Mortality In Elderly Patients Research Articles

Effects of body mass index on mortality in elderly patients with hip fractures.

Hip fractures remain a substantial health concern, particularly among elderly individuals with osteoporosis, leading to high global mortality rates. This study aimed to analyze the association between body mass index (BMI) and postoperative mortality in patients who underwent surgery for hip fractures. A total of 680 patients treated at a single institution between January 2018 and December 2022 were included. Factors such as age, BMI, sex, Charlson Comorbidity Index (CCI), preoperative hemoglobin levels, American Society of Anesthesiologists score, anesthesia method, duration of surgery, and time from injury to surgery were assessed. Underweight status, male sex, higher CCI, and general anesthesia were significantly associated with 1-year and in-hospital mortality. Notably, underweight individuals exhibited a higher risk of mortality than normal-weight individuals, and female patients had lower mortality rates. This study underscores the importance of considering BMI, along with other demographic and clinical factors, in predicting postoperative mortality among patients with hip fractures, aiding the development of tailored management strategies to improve outcomes and reduce complications in this vulnerable patient population.

Surgical intervention for lung cancer in patients aged 75 and above: potential associations with increased mortality rates—a single-center observational study

BackgroundLung cancer, which is diagnosed two to three times more frequently in patients over the age of 70, is a leading cause of cancer-specific mortality. Given the elevated risk of morbidity and mortality, surgical intervention may not always be the most appropriate primary treatment option. This study aims to evaluate specific risk factors associated with postoperative morbidity and mortality in elderly patients and to optimize patient selection therefore improving surgical outcomes.Patients and methodsThe study encompassed a cohort of 73 patients aged 75 and above who underwent surgical treatment for non-small cell lung cancer (NSCLC) at the Department of Thoracic Surgery of the P. Hertsen Moscow Oncological Research Institute between 2015 and 2021. All patients underwent preoperative evaluation, including PET/CT staging and functional assessment, carried out by a multidisciplinary team comprising thoracic surgeons, anesthesiologists, and other medical specialists.ResultsThe investigation revealed a postoperative mortality rate of 5.5% and a postoperative morbidity incidence of 16.4%, with occurrences of atrial fibrillation in 41.6%, persistent air leak in 33.3%, and pneumonia in 25% of complicated cases. At the one-year follow-up, 88% of patients remained free from relapse, whereas at three years, this rate stood at 66%. During the follow-up period, 16 patients (22%) passed away, with a median survival duration of 44 months. Survival rates at one year, three years, and five years were 71%, 66%, and 35%, respectively. Multivariate analysis disclosed several significant factors predicting a complex postoperative period, including stage IIIb (p = 0.023), pN1 (p = 0.049), pN2 (p = 0.030), and central location (p = 0.007). Additionally, overall survival was primarily influenced by a Charlson comorbidity index of 6 (p = 0.044), stage Ia2 (p = 0.033), and the necessity for thoracotomy (p = 0.045).ConclusionEach case of lung cancer in patients aged 75 and older necessitates an individualized approach. Given the higher mortality rate relative to younger patients, comprehensive risk assessment and preoperative management of underlying comorbidities are imperative, with the involvement of anesthesiologists, intensive care physicians, cardiologists, and other relevant specialists as needed.

Predictive value of POSSUM scoring system for postoperative complications and mortality in elderly patients with colorectal cancer.

