Mortality In Elderly Patients Research Articles

Peri-operative score for elderly patients with resectable hepatocellular carcinoma.

Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma (HCC), also in elderly population. Despite this, the evaluation of patient condition, liver function and extent of disease remains a demanding process with the aim to reduce postoperative morbidity and mortality. To identify new perioperative risk factors that could be associated with higher 90- and 180-d mortality in elderly patients eligible for liver resection for HCC considering traditional perioperative risk scores and to develop a risk score. A multicentric, retrospective study was performed by reviewing the medical records of patients aged 70 years or older who electively underwent liver resection for HCC; several independent variables correlated with death from all causes at 90 and 180 d were studied. The coefficients of Cox regression proportional-hazards model for six-month mortality were rounded to the nearest integer to assign risk factors' weights and derive the scoring algorithm. Multivariate analysis found variables (American Society of Anesthesiology score, high rate of comorbidities, Mayo end stage liver disease score and size of biggest lesion) that had independent correlations with increased 90- and 180-d mortality. A clinical risk score was developed with survival profiles. This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality.

Pre-Interventional Risk Assessment in The Elderly (PIRATE): Development of a scoring system to predict 30-day mortality using data of the Peri-Interventional Outcome Study in the Elderly.

Risk assessment before interventions in elderly patients becomes more and more vital due to an increasing number of elderly patients requiring surgery. Existing risk scores are often not tailored to marginalized groups such as patients aged 80 years or older. We aimed to develop an easy-to-use and readily applicable risk assessment tool that implements pre-interventional predictors of 30-day mortality in elderly patients (≥80 years) undergoing interventions under anesthesia. Using Cox regression analysis, we compared different sets of predictors by taking into account their ease of availability and by evaluating predictive accuracy. Coefficient estimates were utilized to set up a scoring system that was internally validated. Model building and evaluation were based on data from the Peri-Interventional Outcome Study in the Elderly (POSE), which was conducted as a European multicenter, observational prospective cohort study. Our risk assessment tool, named PIRATE, contains three predictors assessable at admission (urgency, severity and living conditions). Discriminatory power, as measured by the concordance index, was 0.75. The estimated prediction error, as measured by the Brier score, was 0.036 (covariate-free reference model: 0.043). PIRATE is an easy-to-use risk assessment tool that helps stratifying elderly patients undergoing interventions with anesthesia at increased risk of mortality. PIRATE is readily available and applies to a wide variety of settings. In particular, it covers patients needing elective or emergency surgery and undergoing in-hospital or day-case surgery. Also, it applies to all types of interventions, from minor to major. It may serve as a basis for multidisciplinary and informed shared decision-making.

Shape phenotype of thigh fat and muscle and risk of major adverse cardiovascular events after fragility hip fracture.

Although sarcopenia has been recognized as a predictor of mortality in elderly patients with hip fracture, the association of thigh fat and muscle with cardiovascular (CV) outcome remains unclear. We examined the impact of computed tomography (CT)-derived shape features of thigh fat and muscle on major adverse CV events (MACE) in elderly patients with hip fracture. We conducted a retrospective analysis of consecutive patients aged ≥65years who presented with hip fracture confirmed on pelvic bone CT scan and underwent hip fracture surgery at our institution from April 2019 to December 2021. The cross-sectional area (CSA) and compactness (CM) of both the muscle and fat at the upper-thigh level were calculated from two-dimensional CT images using AVIEW Research (v1.1.38, Coreline Soft, Co. Ltd, Seoul, South Korea). The shape features of thigh fat and muscle were categorized into four groups based on the combination of CSA and CM: fat CSA (fat area [FA])/fat CM (FCM), muscle CSA (muscle area [MA])/muscle CM (MCM), FA/MCM and MA/FCM. In each of them, subjects were categorized into four subgroups: high CSA/high CM, high CSA/low CM, low CSA/high CM and low CSA/low CM. The primary outcome was MACE after 30days of surgery, defined as a composite of all-cause death, acute myocardial infarction, stroke or hospitalization for heart failure. Of 356 patients enrolled (median age, 82years; 76.7% females), 72 (20.2%) had MACE over a median follow-up of 13.1months (ranges 5.9-21.0months). Patients with MACE had a significantly lower median FA (193.7 vs. 226.2cm2 , P<0.0001) and FCM (0.443 vs. 0.513, P=0.001) compared with those without MACE, but no significant differences were found in MA, MCM and FA-MA ratio between the two groups. In a multivariate Cox regression analysis, low FA (<240.1cm2 ) (adjusted hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.39-6.44, P=0.005) and low FCM (<0.477) (adjusted HR 2.00, 95% CI 1.10-3.63, P=0.023) were associated with an increased risk of MACE. Among the shape phenotypes of thigh fat and muscle, the thigh fat phenotype of low FA/low FCM (adjusted HR 3.13, 95% CI 1.81-5.42, P<0.0001 [reference, high FA/high FCM]) was found to be an independent predictor of MACE. In elderly patients with fragility hip fracture, thigh CT-derived measures of FA and FCM may provide useful prognostic information for predicting adverse CV outcomes.

