Injury In Elderly Patients Research Articles

Aging aggravated liver ischemia and reperfusion injury by promoting hepatocyte necroptosis in an endoplasmic reticulum stress-dependent manner.

Aggravated liver ischemia and reperfusion (IR) injury has been reported in aged mice. Although necroptosis inhibition showed no crucial effect on hepatic IR injury in young mice, whether and how necroptosis affects liver IR injury in aged mice remains unclear. Young and aged mice were subjected to liver IR modeling. Liver injury, hepatocyte necroptosis and endoplasmic reticulum (ER) stress were analyzed in different groups. Significantly increased liver necroptosis was found in aged mice post IR compared with young mice. Necroptosis inhibition by necrostatin-1 (Nec-1) decreased hepatocyte necroptosis and liver injury post IR in aged mice, with no significant effects on young mice. Furthermore, IR induced ER stress in both young and aged mice, and enhanced ER stress was observed in aged mice post IR. Administration of 4-phenylbutyrate (4-PBA), an ER stress antagonist, alleviated liver IR injury in both young and aged mice. However, ER stress inhibition reduced hepatocyte necroptosis in aged mice but not in young mice. Aging increased ER stress in IR-stressed hepatocytes, leading to aggravated necroptosis and liver IR injury. Our study demonstrated a novel mechanism of ER stress in the regulation of hepatocyte necroptosis in aged livers post IR, which would be a potential therapeutic target to reduce liver IR injury in elderly patients.

Application of dexmedetomidine for lung injury in elderly patients undergoing one-lung ventilation.

This study aimed to evaluate the effects of dexmedetomidine (DEX) on lung injury, the oxygenation index and perioperative pulmonary complications in elderly patients who underwent thoracotomy with one-lung ventilation (OLV). A total of 120 elderly patients with lung cancer were included in the present study. According to the random number table method, these patients were randomly divided into two groups: group D and group C. Patients in group D were intravenously pumped with 0.5 μg/kg/h of DEX before anesthesia. The infusion was completed within 15 min, and anesthesia was induced by venous injection. Patients in group C were pumped with equal volumes of normal saline. At T2 and T3, compared with group C, group D had a significant decrease in cardiac index, mean arterial pressure and central venous pressure (p < 0.05). At T2, T3 and T4, compared with group C, group D had a significant increase in pH and PaO2 (p < 0.05). At T2, T3 and T4, compared with group C, group D had a significant decrease in Qs/Qt (p < 0.05). At T6, compared with group C, group D had a significant decrease in the supernatant of bronchoalveolar lavage fluid of tumor necrosis factor-α and interleukin 6 (p < 0.05). At T5, compared with group C, group D had a significant decrease in Visual Analogue Scale score (p < 0.05), and a significant increase in Ramsay Sedation Scale score (p < 0.05), and the number of respiratory and cardiovascular events also decreased (p < 0.05). In elderly patients, dexmedetomidine can reduce Qs/Qt and increase PaO2 during OLV in surgery. It can reduce lung injury. Moreover, DEX reduced respiratory and cardiovascular complications in the perioperative period.

Clinical significance of serum cystatin C in early evaluation of renal impairment caused by chemotherapy in elderly patients.

BackgroundThis study aims to discuss the application value of serum cystatin C (Cys C) in detecting early renal function injury in elderly patients with malignant tumors after chemotherapy.MethodsThe data at different chemotherapy time points (before chemotherapy, after two cycles of chemotherapy, and after four cycles of chemotherapy) were analyzed.ResultsSerum Cys C was significantly higher after chemotherapy than before chemotherapy in elderly patients with malignant tumors, and the endogenous creatinine clearance rate (CCr) significantly decreased. These were significantly correlated. However, there was no significant change in serum creatinine (SCr) and blood urea nitrogen (BUN). Cys C continued to increase with the prolonged time of chemotherapy. In addition, Cys C was sensitive for detecting renal impairment caused by platinum-based chemotherapy drugs.ConclusionsThe diagnostic effect of Cys C on early renal function injury after chemotherapy in elderly patients with malignant tumors is better, when compared to traditional renal function test items, such as SCr, BUN and CCr.

Role of eotaxin-1/CCL11 in sepsis-induced myocardial injury in elderly patients.