The POSSUM scoring system, widely employed in assessing surgical risks, offers a simplified and objective approach for the prediction of complications and mortality in patient. Despite its effectiveness in various surgical fields, including orthopedics and cardiovascular surgery, yet its utilization in elderly patients undergoing colorectal cancer surgery is infrequent. To analyze the predictive value of POSSUM scoring system for postoperative complications and mortality in elderly with colorectal cancer. 306 elderly colorectal cancer patients were grouped according to the complications and death within 30 days after surgery. Among them, 108 cases in complication group, 198 cases in non-complication group, 16 cases in death group and 290 cases in survival group. POSSUM scores of all subjects were obtained and its predictive value for postoperative complications and mortality of elderly was conducted by ROC curve. No apparent difference were observed in complications and mortality among patients with different disease types, operation types and operation timing (P> 0.05). The R2 in complication group was higher than non-complication group (P< 0.05). The R1 in death group were higher than survival group (P< 0.05). The AUC of R2 for predicting postoperative complications was 0.955 with a sensitivity of 88.89% and a specificity of 94.44% and the AUC of R1 for evaluating postoperative mortality of elderly with colorectal cancer was 0.783 with a sensitivity of 56.25% and a specificity of 82.93%. POSSUM score system has a certain predictive value for postoperative complications and mortality in elderly with colorectal cancer. However, the predicted mortality rate is higher than actual mortality rate.

Effects of combined morbid insomnia and sleep apnea on long-term cardiovascular risk and all-cause mortality in elderly patients: a prospective cohort study

PurposeIt is reported that insomnia and obstructive sleep apnea (OSA) increase the incidence of adverse cardiovascular events. The aim of this study was to analyze the risk of cardiovascular disease and mortality in elderly patients with comorbid insomnia and obstructive sleep apnea (COMISA).MethodsWe included 868 elderly patients with OSA who underwent sleep monitoring at a multicenter sleep room from January 2015 to October 2017. We collected demographic data, clinical features, medical history, sleep parameters, and laboratory findings. Cox proportional hazards analysis was used to identify the relationship between COMISA and adverse cardiovascular events and all-cause mortality.ResultsThere were 181 elderly patients with COMISA. The median follow-up was 43 months, during which we observed major adverse cardiac events (MACE) in 90 patients. The Kaplan-Meier survival curve indicated a significant relationship between COMISA and MACE (Plog Rank < 0.001). Multivariate Cox regression analysis showed that COMISA increased the incidence of MACE (HR = 2.328, 95% CI: 1.349–4.018, P = 0.002), hospitalization for unstable angina (HR = 2.915, 95% CI: 1.397–6.081, P = 0.004), and the combination of all events (HR = 2.301, 95% CI: 1.393–3.803, P = 0.001). However, there were no significant differences in cardiovascular death, all-cause mortality, myocardial infarction, or hospitalized heart failure in patients with COMISA (P > 0.05). Subgroup analyses showed that among COMISA patients, male sex (HR = 2.800, 95% CI: 1.458-5.377, P = 0.002), age < 70 years (HR = 4.050, 95% CI: 2.022–8.115, P < 0.001), and overweight and obesity (HR = 2.482, 95% CI: 1.383-4.453, P = 0.002) were associated with a higher risk of MACE.ConclusionsOur results showed that COMISA increased the risk of MACE, unstable angina, and the compound occurrence of all events. Male, overweight or obese COMISA patients under 70 years of age have an increased risk of MACE.

DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS

OBJECTIVE: Urinary tract infections are common in older adults and associated with significant morbidity and mortality. This study aimed to characterize the clinical features, bacterial etiologies, antimicrobial resistance patterns, and risk factors for mortality in elderly patients hospitalized with urinary tract infection. MATERIAL AND METHODS: Data were retrospectively analyzed from 118 patients aged ≥65 years hospitalized with a diagnosis of urinary tract infection between January 2018 and December 2022. Urinary tract infections were defined according to Centers for Disease Control and Prevention criteria. Isolated microorganisms in urine cultures and antimicrobial resistance rates were determined. Risk factors associated with mortality were evaluated by logistic regression analysis. RESULTS: 50.8% of patients were female; the mean age was 72.5±7.0 years. The most common symptoms were dysuria (65.3%), anorexia (65.3%), and flank pain (57.6%). Forty-nine patients (41.5%) had nosocomial urinary tract infections. All cause in hospital mortality was observed in 48 patients (40.6%), and 22 patients (18.6%) had in-hospital mortality directly related to urinary tract infection. Urosepsis (OR: 13.518, 95% CI: 1.711-106.793, p=0.014), kidney stones (OR: 7.529, 95% CI: 1.596-35.525, p=0.011) and urinary tract infections caused by multidrug-resistant organisms (OR: 18. 612, 95% CI: 1.564-4.283, p&amp;lt;0.001) were independent risk factors for mortality, and appropriate treatment (OR: 0.090, 95% CI: -3.736--1.085, p&amp;lt;0.001) was an independent protective factor for mortality. CONCLUSIONS: Urinary tract infections in elderly adults present with a wide range of symptoms and are predominantly caused by drug-resistant Escherichia coli. Urosepsis and kidney stones are critical determinants of mortality, emphasizing the need for rapid and appropriate management strategies. Understanding the etiology, clinical features, and mortality risk factors of urinary tract infections in elderly adults is crucial for optimizing infection management in this vulnerable population.