Early and minimal changes in serum creatinine can predict prognosis in elderly patients receiving invasive mechanical ventilation: A retrospective observational study

BackgroundEmerging evidence suggests that minimal acute kidney injury (stage 1 AKI) is associated with increased hospital mortality rates. However, for those who do not meet the AKI diagnostic criteria, whether a small increase in serum creatinine (SCr) levels is associated with an increased mortality rate in elderly patients is not known. Therefore, we aimed to investigate small elevations in SCr of <26.5 µmol/L within 48 h after invasive mechanical ventilation (MV) on the short-term mortality of critically ill patients in the geriatric population. MethodsWe conducted a retrospective, observational, multicenter cohort study enrolling consecutive elderly patients (≥75 years) who received invasive MV from January 2008 to December 2020. Recursive partitioning was used to calculate the ratio of SCr rise from baseline within 48 h after MV and divided into six groups, (1) <10%, (2) 10%–<20%, (3) 20%–<30%, (4) 30%–<40%, (5) 40%–<50%, and (6) ≥50%, where the reference interval was defined as the ratio <10% based on an analysis, which confirmed that the lowest mortality risk was found in this range. Clinical data and laboratory data were noted. Their general conditions and clinical characteristics were compared between the six groups. Prognostic survival factors were identified using Cox regression analysis. Kaplan–Meier survival analysis was employed for the accumulative survival rate. ResultsA total of 1292 patients (1171 men) with a median age of 89 (interquartile range: 85–92) with MV were suitable for further analysis. In all, 376 patients had any stage of early AKI, and 916 patients had no AKI. Among 916 non-AKI patients, 349 patients were in the ratio <10%, 291 in the 10%–<20% group, 169 in the 20%–<30% group, 68 in the 30%–<40% group, 25 in the 40%–<50% group, and 14 in the ≥50% group. The 28-day mortality rates in the six groups from the lowest (<10%) to the highest (≥50%) were 8.0%, 16.8%, 28.4%, 54.4%, 80.0%, and 85.7%, respectively. In the multivariable-adjusted analysis, patients with a ratio of 10%–<20% (hazard ratio [HR]=2.244; 95% confidence interval [CI]: 1.410 to 3.572; P=0.001), 20%–<30% (HR=3.822; 95% CI: 2.433 to 6.194; P <0.001), 30%–<40% (HR=10.472; 95% CI: 6.379 to 17.190; P <0.001), 40%–<50% (HR=13.887; 95% CI: 7.624 to 25.292; P <0.001), and ≥50% (HR=13.618; 95% CI: 6.832 to 27.144; P <0.001) had relatively higher 28-day mortality rates. The 90-day mortality rates in the six strata were 30.1%, 35.1%, 45.0%, 60.3%, 80.0%, and 85.7%, respectively. Significant interactions were also observed between the ratio and 90-day mortality: patients with a ratio of 10%–<20% (HR=1.322; 95% CI: 1.006 to 1.738; P=0.045), 20%–<30% (HR=1.823; 95% CI: 1.356 to 2.452; P <0.001), 30%–<40% (HR=3.751; 95% CI: 2.601 to 5.410; P <0.001), 40%–<50% (HR=5.735; 95% CI: 3.447 to 9.541; P <0.001), and ≥50% (HR=6.305; 95% CI: 3.430 to 11.588; P <0.001) had relatively higher 90-day mortality rates. ConclusionsOur study suggests that a ≥ 10% SCr rise from baseline within 48 h after MV was independently associated with short-term all-cause mortality in mechanically ventilated elderly patients.

Protect the neck: Devastating outcomes of cervical spine fractures in the elderly

BackgroundCervical spine fractures are associated with high mortality in elderly patients. This study aims to identify patient-related and in-hospital factors contributing to this mortality. MethodsA 3-year retrospective study of 235 patients aged 65+ presenting with cervical spine fractures was performed. Age cohorts were 65–74, 75–84, and 85+ years. Mortality was measured at 30, 90, 180 and 365-days post-discharge. ResultsMortality was 11 ​%, 15 ​%, 19 ​%, and 22 ​% at 30-, 90-, 180- and 365-days respectively. Surgery and fracture pattern was not associated with mortality (p ​= ​0.37; p ​= ​0.28). Charlson Comorbidity Index (p ​< ​0.001; hazard ratio [HR] ​= ​1.3), functional dependency (p ​< ​0.001; HR ​= ​2.5) and delirium (p ​< ​0.001; HR ​= ​8.9) were associated with mortality between 0 and 365 days post-discharge. ConclusionsMortality in cervical spine fractures is associated with CCI and delirium, but not associated with operative management or fracture pattern. This suggests the need for careful consideration in patient selection for cervical spine procedures and aggressive inpatient delirium management.

