Mortality In Geriatric Patients Research Articles

Predictors for 1-year mortality in geriatric patients following fragile intertrochanteric fracture surgery

ObjectiveTo investigate the risk factors influencing 1-year mortality after intramedullary nail fixation for fragile intertrochanteric fracture in elderly individuals.MethodsThe medical records of 622 consecutive elderly patients (aged ≥ 65 years) with fragile intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) and followed-up were retrospectively analyzed. The patients were divided into death and survival groups according to their survival status within 1 year after surgery, and the differences in age, sex, region of residence, tobacco use, alcohol use, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, coronary heart disease, stroke, dementia, chronic obstructive pulmonary disease, pneumonia), preoperative hemoglobin, preoperative albumin, deep vein thrombosis, fracture type (AO classification), injury-to-surgery time, American Society of Anesthesiologists (ASA) score, anesthesia modality, duration of surgery, intraoperative blood loss, and blood transfusion were compared. The Kaplan–Meier method was used for univariate analysis to screen for statistically significant differences between the two groups, and the data were entered into the Cox proportional hazards model for multivariate analysis to determine independent risk factors affecting 1-year postoperative mortality. For subgroup analysis, we explored the varying effects of hypoproteinemia and being underweight in patients of different genders, as well as the effects of different age ranges, different injury-to-surgery times, and different blood transfusion volumes on 1-year postoperative mortality.ResultsThe mortality rates at 1, 3, and 6 months, and 1 year after surgery were 3.9%, 7.2%, 10.1%, and 15.3%, respectively. Univariate analysis showed that advanced age, male sex, tobacco use, underweight (BMI < 18.5), coronary heart disease, stroke, dementia, pneumonia, number of comorbidities ≥ 3, hypoproteinemia and injury-to-surgery time ≤ 2 days were associated with the 1-year postoperative survival status (P < 0.1). Multivariate analysis revealed that advanced age, male sex, dementia, number of comorbidities ≥ 3, hypoalbuminemia, and being underweight were independent risk factors for 1-year postoperative mortality. Subgroup analysis showed that being underweight was associated with 1-year postoperative mortality only in male patients but not in female patients, whereas hypoproteinemia was associated with 1-year postoperative mortality in both male and female patients. Furthermore, an injury-to-surgery time of less than 2 days improved patient survival, and patients more than 80 years old showed an elevated risk of postoperative mortality.ConclusionsPreoperative health status is a critical predictor of postoperative outcomes in elderly patients with fragile intertrochanteric fractures. Priority care should be given to the patients who are elderly, male, have dementia, have comorbidities, or are malnourished. Prompt nutritional reinforcement should be provided to patients with intertrochanteric fractures with comorbid hypoproteinemia and underweight. Furthermore, surgery should be performed as early as possible in patients with fewer comorbidities.

S2219 The Association of Nutritional Status with Mortality in Geriatric Patients With Cancer - A 4.5-Year Prospective Study Using Validated Screening Tools

S2219 The Association of Nutritional Status with Mortality in Geriatric Patients With Cancer - A 4.5-Year Prospective Study Using Validated Screening Tools

Mortality and functional outcomes 18 months after hospitalization for COVID-19 in geriatric patients: a multicentric cohort study

BackgroundFew data are available on the long-term mortality and functional status of geriatric patients surviving after hospitalization for COVID-19. We compared the mortality and functional status 18 months after hospitalization for geriatric patients who were hospitalized for COVID-19 or another diagnosis.MethodsThis was a multicentric cohort study in Paris from January to June 2021. We included patients aged 75 years and over who were hospitalized with COVID-19 or not during this period and compared their vital and functional status 18 months after hospitalization.ResultsWe included 254 patients (63 hospitalized for COVID-19). As compared with patients hospitalized for other reasons, those hospitalized for COVID-19 were younger (mean [SD] age 86 [6.47] vs. 88 [6.41] years, p = 0.03), less frail (median Clinical Frailty Scale score 5 [4–6] vs. 6 [4–6], p 0.007) and more independent at baseline (median activities of daily living score 5.5 [4–6] vs. 5 [3.5–6], p 0.03; instrumental activities of daily living score 3 [1–4] vs. 2 [0–3], p 0.04). At 18 months, 50.8% (n = 32/63) of COVID-19 patients had died versus 66% (n = 126/191) of non-COVID-19 patients (p 0.03). On multivariate analysis, COVID-19 positivity was not significantly associated with 18-month mortality (adjusted hazard ratio 0.67, 95% confidence interval 0.40 to 1.13). At 18 months, the two groups did not differ in activities of daily living or frailty scores.ConclusionsIn this multicenter study of long-term mortality in geriatric patients discharged alive after hospitalization, positive COVID-19 status was not associated with excess mortality.