Myocardial injury is a serious complication of sepsis. The present study aimed to identify potential biomarkers of sepsis-induced myocardial injury. Differentially expressed genes (DEGs) in patients and mice with sepsis-induced myocardial injury were identified via bioinformatic analysis. The identified DEG was tested in elderly patients with sepsis-induced myocardial injury. We identified 19 co-expressed DEGs. The most significant DEG was eotaxin-1/CCL11. We enrolled 25 controls without infections and 28 patients with sepsis-induced myocardial injury. Six of patients died within 30 days. Circulating eotaxin-1/CCL11 levels were significantly higher in patients with sepsis-induced myocardial injury than controls and were higher in non-survivors than survivors (both P < 0.01). Eotaxin-1/CCL11 was positively correlated with troponin I (r=0.48, P=0.01), B-type natriuretic peptide (BNP, r=0.44, P=0.02), and white blood cell (WBC) count (r=0.41, P=0.03). For the prediction of 30-day mortality, eotaxin-1/CCL11 had the greatest discriminatory ability (AUC 0.97) compared with troponin I (AUC 0.89), BNP (AUC 0.80), and WBC count (AUC 0.86). Taken together, eotaxin-1/CCL11 was upregulated in sepsis-injured myocardium and circulating eotaxin-1/CCL11 was a biomarker for predicting severity and mortality of elderly patients with sepsis-induced myocardial injury. These results suggest that eotaxin-1/CCL11 may become a useful biomarkers and potential therapeutic target for sepsis-induced myocardial injury.

Effects of dexmedetomidine on injury of lungs and CHOP protein expression in elderly patients with lung cancer during one-lung ventilation

Objective: To evaluate the effect of dexmedetomidine on lung injury and CCAAT/enhancer-binding protein homologous protein (CHOP) expression in elderly patients with lung cancer undergoing thoracoscopic lobectomy. Methods: A total of 120 elderly patients with lung cancer who underwent elective thoracoscopic lobectomy were selected from the Second Affiliated Hospital of Zhengzhou University from October 2018 to March 2019. The random phenotype was divided into dexmedetomidine group (group D, n=60) and control group (group C, n=60). The elapsed time before postoperative awake and spontaneous breathing recovery and agitation occurrence were recorded. The mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SPO(2)), oxygen partial pressure (PaO(2)), alveolar-arterial oxygen partial pressure difference[P(A-a)O(2)], end-tidal carbon dioxide partial pressure (P(ET)CO(2)), and airway pressure peak (P(peak)) were recorded before the anesthetic induction (T(0)), immediately after tracheal intubation (T(1)), immediately after unilateral pulmonary ventilation(T(2)), 1 hour after unilateral pulmonary ventilation (T(3)), immediately after bilateral pulmonary ventilation (T(4)), and at the end of surgery(T(5)). The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-8, IL-10, super oxide dismutase (SOD) and malondialdehyde (MDA)were compared at the time of T(0), T(1), T(2), T(3), T(4) and T(5) in two groups. The ratios of alveolar damage (IQA), apoptotic index (AI), and the expression of CHOP mRNA and their protein in lung tissue were detected. Results: The recovery time of conscious and spontaneous breathing in group D were significantly shorter than that in group C (P<0.05). The MAP and HR of the two groups at T(1)-T(5) were significantly lower than those at T(0)(P<0.05).The levels of P(peak) in group C at T(3)-T(5) was significantly higher than those in group D (P<0.05). The SpO(2) values in the group D at T(1)-T(5) were significantly higher than those in group C (P<0.05). The P(A-a)O(2) values in the group D at T(1)-T(5) was significantly lower than those in group C (P<0.05).The levels of IL-6, IL-8 and MDA in group D at T(1)-T(5) were significantly lower than those in group C(P<0.05). The levels of IL-10 and SOD in group D at T(1)-T(5) were significantly higher than those in group C (P<0.05). The values of IQA, AI, and the expression of CHOP mRNA and their protein in the two groups at T(4) were significantly higher than those at T(2) (P<0.05). The values of IQA, AI, and the expression of CHOP mRNA and their protein in group D at T(4) were significantly lower than those in group C (P<0.05). Conclusions: Dexmedetomidine could attenuate the extent of lung injury in elderly patients with lung cancer undergoing thoracoscopic lobectomy. The pulmonary protective mechanism could be related to the inhibition of inflammatory factors in dexmedetomidine, improving oxidative stress and reducing Chop-mediated apoptosis of lung tissue by the protein.

Antithrombin III expression predicts acute kidney injury in elderly patients with sepsis.