Surgical Outcomes in Different Age Cohorts Undergoing Abdominal Surgery: A Retrospective Study

PurposeThis study aimed to investigate and compare the surgical outcomes of younger and older patients after abdominal surgery and explore risk factors related to postoperative complications and in-hospital mortality in patients ≥65 years old. DesignA retrospective study on 540 adult patients who underwent abdominal surgery and stayed more than 48 hours in the hospital. MethodsThe two groups of patients: younger than 65 years and ≥65 years old were compared related to postoperative complications, length of hospital stay, and mortality rates. The cohort of patients aged ≥65 years was selected to analyze risk factors for complications occurrence and in-hospital mortality. FindingsPatients ≥65 years old had poorer outcomes after abdominal surgery than younger patients. Pre-existence of comorbidities, American Society of Anesthesiologists physical status classification greater than two, emergency admission, and low preoperative serum albumin levels were risk factors for postoperative complications and mortality in elderly patients. Other risk factors for in-hospital mortality were the age ≥75 years, obesity, postoperative serum albumin level less than 30 g/L, presence of anemia before and after surgery, and occurrence of postoperative complications. Logistic regression revealed as independent risk factors for the postoperative complications the American Society of Anesthesiologists' physical status classification greater than two (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.63-5.67, P = .0004) and preoperative serum albumin levels lower than 30 g/L (OR: 2.12, 95% CI: 1.08-4.17, P = .02), while for in-hospital postoperative mortality, independent risk factors were postoperative anemia (OR: 4.13; 95% CI: 1.22-13.97, P = .02) and obesity (OR: 7.65, 95% CI: 2.59-22.57, P = .0002). ConclusionsOptimizing the preoperative conditions of older patients will improve their postoperative outcomes, especially for patients ≥75 years old, with obesity, comorbidities, anemia, severe nutritional risk, and emergency admission.

Risk factors for the in‑hospital and 1‑year mortality of elderly patients hospitalized due to COVID‑19‑related pneumonia.

Coronavirus disease 2019 (COVID-19) is characterized by poor outcomes and a high mortality rate, particularly among elderly patients. Since the beginning of the pandemic, an older age has been recognized as a critical risk factor for disease severity, with increasing mortality rates in each decade of life. This phenomenon may be a consequence of a poor previous health status, with a higher prevalence of pre-existing comorbidities and a higher degree of frailty. The majority of studies on the outcomes and risk factors of elderly patients refer to the first waves of the pandemic and the predictors of in-hospital mortality in these patients. The aim of the present study was to provide a detailed description of the clinical characteristics and management of a cohort of elderly patients (≥65 years of age) who were hospitalized with COVID-19-related pneumonia in all phases of the pandemic, presenting their outcomes, and investigating predictors of in-hospital and out-of-hospital mortality over a period of 1 year in this particularly vulnerable population. A total of 1,124 elderly patients (603 males, 53.7%) with a mean age of 78.51±7.42 years and a median Charlson comorbidity index (CCI) of 5 were included in the study. Of these patients, 104 (9.3%) were hospitalized during the period of prevalence of the original strain Wuhan, 385 (34.3%) were hospitalized during the period of prevalence of the Alpha variant, 221 (19.7%) were hospitalized during the period of prevalence of the Delta variant, and 414 (36.8%) were hospitalized during the period of prevalence of the Omicron variant. Overall, the in-hospital mortality rate was 33.4% (375 patients), and the 1-year mortality rate was 44.7% (502 patients). The majority of patients had not been vaccinated or had not completed full vaccination against severe acute respiratory syndrome coronavirus-2 (843 patients, 75%), given the period of infection. Age, immature granulocytes, lactate dehydrogenase (LDH) levels, ferritin levels, chest X-ray score, as well as the absence of full vaccination, cough and fatigue, were statistically significantly and independently associated with in-hospital mortality, while age, LDH levels, ferritin levels, alanine aminotransferase levels, CCI, chest X-ray score, the absence of cough and fatigue, and a history of dementia were statistically significantly and independently associated with 1-year mortality. On the whole, the present study demonstrates that both the in-hospital mortality and 1-year mortality rates of elderly patients hospitalized due to COVID-19-related pneumonia are high.

Admission Inflammation Markers Influence Long-term Mortality in Elderly Patients Undergoing Hip Fracture Surgery: A Retrospective Cohort Study.

Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture. We reports on a retrospective study of elderly hip fracture patients admitted to a hospital in China between January 2015 and December 2019. A total of 1085 patients were included in the study, and their demographic and pre-operative characteristics were analyzed. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by receiver operating characteristics (ROC) curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression. The 30-day, 1-year, 2-year, and 4-year mortality were 1.6%, 11.5%, 21.4% and 48.9%, respectively. The optimal cut-off values of admission NLR, MLR and CAR for 1-year mortality were 7.28, 0.76, and 1.36. After adjusting the covariates, preoperative NLR ≥ 7.28 (HR = 1.419, 95% CI: 1.080-1.864, p = 0.012) were found to be only independent risk factors with 4-year all-cause mortality, the preoperative CAR ≥ 1.36 was independently associated with 1-year (HR = 1.700, 95% CI: 1.173-2.465, p = 0.005), 2 year (HR = 1.464, 95% CI: 1.107-1.936, p = 0.008), and 4-year (HR = 1.341, 95% CI: 1.057-1.700, p = 0.016) all-cause mortality, While age, CCI score, and low hemoglobin at admission were also risk factors for postoperative all-cause mortality. Admission CAR and NLR may be useful indicators for predicting the long-term mortality of elderly patients undergoing hip fracture surgery, and that more research is needed to validate these findings.

Low Energy Intake Diagnosed Using the Harris-Benedict Equation Is Associated with Poor Prognosis in Elderly Heart Failure Patients.

Insufficient nutrient intake is a strong independent predictor of mortality in elderly patients with heart failure. However, it is unclear to what extent energy intake affects their prognosis. This study investigated the association between patient outcomes and actual measured energy intake in elderly patients (≥65 years) with heart failure. This study enrolled 139 elderly patients who were hospitalized with worsening heart failure at Shingu Municipal Medical Center, Shingu, Japan, between May 2017 and April 2018. Energy intake was evaluated for three days (from three days prior to the day of discharge until the day of discharge). Based on basal energy expenditure calculated using the Harris-Benedict equation, the patients were classified into a low-energy group (n = 38) and a high-energy group (n = 101). We assessed the prognosis in terms of both all-cause mortality and readmission due to worsening heart failure as a primary outcome. Compared to the patients in the high-energy group, the patients in the low-energy group were predominantly female, less frequently had smoking habits and ischemic heart diseases, and had a higher left ventricular ejection fraction. The low-energy group had higher mortality than the high-energy group (p = 0.028), although the two groups showed equivalent event rates of the primary outcome (p = 0.569). Calculations based on the Harris-Benedict equation revealed no significant difference in the primary outcome between the two groups, with a secondary outcome that showed worse mortality in the low-energy group. Given this result, energy requirement-based assessments using the Harris-Benedict equation might help in the management of elderly heart failure patients in terms of improved life outcomes.

The Prognostic Value of Inflammation Indices in Predicting Postoperative ICU Admission and Mortality in Elderly Patients Undergoing Hip Fracture Surgery

The Prognostic Value of Inflammation Indices in Predicting Postoperative ICU Admission and Mortality in Elderly Patients Undergoing Hip Fracture Surgery

Recurrent Non-Variceal Upper Gastrointestinal Bleeding among Patients Receiving Dual Antiplatelet Therapy.

Patients undergoing dual antiplatelet therapy (DAPT) may experience recurrent gastrointestinal bleeding (GIB). We investigated the clinical characteristics and risk factors for recurrent non-variceal upper gastrointestinal bleeding (NVUGIB) in patients who had experienced NVUGIB while receiving DAPT. We enrolled patients diagnosed with NVUGIB while receiving DAPT between 2006 and 2020. Definite bleeding was confirmed by esophagogastroduodenoscopy in all NVUGIB patients. A total of 124 patients were diagnosed with NVUGIB while receiving DAPT. They were predominantly male (n = 103, 83.1%), bleeding mostly from the stomach (n = 94, 75.8%) and had peptic ulcers (n = 72, 58.1%). After the successful hemostasis of NVUGIB, 36 patients (29.0%) experienced at least one episode of recurrent upper GIB, 19 patients (15.3%) died, and 7 (5.6%) patients had a bleeding-related death. Multivariate analysis showed that age was a significant factor for re-bleeding (odds ratio [OR], 1.050; 95% confidence interval [CI]: 1.001-1.102; p-value: 0.047), all-cause mortality (OR, 1.096; 95% CI: 1.020-1.178, p = 0.013), and re-bleeding-related mortality (OR, 1.187; 95% CI: 1.032-1.364, p-value: 0.016). In Kaplan-Meier analysis, the cumulative probabilities of re-bleeding, death, and bleeding-related death were significantly higher in patients aged 70 and older (p = 0.008, <0.001, and 0.009, respectively). Clinicians should be cautious about re-bleeding and mortality in elderly patients who experience NVUGIB while receiving DAPT.

Association Between Plasma Levels of Monocyte Chemoattractant Protein-1 (MCP-1) and 28-Day Mortality in Elderly Patients with Sepsis: A Retrospective Single-Center Study.