Predicting mortality in geriatric patients with fever in the emergency departments: a prospective validation study

ObjectiveEmergency physicians are always faced with the challenge of choosing the appropriate disposition for elderly patients in order to ensure an acceptable care plan and effective use of resources. A clinical decision rule, Geriatric Fever Score (GFS) has been proposed but not validated to help ED physicians with decision-making. This rule employs leukocytosis, severe coma, and thrombocytopenia as predictors of 30-day mortality. Through our study determines the performance of this clinical prediction rule in a prospective study in a setting different from where it was developed.Method and materialsIn this prospective cohort study in a 1200-bed tertiary care, patients older than 65 years old who visited the ED with fever were enrolled. All elements of the rule were collected and the total score was calculated for each patient. Patients were also categorized as low risk (score 0–1) or high risk (score ≥ 2). Thirty-day follow-up was performed to determine the patient outcome (survival or mortality).ResultsA total of 296 patients were included in our final analysis. The mortality rate was 33.1% for patients with a Score of 0, 42.1% for a score of 1, 57.1% for a score of 2, and 100% for a score of 3. When divided into two risk groups, patients’ mortality rates were as follows: low risk group 37.9% and high-risk group 40.5%.ConclusionOur study showed that elderly patients who present to ED with fever and have a score of 2 or higher on the Geriatric Fever Score are at higher risk of mortality at 30 days.

Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy May Be Improved by Proper Pre- and Post-Positioning Management of Elderly Patients with Multimorbidity.

The main risk factors for major complications and early mortality after the positioning of percutaneous endoscopic gastrostomy (PEG) reported in the literature are old age, multimorbidity, and the use of inappropriate methods for PEG positioning. A proper PEG positioning technique and adequate post-positioning patient management and surveillance are the main protective factors, but the information on protective factors in the literature is much poorer. The aim of this study was to provide more information on PEG-related complications and mortality in geriatric patients treated with long-term enteral nutrition administered by PEG according to a specific home enteral nutrition (HEN) protocol. This was a retrospective study based on data from 136 elderly patients in whom PEG was positioned from 2017 to 2023 at the geriatric hospital IRCCS INRCA, Ancona (Italy), 88 of whom were treated with HEN. Data on PEG-related complications, duration of HEN, hospitalizations, and mortality were analyzed. No complications were registered during or immediately after the PEG positioning. The prevalence of a major complication-buried bumper-was in the lower limit of the range reported in the literature (4.32%). The prevalence of minor complications such as peristomal leakage, inadvertent tube removal, and granulation tissue was higher than that reported in the literature (14.71%, 23.53%, 29.41%), while tube blockage and peristomal site infection were less frequent (8.82%, 38.23%). Three hospitalizations for PEG-related complications occurred. Both the all-cause 30-day mortality and within-two-months mortality were lower than those in the literature (1.92% and 3.84%). The impact of the risk factors recognized by the literature on complications and mortality could be probably mitigated by improving the PEG placement techniques and pre- and post-PEG placement patient management practices. Data on the prevalence of complications and mortality must be interpreted in correlation to this information.

Predictors of 2-year mortality in geriatric patients hospitalized with COVID-19 in Türkiye: a retrospective cohort study.

Aim: To reveal factors affecting 2-year mortality in geriatric patients hospitalized with COVID-19.Methods: Demographic characteristics, clinical and laboratory data, thorax computed tomography (CT) images, second-year survival status, and causes of death were analyzed.Results: The 2-year post-discharge mortality rate of 605 patients was 21.9%. Mean age of patients in the deceased group was 76.8±8.1years, which was shorter than the life expectancy at birth in Türkiye. Older age (≥85), delirium, some co-morbidities, and atypical thorax CT involvement were associated with a significant increase in 2-year mortality (p<0.05).Conclusion: This is the first study to evaluate factors associated with 2-year mortality in older COVID-19 patients. Identifying risk factors for long-term mortality in geriatric COVID-19 patients is important.