Elderly people represent the age group most frequently affected by acute kidney injury (AKI). The potential of Antithrombin III (ATIII) level for predicting AKI among elderly patients with sepsis is yet to be elucidated. Therefore, the purpose of the present study was to evaluate the ability of ATIII to predict AKI nondevelopment and prognosis in elderly patients with sepsis, in an intensive care unit (ICU). The present study was retrospective and included 107 elderly patients with sepsis who had been admitted to ICUs between October 2015 and March 2018. An assessment of renal function was performed daily by measuring serum creatinine (Cr) level and urine output, and ATIII level was obtained within 48 h of sepsis diagnosis. Among all enrolled patients, 29 (27.1%) developed AKI. ATIII expression was a predictor of AKI nondevelopment [Area under the curve (AUC)-Receiving operator characteristic (ROC)=0.729; sensitivity, 0.700; specificity, 0.714], and the ATIII/Creatine ratio was also a predictor of AKI nondevelopment (AUC-ROC=0.971; sensitivity, 0.900; specificity, 1). The accuracy of ATIII (AUC-ROC=0.681; sensitivity, 0.802; specificity, 0.542) and ATIII/Cr (AUC-ROC=0.804; sensitivity, 0.596; specificity, 0.875) in predicting survival was intermediate. However, the ATIII serum level was able to accurately predict AKI nondevelopment in elderly patients with sepsis, who were admitted to ICUs. Patients were divided into low- and high-ATIII groups using either 66.95% or 55.7% as cut-off values, both of which were used for further analysis. By comparison, the ICU stay was significantly lower in the high-ATIII group [P=0.020 (69.95%) and 0.049 (55.7%)] and off mechanical ventilation time, off continuous renal replacement therapy time and survival time were significantly higher in the high ATIII group [P=0.049, 0.048, and 0.014, respectively (66.95%); and P=0.041, 0.036, and 0.021, respectively (55.7%)]. The current study indicated that ATIII serum level predicts AKI in elderly patients with sepsis, and that low ATIII levels predicted a poorer prognosis.

Prevalence of Gastric and Small-Intestinal Mucosal Injury in Elderly Patients Taking Enteric-Coated Aspirin by Magnetically Controlled Capsule Endoscopy.

Objective To investigate aspirin-related gastric and small-intestinal mucosal injury in elderly patients by magnetically controlled capsule endoscopy (MCCE). Methods Patients taking enteric-coated aspirin attending the outpatient department of Beijing Anzhen Hospital, Capital Medical University, from September 2017 to July 2019 underwent MCCE to assess injury to the gastric and small-intestinal mucosa. The patients were divided into the elderly group (age ≥ 60 years) and middle-aged group (45 years ≤ age < 60 years), and their clinical data were evaluated. Results Sixty-eight patients (34 per group) taking enteric-coated aspirin were recruited, and the elderly and middle-aged groups did not differ significantly in sex, history of smoking, history of alcohol consumption, body mass index, or accompanying diseases. In the elderly and middle-aged groups, the gastric Lanza scores were 2.0 (2.0, 3.0) and 2.0 (1.0, 3.0; P = 0.192), the numbers of patients with small-intestinal mucosal injuries (at least one erosion and/or ulcer) were 30 (88.2%) and 15 (44.1%; P < 0.001), the numbers of patients with more severe small-intestinal mucosal injuries (larger erosion and/or ulcer) were 11 (32.4%) and 3 (8.8%; P = 0.033), the numbers of patients with ileal erosion were 22 (64.7%) and 8 (23.5%; P = 0.001), and the durations of aspirin use were 30.0 (12.0, 120.0) and 10.5 (2.0–48.0) months (P = 0.007), respectively. Conclusions The rate of small-intestinal mucosal injury was significantly higher in elderly than in middle-aged patients taking enteric-coated aspirin, especially the rate of ileal erosion. MCCE enables the monitoring of aspirin-related gastric and small-intestinal mucosal injury in elderly patients, which can guide treatment decision making.

Thoracic endovascular aortic repair with left subclavian artery reconstruction for blunt traumatic aortic injury in elderly patients