BACKGROUND Previous studies have identified an association between plasma levels of the inflammatory cytokine, monocyte chemoattractant protein-1 (MCP-1), and outcomes for patients with sepsis. This retrospective single-center study assessed the association between plasma levels of MCP-1 and 28-day mortality in 136 patients ≥65 years diagnosed with sepsis between October 2020 and October 2021. MATERIAL AND METHODS The objective was to compare and analyze the parameters in the survival group (n=35) and the 28-day mortality group (n=101), including Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), plasma MCP-1, and laboratory test results. Plasma MCP-1 was quantified by cytokine test kit (LKTM014B, R&D). Statistical analysis was carried out in SPSS 26.0 and MedCalc 92.1.0 software. RESULTS The 28-day mortality group exhibited higher levels of SOFA, APACHEII, and plasma MCP-1 (all P<0.001), as well as lower levels of albumin, compared to the survival group (P<0.05). The logistic regression analysis findings indicated that SOFA, APACHEII, plasma MCP-1, and SBP are all independent risk factors for 28-day mortality. The area under the curve for SOFA, APACHEII, MCP-1, MCP-1+ SOFA, and MCP-1+APACHEII were 0.845, 0.744, 0.712, 0.879, and 0.822, respectively. MCP-1+SOFA exhibited higher sensitivity than SOFA alone. Furthermore, the assessment values of plasma MCP-1 combined with SOFA were superior to those of APACHE II or plasma MCP-1 (Z₁=2.661, Z₂=3.272, both P<0.01). CONCLUSIONS The findings from this study from a single center support those of previous studies that increased plasma levels of MCP-1 are significantly associated with 28-day mortality in patients with sepsis.

Protocol: dexmedetomidine on myocardial injury after noncardiac surgery—a multicenter, double-blind, controlled trial

AimsMyocardial injury after noncardiac surgery (MINS) is common in elderly patients and considered as an independent predictor of 30-day mortality after noncardiac surgery. Dexmedetomidine possesses cardiac-protective profile. Previous clinical studies have found that perioperative application of dexmedetomidine is associated with decreased 1-year mortality in patients undergoing cardiac surgery. The current study protocol aims to investigate the effects of dexmedetomidine on the incidence of MINS, complications, and 30-day mortality in elderly patients subjected to noncardiac surgery.MethodsA multicenter, randomized, controlled, double-blind, prospective trial is designed to explore cardiac protection of dexmedetomidine in the elderly patients undergoing noncardiac surgery. A total of 960 patients aged over 65 years will be recruited and randomly assigned to dexmedetomidine group (group Dex) and normal saline placebo group (group NS) in a ratio of 1:1. Patients in group Dex will receive a bolus dose of 0.5 μg/kg dexmedetomidine within 10 min before surgical incision, followed by a consistent infusion at the rate of 0.3–0.5 μg/kg/h throughout the operation. Group NS patients will receive the same volume of normal saline. The primary outcome is the incidence of MINS via detecting the hs-TnT level within 3 days after the operation. The secondary outcome includes myocardial ischemic symptoms, the incidence of major adverse cardiovascular events (MACE) in hospital, length of ICU and postoperative hospital stay, the incidence of inhospital complications, and 30-day all-cause mortality.DiscussionThe results of the current study will illustrate the effect of dexmedetomidine on myocardial injury for elderly patients undergoing major noncardiac surgery.Trial registrationThe trial was registered with Chinese Clinical Trial Registry (CHICTR) on Aug 24, 2021 (ChiCTR2100049946, http://www.chictr.org.cn/showproj.aspx?proj=131804).

Dose-Response Relationship between C-Reactive Protein/Albumin Ratio and In-Hospital Mortality in Elderly Patients with Acute Ischemic Stroke

Introduction: The C-reactive protein/albumin ratio is a reliable indicator of outcome risk in several diseases. This study aims to evaluate prognostic power of the C-reactive protein/albumin ratio for in-hospital mortality and the dose-response relationship between the two in the oldest-old patients with acute ischemic stroke. Methods: A longitudinal observational study was conducted on patients with acute ischemic stroke (aged ≥80 years) from two tertiary hospitals between January 1, 2014, and January 31, 2020. Based on the tertiles of the C-reactive protein/albumin ratio, the patients were divided into three groups. Restrictive cubic spline and robust locally weighted regression analysis were performed on continuous variables to examine the dose-response relationship between the C-reactive protein/albumin ratio and in-hospital mortality risk. All-cause mortality during hospitalization was the outcome for this study. Results: The study included 584 patients (mean age = 84.6 ± 3.1 years; 59.6% men). The C-reactive protein/albumin ratio was divided into three groups, namely, T1 of <0.73, T2 of 0.73–2.03, and T3: >2.03. After adjusting for demographic and clinical characteristics, a higher C-reactive protein/albumin ratio was independently associated with in-hospital mortality. The hazard ratio for this association was 2.01 (95% confidence interval: 1.12–3.60, p = 0.019). A dose-response relationship between the C-reactive protein/albumin ratio and in-hospital mortality risk was observed. Sensitivity analysis found no attenuation in the hazard ratio in uninfected individuals, whereas no difference in the hazard ratio was noted in individuals with infections. Conclusions: When predicting in-hospital mortality in the oldest-old patients with ischemic stroke, the C-reactive protein/albumin ratio might be a helpful and convenient metric.