Predictive ability of the REMS and HOTEL scoring systems for mortality in geriatric patients with pulmonary embolism

BackgroundPulmonary embolism (PE) is an important cause of mortality and morbidity in the geriatric population. We aimed to compare the ability of the pulmonary embolism severity index (PESI), rapid emergency medicine score (REMS), and hypotension, oxygen saturation, low temperature, electrocardiogram change, and loss of independence (HOTEL) to predict prognosis and intensive care requirement in geriatric patient with PE.ResultsThe median age of 132 patients was 77 (71–82) years. PESI was higher in the non-survivor group [132 (113–172)] (P =0.001). The median REMS was 8 (7–10), and it was higher in the non-survivor group [10 (7.5–12.0)] (p = 0.005). The median HOTEL score was 1 (0–2) in the whole cohort and 2 (1–3) in the non-survivor group, indicating significant difference compared to the survivor group (P = 0.001). The area under the curve (AUC) values of HOTEL, REMS, and PESI were determined as 0.72, 0.65, and 0.71, respectively. For the prediction of intensive care requirement, the AUC values of HOTEL, REMS, and PESI were 0.76, 0.75, and 0.76, respectively, with no significant difference in pairwise comparisons (PESI vs. REMS: p = 0.520, HOTEL vs. PESI: P = 0.526, REMS vs. HOTEL: P = 0.669, overall test: P = 0.96, DeLong’s test). The risk ratios of HOTEL and PESI were parallel to each other [5.31 (95% confidence interval (CI): 2.53–11.13) and 5.34 (95% CI: 2.36–12.08), respectively].ConclusionHOTEL and REMS were as successful as PESI in predicting short-term mortality and intensive care requirement in geriatric patients with PE. These scores are also more practical since they have fewer parameters than PESI.

Outcomes of severe isolated blunt chest trauma in young and geriatric patients.

Our understanding of the growing geriatric population's risk factors for outcomes after traumatic injury remains incomplete. This study aims to compare outcomes of severe isolated blunt chest trauma between young and geriatric patients and assess predictors of mortality. The ACS-TQIP 2017-2020 database was used to identify patients with severe isolated blunt chest trauma. Patients having extra-thoracic injuries, no signs of life upon presentation to the emergency department (ED), prehospital cardiac arrest, or who were transferred to or from other hospitals were excluded. The primary outcome was in-hospital mortality. Univariate and multivariable regression analyses were performed to assess independent predictors of mortality. A total of 189,660 patients were included in the study, with a median age of 58 years; 37.5% were aged 65 or older, and 1.9% died by discharge. Patients aged 65 and older had significantly higher mortality (3.4% vs. 1.0%, p < 0.001) and overall complications (7.0% vs. 4.7%, p < 0.001) compared to younger patients. Age ≥ 65 was independently associated with mortality (OR: 5.45, 95%CI: 4.96-5.98, p < 0.001), prolonged hospitalization, and complications. In the geriatric group, age > 75 was an independent predictor of mortality compared to ages 65-75 (OR: 2.62, 95%CI: 2.37-2.89, p < 0.001). Geriatric patients with an MVC, presenting with a GCS ≤ 8, and having an SBP < 90 had the highest mortality of 56.9%. The geriatric trauma patient with isolated severe blunt chest injury has significantly higher mortality and morbidity compared to younger patients and warrants special consideration of multiple factors that affect outcomes. Individual predictors of mortality carry a greater impact on mortality in geriatric patients.

Preoperative Thyroid-Stimulating Hormone Levels and Three-Year Mortality in Elderly Hip Fracture Patients: Insights from a Prospective Cohort Study.