IntroductionBlunt thoracic aortic injury (BTAI) is rare in elderly patients. As the population ages and life expectancy increases, the frequency of this injury will increase, while the treatment and outcomes remain unclear. MethodsWe retrospectively analyzed the collected data of patients >60 years old with BTAI to investigate the mechanism of trauma; time interval from injury to diagnosis; type and timing of surgical intervention; aortic arch pattern; choice of left subclavian artery reconstruction; endograft to treat BTAI; length of the endovascular procedure; endoleaks; complications including stroke, paraplegia, and renal failure; length of hospital stay (LOS) and intensive care unit stay (L.ICUS); and 30-day mortality. ResultsFive elderly trauma patients were found to have BTAI. Four (80%) were males, the cohort mean age was 68 years, the major mechanism of trauma was fall injury, and the associated injury was thoracic trauma. All patients were transferred to our hospital, and emergency computed tomography angiography showed BTAI in each patient. The average time interval from injury to diagnosis was 2.7 days. Two patients suddenly showed signs of instability in their vital signs and underwent immediate endovascular repair, while 3 patients underwent delayed endovascular repair. The injury site was located in the aortic isthmus just distal to the origin of the left subclavian artery; the aortic arch pattern was II (80.0%) in 4 cases and III in 1 case (20.0%). The choice of left subclavian artery reconstruction included chimney, double chimney, prefenestration, and chimney combined with in situ fenestration. Endografts to treat BTAI included the Ankura (Lifetech Scientific, Shenzhen, China) and the C-TAG (W.L. Gore & Associates, Flagstaff, AZ USA).The length of the endovascular procedure was 75.4 min; there were no endoleaks and no complications including stroke, paraplegia, or renal failure. The average LOS was 25 days, and the average L.ICUS of 2 patients was 15 days, with no 30-day mortality. ConclusionElderly patients with fall injury should promptly exclude BTAI. Thoracic endovascular aortic repair (TEVAR) with a left subclavian artery reconstruction technique provided good results without procedure-related or neurological complications. Because of the low incidence of this type of injury, we are unable to provide any evidence to guide the treatment option for this life-threatening condition.

P5532Predictive value of objective nutritional scores for contrast-induced acute kidney injury in elderly patients undergoing percutaneous coronary intervention

Abstract Background Age &gt;75 years had been generally considered to be an important and independent risk factor of contrast-induced acute kidney injury (CI-AKI), while these patients often suffer from malnutrition. However, the predictive value of objective nutritional status for CI-AKI in elderly patients undergoing percutaneous coronary intervention (PCI) remains unknown. Purpose To evaluate the association of two kinds of objective nutritional indices includes controlling nutritional (CONUT) score and prognostic nutritional index (PNI) with CI-AKI in elderly patients undergoing PCI. Methods In a single center prospective cohort study,we enrolled 714 consecutive patients who aged &gt;75 years undergoing PCI between January 2012 and December 2015 were screened based on their serum albumin, lymphocyte count, and total cholesterol measures. Patients were stratified into different groups according to two kinds of objective nutritional scores. Patients were divided into low-PNI (PNI &lt;35), middle-PNI (35 ≤ PNI &lt;38), and high-PNI (PNI ≥38). They were also divided into four groups according to CONUT score: normal-CONUT (0–1), mild-CONUT (2–4), moderate-CONUT (5–8), and severe-CONUT (≥9). CI-AKI was defined as an increase in the serum creatinine levels of ≥50% or 0.3 mg/dL above the baseline level within 48hrs after contrast medium exposure. Results Overall, 55 (7.7%) had moderate-severe CONUT scores, and 35 (4.9%) had low-middle PNI scores,while 93 (13.0%) patients developed CI-AKI. Patients with a lower PNI score or higher CONUT score had significantly higer incidence of CI-AKI [PNI score: high (11.8%), middle (33.3%), and low (45.5%), respectively; P&lt;0.0001; CONUT score: normal (9.6%), mild (12.7%), moderate (30.2%), and severe (100%), respectively; P&lt;0.0001]. After adjusting 6 confounders, including age, serum creatinine (SCR) &gt;1.5mg/dl, left ventricular ejection fraction (LEVF) &lt;45%, myocardial infarction, peri-hypotension and the contrast volume &gt;200 ml, multivariate analysis showed that worse objective nutritional status (either lower PNI scores or higer CONUT scores) was associated with an increased CI-AKI risk (Low PNI vs High PNI: OR: 5.274, P=0.015; Moderate-Severe CONUT vs Normal CONUT: OR: 2.891, P=0.007). Incidence of CIAKI Conclusions Worse objective nutritional status was associated with CI-AKI in elderly patients after PCI.

Comparison of injury pattern and clinical outcomes between young adults and elderly patients with alcohol-related injury in South Korea 2011-2016.

