicted and actual complication rates (observed/expected, OE ratio), and receiver operating characteristic (ROC) curve.ResultsThe complication rate predicted by POSSUM (R1) was 22.57%, while the actual postoperative complication rate was 17.88% (P>0.05). The mortality rate predicted by POSSUM (R2) was 4.61%, while the actual rate was 1.09% (P<0.05). The mortality rate predicted by P-POSSUM (R) was 1.42%, while the actual rate was 1.09% (P>0.05). Patients with complications had higher physiology scores (PS), operative severity scores (OS), and POSSUM scores than those without complications (P<0.05). Furthermore, PS, OS, and POSSUM scores were higher in the mortality group than in the survival group. However, the number of individuals in the mortality group was too small to accurately reflect the overall situation. Stratified analysis showed that consistency of the OE ratio in different subgroups was close to 1. The ROC curve showed that the area under the curve for the complication rate predicted by POSSUM was 0.76.ConclusionAlthough the postoperative mortality rate was higher than the actual value, POSSUM could accurately predict the postoperative complication rate in elderly patients undergoing hepatobiliary and pancreatic surgery. The P-POSSUM accurately predicted the postoperative mortality rate in this population. Patients with complications had higher POSSUM scores.