Clinical characteristics and mortality risk factors among trauma patients by age groups at a single center in Korea over 7 years: a retrospective study

Purpose: In this study, we aimed to compare the characteristics of patients with trauma by age group in a single center in Korea to identify the clinical characteristics and analyze the risk factors affecting mortality. Methods: Patients aged ≥18 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022 were included. The accident mechanism, severity of the injury, and outcomes were compared by classifying the patients into group A (18–64 years), group B (65–79 years), and group C (≥80 years). In addition, logistic regression analysis was performed to identify factors affecting death.Results: The most common injury mechanism was traffic accidents in group A (40.9%) and slipping in group B (37.0%) and group C (56.2%). Although group A had the highest intensive care unit admission rate (38.0%), group C had the highest mortality rate (9.5%). In the regression analysis, 3 to 8 points on the Glasgow Coma Scale had the highest odds ratio for mortality, and red blood cell transfusion within 24 hours, intensive care unit admission, age, and Injury Severity Score were the predictors of death.Conclusions: For patients with trauma, the mechanism, injured body region, and severity of injury differed among the age groups. The high mortality rate of elderly patients suggests the need for different treatment approaches for trauma patients according to age. Identifying factors affecting clinical patterns and mortality according to age groups can help improve the prognosis of trauma patients in the future.

Abstract 11810: Is the Presence of Statin Use Before Onset of Disease Associated With In-Hospital Mortality in Elderly Patients With Acute Myocardial Infarction?

Introduction: The effect of statin on preventing cardiovascular events is clear, and aggressive lipid-lowering therapy with statins is strongly recommended for patients with coronary artery disease including of acute myocardial infarction (AMI). Hypothesis: The relationship between in-hospital mortality of AMI and statin use before onset of AMI in the elderly patients is unknown, we thus assessed. Methods: The subjects were 207 consecutive AMI patients aged 65 years or older who underwent successful percutaneous coronary intervention (PCI) at Kagoshima university hospital between January 2015 and March 2021. We investigated the association between in-hospital mortality after PCI and baseline characteristics including Global Registry of Acute Coronary Events (GRACE) risk score, which is widely used for estimating mortality in AMI patients. Results: Twenty-three patients (11%) died in-hospital. The mortality rate was significantly lower in patients who were taking statins at presentation compared to those who were not (3% vs. 16%, p=0.002). Univariate logistic regression analysis of risk factors for in-hospital mortality revealed that statin use before onset of AMI, level of serum albumin, level of high sensitivity C-reactive protein (hs-CRP) and GRACE risk score were associated with in-hospital mortality. Multivariate logistic analysis models adjusted for age, statin use, level of serum albumin, level of hs-CRP, and GRACE risk score showed that statin use [Odd's ratio (OR): 0.13, 95% confidence interval (CI): 0.02-0.81, p=0.029] and GRACE risk score (OR: 1.04, 95% CI: 1.02-1.06, p &lt;0.001) were independently associated with in-hospital mortality. The optimal cut-off on the receiver-operating characteristic curve of GRACE risk score for predicting in-hospital mortality was 160. In addition, multivariate logistic analysis models using GRACE risk score ≥160 and non-use of statin before the onset of AMI showed greater risk of in-hospital mortality (HR 19.24; 95% CI 6.62-55.94; p &lt;0.001) after PCI as compared to patients with GRACE risk score &lt;160 and statins use. Conclusions: In elderly AMI patients undergoing PCI, statin use before the onset of AMI was an independent risk factor for in-hospital mortality, as was the GRACE risk score.