BackgroundAlcohol is an important factor that contributes to emergency department (ED) visits due to injury. However, the role of alcohol in elderly patients visiting ED due to injury has not been clearly defined. This study aims to examine age and alcohol as risk factors of injury severity and clinical outcomes.MethodsThis study included patients who visited EDs between January 2011 and December 2016. Data was obtained from the Emergency Department-Based Injury In-depth Surveillance of the Korea Centers for Disease Control and Prevention, South Korea. Injury patients aged ≥18 years were included, but those who visited the ED more than 48 hours after injury, with unknown clinical outcomes (admission, mortality, and excess mortality ratio-adjusted injury severity score [EMR-ISS]) were excluded.ResultsWe analyzed 887,712 patients, of whom 131,708 (17.7%) non-elderly and 9,906 (7.0%) elderly had alcohol-related injury. Falls and slips are the most common injury mechanism (37.9%) in patients consuming alcohol (36.3% non-elderly/58.40% elderly). The injury occurred on roads (40.6%), houses (33.8%), and commercial facilities (11.9%) in elderly patients consuming alcohol. Suicide rate was 12.0% in elderly and 9.7% in non-elderly patients. According to the time of day of injury, evening (60.8%) was the most common in elderly and night (62.6%) in non-elderly patients. Admission rate (odds ratio [OR] 2.512 confidence interval [CI] 2.407–2.621), intensive care unit (ICU) care rate (OR 5.507 [CI] 5.178–5.858), mortality rate (OR 4.593 [CI] 4.086–5.162), and EMR-ISS >25 (OR 5.498 [CI] 5.262–5.745) were compared between patients with alcohol-related injury and non-elderly with non-alcohol-related injury patients. Alcohol consumption in elderly patients results in significant impairment and increases EMR-ISS, ICU care rate, and mortality rate. To reduce injury in elderly patients, alcohol screening, appropriate counseling, and intervention are needed.

Clinical characteristics and prognosis of acute kidney injury in elderly patients with sepsis

To analyze the incidence of acute kidney injury (AKI) in elderly patients with sepsis, compare the clinical characteristics and prognosis between AKI and non-AKI elderly patients with sepsis, and to investigate the impact of classification of AKI and renal replacement therapy (RRT) on the outcome of elderly patients with sepsis. The clinical data of 490 septic patients over 65 years old, admitted to intensive care unit (ICU) of Tianjin First Center Hospital from April 1st, 2016 to December 31st, 2018 were retrospectively analyzed. The patients were divided into two groups according to those with or without AKI. The clinical characteristics of patients were compared, and subgroup analysis of elderly septic patients with AKI was performed according to Kidney Disease: Improving Global Outcomes (KDIGO) staging criteria and whether RRT was performed, to observe the effects of AKI staging and RRT on the prognosis of elderly septic patients with AKI. Multivariate Cox regression analysis was used to screen the risk factors of death in elderly patients with sepsis associated AKI. (1) A total of 490 septic elderly patients were enrolled, including 249 patients with AKI and 241 patients without AKI, with the AKI incidence of 50.8%. Compared with non-AKI group, the patients in AKI group were older (years old: 72.0±7.2 vs. 68.8±5.1), acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score were evidently higher (23.1±6.1 vs. 22.0±3.7, 9.4±3.8 vs. 6.1±3.5); the duration of mechanical ventilation [days: 7.0 (5.0, 10.0) vs. 6.0 (3.0, 9.0)], length of ICU stay [days: 12.0 (7.0, 15.0) vs. 7.0 (4.0, 13.0)] and total length of hospital stay [days: 15.0 (10.0, 21.5) vs. 12.0 (7.0, 15.0)] were longer, and ICU mortality and 28-day mortality were evidently higher [22.9% (57/249) vs. 14.1% (34/241), 36.1% (90/249) vs. 24.5% (59/241), all P < 0.05]. (2) According to KDIGO staging, 93 patients were in stage 1, 70 in stage 2 and 86 in stage 3 of AKI. The rate of RRT was increased with increase in KDIGO staging [14.0% (13/93), 30.0% (21/70), 88.4% (76/86)], the duration without mechanical ventilation within 28 days was shortened [days: 20.0 (0, 23.0), 8.0 (0, 20.5), 8.0 (0, 13.0)], the rate of kidney recovery was decreased [71.0% (66/93), 51.4% (36/70), 37.2% (32/86)], meanwhile, the ICU and 28-day mortality was increased [12.9% (12/93), 38.6% (27/70), 20.9% (18/86), and 26.9% (25/93), 35.7% (25/70), 46.5% (40/86), all P < 0.05]. (3) 110 elderly septic patients with AKI were treated with RRT, and 139 without RRT. Compared with non-RRT group, the ratio of mechanical ventilation in RRT group was lowered [46.4% (51/110) vs. 68.3% (95/139)], the duration without mechanical ventilation within 28 days [days: 18.0 (0, 23.0) vs. 10.0 (0, 13.0)], the length of ICU stay [days: 13.0 (12.0, 17.9) vs. 10.0 (6.0, 14.0)] and the total length of hospital stay [days: 22.5 (15.0, 46.0) vs. 16.0 (12.0, 23.0)] were prolonged, and the 28-day mortality was evidently increased [50.0% (55/110) vs. 25.2% (35/139), all P < 0.01], however, no significant difference in ICU mortality was found [27.3% (30/110) vs. 19.4% (27/139), P > 0.05]. (4) Cox regression analysis showed that SOFA score [relative risk (RR) = 1.214, 95% confidence interval (95%CI) = 1.117-1.319], KDIGO stage (RR = 4.077, 95%CI = 1.850-8.982), vasoactive substance usage (RR = 2.896, 95%CI = 1.502-5.584), and mechanical ventilation (RR = 5.787, 95%CI = 1.512-22.156) were the risk factors of 28-day mortality in elderly septic patients with AKI (all P < 0.05). The incidence of AKI for elderly septic patients with AKI was about 50%, who had a worse prognosis as compared with non-septic AKI patients. The higher the stage of KDIGO, the higher the mortality in elderly septic patients with AKI was. RRT can decrease the rate of mechanical ventilation, whereas, it may not improve the prognosis of elderly septic patients with AKI.