BACKGROUND It is unclear whether preoperative thyroid-stimulating hormone (TSH) level is correlated with long-term mortality in the elderly after hip fracture surgery. We aimed to assess the association between TSH levels and 3-year mortality in these patients. MATERIAL AND METHODS We enrolled patients aged 65 and above who had hip fracture surgery and thyroid function tests upon admission from 2018 to 2019. Patients were categorized based on TSH median value, quartiles, or thyroid function status. The median follow-up time was 3.1 years. Cox proportional hazards models were used to examine the correlation between TSH levels and mortality, adjusting for covariates. RESULTS Out of 799 eligible patients, 92.7% (741/799) completed the follow-up, with 20.6% (153/741) of those having died by the end of the follow-up. No statistically significant differences in mortality risks were found when stratified by TSH median value (HR 0.88, 95% CI 0.64-1.22, P=0.448) or quartiles (HR ranging from 0.90 to 1.13, P>0.05). Similarly, when categorized based on admission thyroid function status, patients who presented with hypothyroidism, subclinical hypothyroidism, hyperthyroidism, and subclinical hyperthyroidism upon admission did not demonstrate a statistically significant difference in mortality risk compared to those who were considered euthyroid (HR 1.34, 95% CI 0.72-2.49, P=0.359; HR 0.77, 95% CI 0.38-1.60, P=0.489; HR 1.15, 95% CI 0.16-8.30, P=0.890; HR 1.07, 95% CI 0.34-3.38, P=0.913, respectively). CONCLUSIONS Admission TSH is not significantly associated with 3-year mortality in geriatric patients after hip fracture surgery.

The association between preoperative serum cholinesterase and all-cause mortality in geriatric patients with hip fractures: a cohort study of 2387 patients

ObjectiveThis study is to evaluate the association between preoperative cholinesterase levels and all-cause mortality in geriatric hip fractures.MethodsElderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative cholinesterase levels and mortality in these patients. Analyses were performed using EmpowerStats and the R software.ResultsTwo thousand three hundred eighty-seven patients were included in this study. The mean follow-up period was 37.64 months. Seven hundred eighty-seven (33.0%) patients died due to all-cause mortality. Preoperative cholinesterase levels were 5910 ± 1700 U/L. Linear multivariate Cox regression models showed that preoperative cholinesterase level was associated with mortality (HR = 0.83, 95% CI: 0.78–0.88), P < 0.0001) for every 1000 U/L. However, the linear association was unstable, and nonlinearity was identified. A cholinesterase concentration of 5940 U/L was an inflection point. When preoperative cholinesterase level < 5940 U/L, the mortality decreased by 28% for every 1000 U/L increase in cholinesterase (HR = 0.72, 95%CI: 0.66–0.79, P < 0.0001). When cholinesterase was > 5940 U/L, the mortality was no longer decreased with the rise of cholinesterase (HR = 1.01, 95%CI: 0.91–1.11, P = 0.9157). We found the nonlinear association was very stable in the propensity score-matching sensitive analysis.ConclusionsPreoperative cholinesterase levels were nonlinearly associated with mortality in elderly hip fractures, and cholinesterase was a risk indicator of all-cause mortality.Trial registrationThis study is registered on the website of the Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323) (08/03/2022).

Effects of Albumin/Globulin Ratio on Mortality in Geriatric Patients with Hip Fracture Presenting to the Emergency Department

Backgrounds: Albumin and globulin are known as markers of systemic inflammation. While low albumin levels are associated with both inflammation and poor nutritional status, globulin levels may increase during inflammation. The aim of this study is to determine the prognostic value of albumin/globulin ratio on mortality after hip fractures in geriatric patients. Methods: The data of patients aged between 65 and 111 with geriatric hip fractures who presented to the Emergency Department of Dicle University Medical Faculty Hospital between December 1, 2019, and December 31, 2021, were retrospectively analyzed. The study investigated clinical data of these patients, and the effects of the albumin/globulin ratio in biochemistry on mortality. Results: In our study, 140 participants were included, 81 of whom were female. The average age of the participants was 79.8 ± 8.7 years. Among the participants, 73.6% had at least one comorbidity. It was found that the ages of the patients in the dying group were significantly lower compared to those in the surviving group (p

Association of Serum Lactate Levels Measured in the Emergency Department with 30-Day Mortality in Older Patients with Unilateral Hip Fractures.

Hip fractures are frequent injuries in older patients and are associated with high mortality rates. This study assessed the association between serum lactate level and 30-day mortality in older patients with unilateral hip fractures and examined the prognostic value of this association on the clinical outcomes of these patients. This retrospective, single-center study included patients aged ≥65 years admitted to the emergency department due to low-energy trauma and diagnosed with unilateral hip fracture upon admission. The additional inclusion criteria were patients with independent ambulation or walker or cane assistance before the injury, with available data on serum lactate levels on venous blood gas analysis, and who underwent surgery. Among the 330 included patients, 30.9% experienced postoperative complications and 10.3% died within 30 days. Using a lactate cut-off value of 2 mmol/L to distinguish between living and deceased patients, the sensitivity and specificity were 41% and 88%, respectively. Multivariate logistic regression analysis revealed that high lactate and low albumin levels and male sex were associated with mortality. Identifying risk factors for mortality in geriatric patients with hip fractures is important. Male sex, low albumin levels, and particularly increased lactate levels were independent predictors of short-term mortality in these patients.