Impact of Baseline Patient Characteristics on Short- and Long-Term Overall Mortality in Elderly Patients with COVID-19: A Retrospective Cohort Study

Impact of Baseline Patient Characteristics on Short- and Long-Term Overall Mortality in Elderly Patients with COVID-19: A Retrospective Cohort Study

Optimizing Prediction of In-Hospital Mortality in Elderly Patients With Acute Myocardial Infarction: A Nomogram Approach Using the Age-Adjusted Charlson Comorbidity Index Score.

To study the age-adjusted Charlson comorbidity index (ACCI) scale, which is a comprehensive quantification of multimorbidity coexistence, for the assessment of the risk of acute myocardial infarction death in elderly people. A total of 502 older patients with acute myocardial infarction were studied at Qilu Hospital from September 2017 to March 2022. They were categorized on the basis of ACCI into low (≤5), intermediate (6, 7), and high (≥8) risk groups. Hospitalization duration was observed, with death as the end point. least absolute shrinkage and selection operator regression was used to screen variables, 10-fold cross-validation was performed to validate the screened variables, a Cox regression nomogram predicting the risk of patient death was prepared, hazard ratio with 95% CI was calculated, a nomogram calibration curve was constructed, and a receiver operating characteristic curve, decision curve analysis, and a clinical impact curve were established. From 62 potential factors in a least absolute shrinkage and selection operator regression, 12 were selected via 10-fold cross-validation. Retain variables with significant statistical differences in the Cox regression. A nomogram of the risk of death from acute infarction was constructed, and risk factors included ventricular tachycardia/fibrillation, atrial fibrillation, nicorandil, angiotensin-converting enzyme inhibitors/angiotensin-converting enzyme inhibitors, β blockers, and ACCI score, carbon dioxide combining power, and blood calcium concentration. The ACCI score effectively assesses multimorbidity in the older patients. As ACCI rises, the death risk from acute myocardial infarction grows. The study's nomogram is valid and clinically applicable.