Abstract 17260: Endothelium-Targeted Nanoparticle Delivery of FOXM1 Reactivates Aging-Impaired Endothelial Regeneration for Vascular Repair and Inflammatory Lung Injury Resolution: Precision Gene Therapy of Acute Respiratory Distress Syndrome

Introduction: Aging is a major risk factor of high incidence and increased mortality of acute respiratory distress syndrome (ARDS). However, the underlying molecular mechanisms remain elusive and there is no effective therapy for ARDS. Hypothesis: Impaired endothelial regeneration and vascular repair in aged lungs causes persistent lung injury leading to high incidence of ARDS and high mortality in elderly patients following sepsis challenge. Methods: Genetic lineage tracing was employed to determine the cell origin of endothelial regeneration. Aged Foxm1Tg mice was used for assessing the role of FoxM1 in activating endothelial regeneration. Endothelium-targeted nanoparticles were employed to deliver FOXM1 gene selectively to endothelial cells (ECs) in aged mice. Methylation analysis was employed to determine how aging impairs FoxM1 expression. Results: Genetic lineage tracing study showed that endothelial regeneration was mediated by lung endothelial proliferation in adult mice whereas this intrinsic regenerative program was impaired in aged mice. Expression of FoxM1, an important mediator of endothelial regeneration in young adult mice, was not induced in lungs of aged mice due to aging-induced hypermethylation of the Foxm1 promoter. Transgenic FOXM1 expression or in vivo endothelium-targeted nanoparticle delivery of FOXM1 gene reactivated endothelial regeneration, normalized vascular repair and promoted survival of aged mice following sepsis. Furthermore, nanoparticle delivery of FoxM1 gene selectively in lung ECs also reactivated endothelial regeneration in aged mice, supporting the novel concept of precision gene therapy. In COVID-19 lung autopsy samples, FOXM1 expression was not induced in vascular ECs of elderly patients in contrast to mid-age patients, validating the clinical relevance of our findings. Conclusions: We have demonstrate that persistent lung injury and high mortality in aged mice following sepsis challenge is ascribed to impaired endothelial regeneration and vascular repair. Therapeutic reactivation of FoxM1-dependent endothelial regeneration and vascular repair represents a potential effective therapy for elderly ARDS patients by endothelium-targeted nanoparticle delivery of FOXM1 gene.

Abstract 13013: Predictors of Mortality in Elderly Patients Admitted With Takotsubo Cardiomyopathy and a History of Depression

Introduction: Takotsubo cardiomyopathy(TC) (broken heart syndrome or stress-induced cardiomyopathy) is usually a catecholamine-driven weakening of the left ventricle wall motion due to severe emotional or physical stress. It presents as an acute onset of reversible symptoms resembling acute coronary syndrome without occluded coronary arteries. As emotional stressors often trigger the condition, we aim to evaluate factors that can cause hospital death following admission for TC among elderly patients with depression. Methods: Our study group assessed mortality risk factors in patients ages ≥60 years with a diagnosis of TC and depression from the 2016-2020 National Inpatient Sample. Results: There were a total of 26375 elderly patients who had a diagnosis of TC. Amongst them, 25225 (95.6%) did not survive their hospitalization. After adjusting for variables, we found several factors that increased the odds of all-cause mortality in these patients, such as cirrhosis (aOR 2.093, p&lt;0.01), peripheral vascular disease (PVD)(aOR 1.319, p=0.017), and events of Acute Kidney Injury (AKI)(aOR 3.072, p&lt;0.01). Meanwhile, Females (vs. Males, aOR 0.597, p&lt;0.01), the presence of hypertension(aOR 0.854, p=0.029), lipid disorder (aOR 0.696, p&lt;0.01), smoking (aOR0.74, p&lt;0.01), history of stroke (aOR 0.612, p&lt;0.01) or history of myocardial infarction (aOR 0.536, p&lt;0.01) showed lower odds of mortality among elderly patients admitted with TC. No disparities based on race or insurance forms were observed (Table 1). Conclusions: Our analysis found that patients ages ≥ 60 years with TC had poorer outcomes if they had cirrhosis, PVD, or AKI. While reduced odds of death were seen in females and patients with specific comorbidities such as smoking, hypertension, lipid disorder, history of stroke, or myocardial infarction, further studies, adjusting for the length of diagnosis and the medications being used, should be encouraged to expand and understand our results better.

Risk factors for short-term mortality in elderly hip fracture patients with complicated heart failure in the ICU: A MIMIC-IV database analysis using nomogram

BackgroundHip fracture is a prevalent and hazardous injury among the elderly population that often results in intensive care unit (ICU) admission due to various complications, despite advanced medical science. One common complication experienced in the ICU by elderly hip fracture patients is heart failure, which significantly impacts short-term survival rates. Currently, there is a deficit of adequate predictive models to forecast the short-term risk of death following heart failure for elderly hip fracture patients in the ICU. This study aims to identify independent risk factors for all-cause mortality within 30 days for elderly patients with hip fractures and heart failure while in the ICU in order to develop a predictive model.MethodA total of 641 elderly patients with hip fractures combined with heart failure were recruited from the Medical Information Mart for Intensive Care IV dataset and randomized to the training and validation sets. The primary outcome was all-cause mortality within 30 days. The least absolute shrinkage and selection operator regression was used to reduce data dimensionality and select features. Multivariate logistic regression was used to build predictive models. Consistency index (C-index), receiver operating characteristic curve, and decision curve analysis (DCA) were used to measure the predictive performance of the nomogram.ResultOur results showed that these variables including MCH, MCV, INR, monocyte percentage, neutrophils percentage, creatinine, and combined sepsis were independent factors for death within 30 days in elderly patients with hip fracture combined with heart failure in the ICU. The C-index was 0.869 (95% CI 0.823–0.916) and 0.824 (95% CI 0.749–0.900) for the training and validation sets, respectively. The results of the area under the curve and decision curve analysis (DCA) confirmed that the nomogram performed well in predicting elderly patients with hip fractures combined with heart failure in the ICU.ConclusionWe developed a new nomogram model for predicting 30-day all-cause mortality in elderly patients with hip fractures combined with heart failure in the ICU, which could be a valid and useful clinical tool for clinicians for targeted treatment and prognosis prediction.