Serum cystatin C as an early marker of Acute Kidney Injury in elderly patients after surgery for femur fracture. An observational study

Background: Acute kidney injury (AKI) is prevalent in hospitalized patients, primarily in patients undergoing major surgical procedures. AKI is associated with increased morbimortality, and patients would benefit from a very early diagnosis that would allow implementation of specific therapeutic or additional prophylactic measures. The present study evaluated serum cystatin C as an early predictor of AKI in elderly patients during the postoperative period. Methods: Fifty-nine patients, aged 60 years or older undergoing correction of femur fracture under spinal anaesthesia, were prospectively evaluated up to 48 hours after surgery. Serum cystatin C was measured immediately after surgery and four (early marker) and 24 hours after surgery. The diagnosis of AKI was based on creatinine values up to 48 hours after surgery (Kidney Disease Improving Global Outcomes, KDIGO), and the impact of serum cystatin C on the diagnosis of AKI was evaluated four hours after surgery.

Mortality After Traumatic Brain Injury in Elderly Patients: A New Scoring System

Traumatic brain injury (TBI) remains a life-threatening condition characterized by growing incidence worldwide, particularly in the aging population, in which the primary goal of treatment appears to be avoidance of chronic institutionalization. To identify independent predictors of 30-day mortality or vegetative state in a geriatric population and calculate an intuitive scoring system, we screened 480 patients after TBI treated at a single department of neurosurgery over a 2-year period. We analyzed data of 214 consecutive patients aged ≥65 years, including demographics, medical history, cause and time of injury, neurologic state, radiologic reports, and laboratory results. A predictive model was developed using logistic regression modeling with a backward stepwise feature selection. The median Glasgow Coma Scale (GCS) score on admission was 14 (interquartile range, 12-15), whereas the 30-day mortality or vegetative state rate amounted to 23.4%. Starting with 20 predefined features, the final prediction model highlighted the importance of GCS motor score (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.09-0.32); presence of comorbid cardiac, pulmonary, or renal dysfunction or malignancy (OR, 2.86; 9 5% CI, 1.08-7.61); platelets ≤100× 109 cells/L (OR, 13.60; 95% CI, 3.33-55.49); and red blood cell distribution width coefficient of variation ≥14.5% (OR, 2.91; 95% CI, 1.09-7.78). The discovered coefficients were used for nomogram development. It was further simplified to facilitate clinical use. The proposed scoring system, Elderly Traumatic Brain Injury Score (eTBI Score), yielded similar performance metrics. The eTBI Score is the first scoring system designed specifically for older adults. It could constitute a framework for clinical decision-making and serve as an outcome predictor. Its capability to stratify risk provides reliable criteria for assessing efficacy of TBI management.