627 Epidemiology, Admissions Outcomes, and Mortality for Geriatric Trochanteric Fractures. A Major Trauma Centre Study

Abstract Aim Femur trochanteric fractures are very debilitating injuries yet are under investigated in orthopaedic literature. We study the epidemiology, hospital admission factors, and mortality for elderly patients with trochanteric fractures. Method All patients over 65 years old at a level-1 trauma-centre with a trochanteric hip fracture from January-2015 to June-2021 were included. Fractures were subdivided with AO/OTA subclassifications into intertrochanteric (31-A1,A2,A3) and subtrochanteric (32-A1,A2) sub-types. Patient demographics, preadmission mobility, time-to-surgery, length-of-surgery, surgical fixation used, inpatient rehabilitation/mobilisation, and post-operative mortality at 1,3,6 and 12 months, were collected. Patients were followed up for minimum of 2-years. Statistical significance was p&amp;lt;0.05. Results A total of 1101 patients were included. The AO/OTA classification was: 31-A1(123), 31-A2(491), 31-A3(105), 32-A1(221), 32-A2(161). Average age was 84.9, with 72.8% patients being female. Average admission-to-surgery, surgery-time, and surgery-to-discharge-time was 21.6hours, 1.2hours, and 15.5days respectively. Overall mortality was 7.2%(1-month), 15.4%(3-months), 20.4%(6-months) and 27.1%(12-months). There were no statistically significant associations of type of fracture, operative method, or surgery-within-36hours, with mortality at any scale. Post-operative mobilisation within 24-hours, with or without physiotherapist aid, was associated with lower mortality on all investigated time scales, compared to no mobilisation (p&amp;lt;0.05). Conclusions Our study presents a large and detailed cohort of patients with trochanteric fractures classified with AO/OTA, the first in the UK, and investigated the associations with inpatient admission and mortality outcomes. Our detailed analysis and high-resolution data will allow for cross region and country comparisons and inform guideline and quality improvement efforts.

Update on the management of pT1 colorectal cancer

Abstract With the implementation of CRC screening programs, the incidence of pT1 CRC has increased significantly: up to 40% of colon tumors detected in screening colonoscopies are pT1. Traditionally, the treatment of choice for CRC is surgery with lymph node resection, but pT1 CRC has a very good prognosis with 5-year disease-free survival rates greater than 90% and thanks to advanced endoscopy, it can be treated locally with a minimally invasive approach in many cases. After resection of the lesion, an adequate histological description of the specimen will guide us to make the final decision in the management of pT1 CRC: whether endoscopic resection is considered curative or whether additional surgery will be required to prevent local recurrence, lymphatic dissemination and /or distant metastasis. The decision to proceed with additional surgery or surveillance depends primarily on the estimated oncologic benefit of surgery, operative risk, and patient preferences. It must be taken into account that colorectal surgery carries a significant risk of morbidity and mortality for elderly patients. Currently we base our decisions on histological criteria, but the natural history of pT1 CRC resected by endoscopy is really unknown and there are not enough quality prospective studies with results after long-term follow-up of pT1 CRC non-surgically managed, especially in the case of high-risk pT1, which would explain the great variability in the management of these patients. In this thematic review we have analyzed the current state of management of pT1 CRC in the field of endoscopic diagnosis and treatment, histological evaluation and its prognostic implications. We have also reviewed the most recent evidence regarding surveillance: how to carry out adequate follow-up and determine the optimal frequency and the most appropriate surveillance method after local resection of pT1 CRC.

926 Long-Term Outcomes of Internal Fixation vs Hemiarthroplasty for Femoral Neck Fractures: A Quantitative Analysis of the Correlation Between Harris Hip Score and Mortality in Elderly Patients

926 Long-Term Outcomes of Internal Fixation vs Hemiarthroplasty for Femoral Neck Fractures: A Quantitative Analysis of the Correlation Between Harris Hip Score and Mortality in Elderly Patients

Factors Associated with Mortality in Elderly Patients Admitted to Intensive Care Unit due to Acute Drug Intoxication from Suicide Attempts

Factors Associated with Mortality in Elderly Patients Admitted to Intensive Care Unit due to Acute Drug Intoxication from Suicide Attempts

Association between the red cell distribution width and mortality in elderly patients with non-traumatic coma: An observational cohort study.

Elevated red blood cell distribution width (RDW) can be associated with disease severity. However, studies on RDW for the prognosis of elderly patients with non-traumatic coma (NTC) are lacking. This study aims to examine the relationship between RDW and outcomes in elderly patients with NTC. This observational cohort study included elderly patients (aged ≥ 65 years) with NTC between January 2022 and December 2022. We measured RDW upon patient arrival at the emergency department (ED). We conducted a multivariable analysis using logistic regression of relevant covariates to predict in-hospital mortality. Survival curves based on 30-day mortality were designed using the Kaplan-Meier method. The primary outcome was in-hospital mortality, and the secondary outcome was 30-day mortality. A total of 689 patients were included in the study, and in-hospital mortality was 29.6% (n = 204). Our results found that the RDWs of non-survivors were significantly greater than those of survivors (14.6% vs 13.6%). Multivariable analysis showed that RDWs at ED arrival were independently associated with in-hospital mortality (odds ratio, 1.126; 95% confidence interval, 1.047-1.212; P < .001). The Kaplan-Meier curve indicated that the survival probability of patients with a low RDW was greater than those with a high RDW. Having a high RDW at ED arrival was associated with in-hospital mortality in elderly patients with NTC.