Use of Prephase Steroids in Older Patients Treated for Diffuse Large B-Cell Lymphoma

Background Treatment related morbidity and mortality (TRM) are significant contributors to overall morbidity and mortality for elderly patients with diffuse large B-cell lymphoma (DLBCL). Several studies have shown that TRM is greatest during the first two cycles of treatment. While attenuated doses of standard-of-care treatment regimens (such as R-mini-CHOP) are commonly used to reduce TRM, one additional strategy that has shown promise is the use of glucocorticoids prior to initiation of systemic chemoimmunotherapy (CIT). This approach, defined as prephase steroid use, has been evaluated in small studies, primarily single-center and retrospective in nature. However, older patients with comorbidities are both at greatest risk of TRM and less frequently included in clinical trials. Moreover, patient populations may differ across clinical settings. We conducted an analysis of prephase steroid use in a broader, real-world population treated across multiple centers. Methods We used longitudinal data from the US nationwide, Flatiron Health electronic health record-derived de-identified database. We included patients aged &amp;gt;60 with a diagnosis of DLBCL treated with CIT. This included high-grade B-cell lymphoma, but omitted diagnoses of Burkitt's or primary CNS lymphoma. We utilized a prespecified data analysis plan to determine whether outcomes differed by our exposure of interest, use of prephase steroids. The primary outcome measure was the combined endpoint of time to start of next treatment or death (real-world time to next treatment [rwTTNT]). The secondary outcome was real-world overall survival (rwOS). Outcomes were measured from frontline treatment start date. We also assessed rates of dose delays to evaluate whether prephase steroid use facilitates the maintenance of dose intensity. Prephase steroid use (the exposure) was defined as an order or administration for steroids occurring 5-21 days prior to the start of antineoplastic therapy (excluding steroids used as part of a standard treatment regimen). Patients were stratified by use of anthracycline-based CIT, with sensitivity analyses conducted limited to the anthracycline CIT group. To reduce confounding, we used propensity score-based inverse probability of treatment weighting (IPTW) for the primary analysis. Time to event endpoints were assessed using weighted Kaplan-Meier curves and log-rank tests. Odds of dose delays were assessed using weighted logistic regression. Results We included 3587 patients meeting our criteria, of whom 569 (15.9%) received prephase steroids prior to first-line CIT. A greater percentage of patients treated with anthracycline-based CIT received prephase steroids as compared to those treated with non-anthracyline CIT: 16.3% vs 12.4%, respectively (Table 1). In adjusted analysis using IPTW, there was no significant difference in the rwTTNT by prephase steroid use (p=0.807, Figure 1). Median rwTTNT was 41.2 months (95% CI, 34.6 to 52.4) vs 40.8 months (95% CI, 35.1 to 46.7) with and without prephase steroids, respectively. There was no difference in median rwOS by prephase steroid use: 65.7 months (95% CI, 52.4 to 84.8) vs 74.8 months (95% CI, 67.4 to 82.5) (p=0.707). No differences were seen in sensitivity analyses limiting to patients treated with anthracycline-based CIT. For dose delays, adjusted analysis showed a numerically lower odds of dose delay in patients administered prephase steroids in the total study population: 40.6% vs 50.7% (OR 0.796; p=0.0569). Discussion In this retrospective study of 3587 real-world, elderly patients with DLBCL, prephase steroid use within 21 days of induction CIT did not improve the rwTTNT or rwOS. There was a suggestion that use of prephase steroids may promote maintenance of dose intensity by reducing delays in CIT administration, though this finding did not reach statistical significance. The strengths of this analysis included use of a large, nationwide, real-world dataset and propensity score methods to control for confounding. Limitations include the retrospective nature of the study and potential for unmeasured confounding. In summary, in a real-world cohort of older patients with DLBCL, use of prephase steroids was not associated either with longer TTNT/death, or with longer OS. However, it may be associated with maintenance of CIT dose intensity. This finding is worth exploring in future studies.