Retrospective study on the characteristics of early organ injury in elderly patients with severe burns

Objective: To analyze the clinical characteristics of early organ injury in elderly patients with severe burns and the effects on the prognosis of patients. Methods: From January 2010 to August 2018, 62 patients with severe burns (43 men and 19 women, aged from 60 to 89 years at the time of admission) who were hospitalized in the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as the author's affiliation), meeting the inclusion criteria, were included in elderly (E) group, and 124 patients with severe burns (86 men and 38 women, aged from 18 to 59 years at the time of admission) at the same term were included in young and middle-aged (YM) group. Treatment of patients in the 2 groups followed the conventional procedures of the author's affiliation. The following data of patients in the 2 groups were retrospectively analyzed. (1) Fluid replacement volume and urine volume within the first and second post injury hour (PIH) 24 were recorded. The levels of hemoglobin, haematocrit, and blood lactic acid at admission, PIH 24 and 48 were recorded. (2) The creatine kinase isozyme-MB (CK-MB), total bilirubin, blood creatinine, oxygenation index, and blood platelet count at admission, at shock stage, and on post injury day (PID) 3 to 7 were collected. (3) The days of seriously or critically ill and deaths were recorded. Data were processed with chi-square test, group t test, Mann-Whitney U test, analysis of variance for repeated measurement, and Bonferroni correction. Results: (1) There were no statistically significant differences in fluid replacement volume within the first and second PIH 24, and urine volume within the second PIH 24 between patients in the 2 groups (t=0.351, 1.307, 1.110, P>0.05). The urine volume of patients in group E within the first PIH 24 was significantly less than that in group YM (t=5.628, P<0.05). There were no statistically significant differences in levels of hemoglobin (t=0.011, 1.075, 0.239), haematocrit (t=0, 0.033, 0.199), and blood lactic acid (t=0.017, 1.002, 0.739) at admission, PIH 24 and 48 between patients in the 2 groups (P>0.05). (2) There were no statistically significant differences in levels of CK-MB at admission and on PID 3 to 7 between patients in the 2 groups (t=0.069, 0.001, P>0.05). The level of CK-MB of patients in group E at shock stage was significantly higher than that in group YM (t=4.017, P<0.05). There were no statistically significant differences in levels of total bilirubin at admission and on PID 3 to 7 between patients in the 2 groups (t=0.227, 0.002, P>0.05). However, the level of total bilirubin of patients in group E at shock stage was significantly higher than that in group YM (t=6.485, P<0.05). The levels of blood creatinine of patients in group E at admission and shock stage were significantly higher than those in group YM (t=4.226, 12.299, P<0.05 or P<0.01), while there was no statistically significant difference between them on PID 3 to 7 (t=0.693, P>0.05). The oxygenation indexes of patients in group E at admission and shock stage and on PID 3 to 7 [(371±16), (263±16), and (228±18) mmHg (1 mmHg=0.133 kPa)] were lower than (420±13), (327±13), and (281±17) mmHg of patients in group YM, respectively (t=5.650, 9.782, 4.856, P<0.05 or P<0.01). There were no statistically significant differences in levels of blood platelet count at admission and shock stage between patients in the 2 groups (t=0.038, 0.588, P>0.05), while the level of blood platelet count of patients in group E on PID 3 to 7 was significantly lower than that in group YM (t=6.636, P<0.05). (3) The days of seriously or critically ill and death rate of patients in group E were respectively longer or higher than those in group YM (Z=-2.303, χ(2)=13.676, P<0.05 or P<0.01). Conclusions: In the case of the same tissue perfusion at shock stage, injuries in heart, liver, kidney, lung, and coagulation system in elderly patients with severe burns are more obvious than those in young and middle-aged patients, with more severe illness and higher mortality.

Outcomes of hospital-acquired acute kidney injury in elderly patients: a single-centre study.

HAAKI is a common clinical problem in hospitalized patients. Its incidence is high in older patients and carries worse prognosis. The presence of multiple co-morbidities, aging process, and frequent diagnostic and therapeutic interventions predispose elderly patients to HAAKI. This study aims to evaluate the spectrum, risk factors and determinants of outcome of elderly patients with HAAKI. This prospective study was conducted during January 2014 to September 2015 in the Department of nephrology, Institute of Medical Sciences, BHU, Varanasi, UP, India. First 100 HAAKI elderly (> 60years) patients, who fulfilled the inclusion criteria were enrolled for study. HAAKI was defined as per RIFLE criteria after minimum 48h of hospitalization. Clinical, biochemical, and radiological evaluation were done. Follow up was done till discharge or up to 30days whichever was later. Till selection and enrollment of first 100 HAAKI patients, total 23507 patients were hospitalized. 11.2% (n = 2635) patients were ≥ 60years of age. Among 2635 elderly patients, 3.79% (n = 100) developed HAAKI. Commonest causes of HAAKI were sepsis (37%) followed by drugs like NSAID, Contrast agent, Amphotericin B, and antibiotics including amino glycosides in (24%) patents. DM and HTN were the commonest risk factors. Mortality was noted in 45% cases and rest 55% patients recovered with partial or full recovery of renal function. ICU admission, Oliguria, RIFLE-F, need of RRT, and SOFA score > 11 were independent determinants of outcome of elderly patients with HAAKI. HAAKI is associated with increased morbidity and mortality in elderly patients. Associated co-morbid conditions predispose elderly patients to HAAKI. ICU admission, Oliguria, severity of renal failure, requirement of RRT, and initial SOFA score were strong predictors of survival of elderly patients with HAAKI.