Association between increased neutrophil-to-lymphocyte ratio and postoperative 1-year mortality in elderly patients with pertrochanteric hip fracture

Association between increased neutrophil-to-lymphocyte ratio and postoperative 1-year mortality in elderly patients with pertrochanteric hip fracture

Clinical Characteristics and Prognosis of Older Adult Patients With Necrotizing Pancreatitis: A single center retrospective study

Background: Acute pancreatitis (AP) is a common condition encountered during clinical practice; 20% of patients have pancreatic necrosis, and the mortality is high. This study aimed to explore the clinical characteristics and prognosis of older adult patients with necrotizing pancreatitis (NP). Methods: We searched for 1159 patients with AP admitted to the General Surgery Department of Xuanwu Hospital from January 2014 to December 2021. After screening medical history and imaging examinations, a total of 109 patients were divided into a death group (n=31) and a survival group (n=78), and their clinical characteristics and prognosis were further analyzed. Results: In the death group, the scope of pancreatic necrosis was more extensive, the evidence of infection was apparent, the nutritional status and the clinical outcome were worse; In addition, patients in the death group have a higher proportion of organ failure and infection, and longer intensive care unit (ICU) hospitalization time. Conclusion: Preoperative persistent organ failure (POF) and prolonged hospitalization in ICU are independent risk factors leading to increased mortality in elderly patients with NP. Early identification of risk factors ,timely drug treatment and surgical intervention are essential to improve the prognosis of older adult patients and reduce mortality.

Unraveling complexity: morbidity factors in elderly kidney transplant recipients.

The rising prevalence of end-stage renal failure in the elderly has led to an increased number of kidney transplantations in older individuals. While age does not solely determine transplant eligibility, frailty in elderly recipients significantly impacts post-transplant outcomes, particularly within the first year. The RETRAITE (REnal TRAnsplantIon ouTcome in Elderly recipients) study, a single-center retrospective cohort study at Grenoble Alpes University Hospital (France), examined kidney transplant recipients aged 70years and above transplanted between 2015 and 2020. The composite primary endpoint was defined as either of any hospital stay exceeding 40days, death and/or return to dialysis within the first post-transplant year. The study explored risk factors for recipient and graft survival, rejection, hospitalizations over 40days, and severe infections during the initial post-transplant year. Over six years, 149 patients aged 70years or older received transplants. Eleven patients died, and seven returned to dialysis within the first year, corresponding to a 1-year graft survival rate of 87.9%. At 1year, 49 patients (33%) met the composite endpoint. There was a significant association between the composite endpoint and curative anticoagulation [odds ratio (OR) 5.20; P<.001], peripheral arteriopathy (OR 3.14; P<.001) and delayed graft function (OR8.24; P<.001). This cohort then was merged with a cohort of 150 younger kidney transplanted patients and we confirmed these results. Time on dialysis, prolonged cold ischemia and donor age contributed to higher morbidity and mortality. Conversely, preemptive and living donor transplants were associated with lower morbidity and mortality. In this cohort aged over 70years, age alone did not statistically correlate with increased morbidity and mortality. Variables related to grafts and donors, especially curative anticoagulation, were linked to poorer outcomes, emphasizing the favorable impact of preemptive and living donor transplants on morbidity and mortality in elderly patients.

Mortality of elderly patients with acute kidney injury undergoing continuous renal replacement therapy: is age a risk factor?

Whether advanced age is associated with poor outcomes of elderly patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is controversial. This study aimed to evaluate age effect and predictors for mortality in elderly AKI patients undergoing CRRT. Data of 480 elderly AKI patients who underwent CRRT were retrospectively analyzed. Subjects were stratified into two groups according to age: younger-old (age, 65-74 years; n = 205) and older-old (age, ≥75 years; n = 275). Predictors for 28-day and 90-day mortality and age effects were analyzed using multivariable Cox regression analysis and propensity score matching. Urine output at the start of CRRT (adjusted hazard ratio [aHR], 0.99; 95% confidence interval [CI], 0.99-1.00; p = 0.04), operation (aHR, 0.53; 95% CI, 0.30-0.93; p = 0.03), and use of an intra-aortic balloon pump (aHR, 3.60; 95% CI, 1.18-10.96; p = 0.02) were predictors for 28-day mortality. Ischemic heart disease (aHR, 1.74; 95% CI, 1.02-2.98; p = 0.04) and use of a ventilator (aHR, 0.56; 95% CI, 0.36-0.89; p = 0.01) were predictors for 90-day mortality. The older-old group did not exhibit a higher risk for 28- day or 90-day mortality than the younger-old group in multivariable or propensity score-matched models. Advanced age was not a risk factor for mortality among elderly AKI patients undergoing CRRT, suggesting that advanced age should not be considered for therapeutic decisions in critically ill elderly patients with AKI requiring CRRT.

Morbidity and mortality of elderly patients with pancreaticobiliary disease according to age and comprehensive geriatric assessment: A prospective observational study

BackgroundThis study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. MethodsA prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75–79 years old; group 2: 80–84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. ResultsOverall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). ConclusionsNo significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.

Short-Term Morbidity and Mortality after Distal Femur Open Reduction Internal Fixation in the Geriatric Population.

Distal femur fractures remain a significant cause of morbidity and mortality for elderly patients. There is a lack of large population studies investigating short-term outcomes after distal femur c in elderly patients. The purpose of this study is to assess the incidence of and risk factors for various short-term outcomes after distal femur open reduction internal fixation (ORIF) in the geriatric population. The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database was used to identify all primary distal femur ORIF cases in patients 60+ years old between January 1, 2015 and December 31, 2020 using Current Procedural Terminology (CPT) codes 27511, 27513, and 27514. Demographic, medical, and surgical variables were extracted for all patients. Propensity score matching was used to match cases in the two age groups based on various demographic and medical comorbidity variables. Several 30-day outcome measures were compared between the 60-79-year-old and 80+-year-old groups both before and after matching. Subsequent multivariate logistic regression was used to identify independent risk factors for 30-day outcome measures in the matched cohort. A total of 2913 patients were included in the final cohort: 1711 patients in the 60-79-year-old group and 1202 patients in the 80+-year-old group. Most patients were female (n = 2385; 81.9%). Prior to matching, the older group had a higher incidence of 30-day mortality (1.9% vs. 6.2%), readmission (3.7% vs. 9.7%, p = 0.024), and non-home discharge (74.3% vs. 89.5%, p < 0.001). Additionally, the older group had a higher rate of blood loss requiring transfusion (30.9% vs. 42.3%, p < 0.001) and medical complications (10.4% vs. 16.4%, p < 0.001), including myocardial infarction (0.7% vs. 2.7%, p < 0.001), pneumonia (2.7% vs. 4.6%, p = 0.008), and urinary tract infection (4.1% vs. 6.1%, p = 0.0188). After matching, the older group consistently had a higher incidence of mortality, non-home-discharge, blood loss requiring transfusion, and myocardial infarction. Various independent risk factors were identified for 30-day morbidity and mortality, including American Society of Anesthesiologists (ASA) classification, body mass index (BMI) status, operative duration, and certain medical comorbidities. Geriatric patients undergoing distal femur ORIF are at significant risk for 30-day morbidity and mortality. After matching, octogenarians and older patients specifically are at increased risk for mortality, non-home discharge, and surgical complications compared to patients aged 60-79 years old. Multiple factors, such as BMI status, ASA classification, operative time, and certain medical comorbidities, are independently associated with poor 30-day outcomes.