Diastolic dysfunction and acute kidney injury in elderly patients with femoral neck fracture.

BackgroundFemoral neck fracture is common in the elderly population. Acute kidney injury (AKI) is an important risk factor for mortality in patients who have had such fracture. We evaluated the incidence of AKI in patients who had femoral neck fracture and identified risk factors for AKI and mortality.MethodsThis was an observational cohort study including 285 patients who were ≥ 65 years of age and who underwent femoral neck fracture surgery between 2013 and 2017.ResultsThe mean age was 78.63 ± 6.75 years. A total of 67 (23.5%) patients developed AKI during the hospital stay: 57 (85.1%), 5 (7.5%), and 5 (7.5%) patients were classified as having stage 1, 2, and 3 AKI, respectively. Patients with AKI had a lower baseline estimated glomerular filtration rate and higher left atrial dimension, left ventricular mass index, pulmonary artery pressure, and the ratio of early mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) and were more likely to have diabetes or hypertension (HTN) (P < 0.05). The presence of HTN (odds ratio [OR], 4.570; 95% confidence interval [CI], 1.632–12.797) higher E/e’ (OR, 1.105; 95% CI, 1.019–1.198), and lower hemoglobin (OR, 0.704; 95% CI, 0.528–0.938) were independently associated with a higher risk for developing AKI. Severe AKI (OR, 24.743; 95% CI, 2.822–212.401) was associated with a higher risk of mortality.ConclusionElderly patients with femoral neck fracture had a high incidence of AKI. Diastolic dysfunction was associated with AKI. Severe AKI was associated with in-hospital mortality.

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

Effect of hip fracture surgery within 24 hours on short-term mobility

BackgroundHip fracture constitutes a high-mortality injury in elderly patients. In addition, caregiver burden is also a relevant issue, as patients after hip fracture surgery lose ambulation and require support in the perioperative period and after discharge. Early surgery is recommended to improve mortality. However the positive effect of early surgery on the short-term postoperative ambulatory function is unknown. The objective of this study was to determine whether a shorter waiting time for hip fracture surgery improves short-term postoperative mobility in elderly patients. We used the cumulated ambulation score (CAS), a feasible function scoring system using low-demand activities, to measure short-term postoperative mobility. MethodsIn this retrospective, observational study of 175 hip fracture patients at a single hospital, the patients were divided based on the waiting period for surgery (within 24 hours of arrival, early group; after 24 hours of arrival, delayed group). The primary outcome was postoperative mobility, assessed using the CAS. Multivariable linear regression analysis with adjustment for covariates, age, sex, mobility before injury, comorbidity, presence of dementia and type of fracture. As a subgroup analysis, cognitive function and the interaction between the surgical waiting time and the presence of dementia were considered. ResultsThe early group had a significantly better CAS (adjusted beta = 1.36; 95% confidence interval [95% CI]: 0.24–2.48, p = 0.02) than the delayed group. Significant CAS improvement was observed among cognitively intact patients (adjusted beta = 2.66; 95% CI: 0.62–4.69, p = 0.01), but not among those with dementia (adjusted beta = 0.43; 95% CI: −0.93 to 1.79, p = 0.53). However, the interaction between the surgical waiting time and the presence of dementia in the entire population did not reach statistical significance (p for interaction = 0.15). ConclusionsHip fracture surgery within 24 hours could improve the recovery of postoperative ambulatory function faster. The postoperative caregiver burden would be reduced by early surgery.

GW29-e0600 Preprocedural risk score for contrast-induced acute kidney injury in elderly patients undergoing percutaneous coronary intervention

GW29-e0600 Preprocedural risk score for contrast-induced acute kidney injury in elderly patients undergoing percutaneous coronary intervention

GW29-e1889 Hyperhomocysteinemia Impact on Blood Pressure Variability and Target Organ Injured in Old Patients with Hypertension and Stroke

To research the effects of hyperhomocysteinemia (HHcy)on blood pressure variability, heart, kidney and brain target organ injury in elderly patients with essential hypertension with stroke. From June 2015 to February 2016, 66 elderly inpatients with essential hypertension complicated with acute