Prognostic utility of paraspinal muscle index in elderly patients with community-acquired pneumonia.

This study investigated the associations between paraspinal muscle measurements on chest computed tomography and clinical outcomes of elderly patients with community-acquired pneumonia (CAP). This single-center, retrospective, observational study analyzed elderly patients (≥65 years) with CAP hospitalized through an emergency department between March 2020 and December 2022. We collected their baseline characteristics and laboratory data at the time of admission. The paraspinal muscle index and attenuation were calculated at the level of the 12th thoracic vertebra using chest computed tomography taken within 48 hours before or after admission. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between paraspinal muscle measurements and 28-day mortality. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to evaluate the prognostic predictive power. Of the 338 enrolled patients, 60 (17.8%) died within 28 days after admission. A high paraspinal muscle index was associated with low 28-day mortality in elderly patients with CAP (adjusted odds ratio, 0.994; 95% confidence interval, 0.992-0.997). The area under the ROC curve for the muscle index was 0.75, which outperformed the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65 years) metric, both of which showed an AUC of 0.64 in predicting mortality. A high paraspinal muscle index was associated with low 28-day mortality in patients aged 65 years or older with CAP.

Comparison of the Value of Four Objective Nutritional Indices in Assessing the Long-Term Prognosis of Elderly Patients with Heart Failure with Preserved Ejection Fraction.

The long-term prognosis of heart failure with preserved ejection fraction (HFpEF) is influenced by malnutrition. Currently, there's a deficit in objective and comprehensive nutritional assessment methods to evaluate the nutritional status and predicting the long-term outcomes of HFpEF patients. Our retrospective study included two hundred and eighteen elderly HFpEF patients admitted to the cardiovascular ward at the Air Force Medical Centre from January 2016 to December 2021. Based on follow-up outcomes, patients were categorized into all-cause death (99 cases) and Survival (119 cases) groups. We compared general data, laboratory results, and nutritional indexes between groups. Differences in subgroups based on Triglyceride-Total Cholesterol-Body Weight Index (TCBI), Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlled Nutrition Score (CONUT) were analyzed using Kaplan-Meier survival curves and log-rank test. COX regression was used to identify all-cause mortality risk factors, and the predictive accuracy of the four nutritional indices was assessed using receiver operating characteristic (ROC) curves and Delong test analysis. A total of 101 (45.41%) HFpEF patients experienced all-cause mortality during 59.02 1.79 months of follow-up. The all-cause mortality group exhibited lower GNRI and PNI levels, and higher CONUT levels than the Survival group (p 0.05). Kaplan-Meier analysis revealed lower cumulative survival in the low GNRI ( 96.50) and low PNI ( 43.75) groups, but higher in the low CONUT ( 2) group, compared to their respective medium and high-value groups. Multifactorial COX regression identified low PNI ( 43.75) as an independent all-cause mortality risk factor in elderly HFpEF patients. ROC and Delong's test indicated PNI (area under the curve [AUC] = 0.698, 95% confidence interval [CI] 0.629-0.768) as a more effective predictor of all-cause mortality than TCBI (AUC = 0.533, 95% CI 0.456-0.610) and CONUT (AUC = 0.621, 95% CI 0.547-0.695; p 0.05). However, there was no significant difference compared to GNRI (AUC = 0.663, 95% CI 0.590-0.735; p 0.05). In elderly HFpEF patients a PNI 43.75 was identified as an independent risk factor for all-cause mortality. Moreover, PNI demonstrates superior prognostic performance in predicting all-cause mortality in elderly patients with HFpEF when compared to TCBI, GNRI, and COUNT.