Effects of anesthesia and perioperative management on mortality in geriatric orthopedic surgery: a retrospective study of 451 patients.

We aimed to investigate the effects of anesthesia methods and perioperative procedures on mortality in geriatric patients operated for hip fracture. This retrospective study included patients over 65 years of age who underwent hip fracture surgery. Demographic data, risk scores, perioperative and anesthesia management were analyzed in terms of mortality. Data from 451 patients who were eligible for the study were analyzed. It was determined that there was no difference in mortality between the anesthesia methods administered to the patients in hip fracture surgery (p>0.05). Being male increased the mortality risk by 4.568 times (95% CI: 1.215-17.168), and a one-unit increase in the number of erythrocyte suspensions given perioperatively increased the mortality risk by 2.801 times (95% CI: 1.509-5.197). Additionally, an American Society of Anesthesiologists (ASA) II score increased the mortality risk by 0.120 times (95% CI: 0.021-0.690), and a higher modified Charlson comorbidity index (mCCI) of 5-7 increased the mortality risk by 0.052 times (95% CI: 0.009-0.289). Although high ASA and mCCI scores, male sex, and blood transfusion were associated with mortality in geriatric hip fracture surgery, we found that the method of anesthesia did not affect mortality.

Proximal femoral fractures in patients with COVID-19 : Pneumonia and admission from anursing home are the strongest predictors of mortality.

Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at ahigh risk of death due to coronavirus disease 2019 (COVID-19). To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures. Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from anursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes. In this study 46 patients with COVID-19 (female/male 31/15, median age87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had asevere course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3‑month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3‑month mortality rates were admission from anursing home, the presence of pneumonia (increased the risk of death) and female gender (protective). The occurrence of COVID-19 in patients with proximal femoral fractures has ahigh mortality. Admission from anursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.

The correlation of risk factors with mortality of geriatric patients in non-operating room anesthesia services

The correlation of risk factors with mortality of geriatric patients in non-operating room anesthesia services

Yoğun Bakım Ünitesinde Geriatrik Kritik Hastalarda Ultrason Kullanımının Akciğer Patolojilerini Tespit Etmedeki Rolünün Prognoz, Mortalite ve Skorlamalarla Karşılaştırılması

Objective: It is crucial to correctly and promptly diagnose pulmonary diseases and to initiate treatment in elderly patients diagnosed with respiratory failure who are on mechanical ventilator support. The aim of this study is to investigate the effect of lung ultrasound (USG) on prognosis and mortality in geriatric patients we follow up in the intensive care unit, by scoring. Methods: Patients who were followed up in the intensive care unit were grouped as AUSG group (n=48), those who underwent lung USG and NAUSG group (n=74) who underwent chest radiography, computed tomography (CT), magnetic resonance imaging (MRI) or bronchoscopy. The hospital information management system was used to compare the two groups in terms of diagnosis time, number of additional consultations, treatment and discharge time, hospital stay, mortality, and scores. The arterial blood gas analysis, complete blood count, biochemistry, procalcitonin, C-reactive protein, and endotracheal aspirate culture results of the patients were recorded. The clinical pulmonary infection score, pneumonia severity index-65, pulmonary severity index, and acute physiology and chronic health evaluation 2 scores of the groups were compared. Results: The diagnosis time in Group AUSG was 1 ± 0.64 day, the treatment time was 10 ± 4.62 day, and the number of required consultations was 1 ± 0.68, which was significantly lower than in Group NAUSG (p&lt;0.05). The mortality rate was 14 (29.2%) patients in Group AUSG and 25 (33.8%) patients in Group NAUSG (p&gt;0.05). When comparing the scores of the patients, the clinical pulmonary infection score, pneumonia severity index-65 (4 ± 0.79), and pulmonary severity index (3 ± 0.87) were significantly lower in Group AUSG (p&lt;0.05). There was no significant difference in acute physiology and chronic health evaluation 2 scores. Conclusion: Performing lung USG for the diagnosis and treatment of critically ill elderly patients can lead to earlier detection and treatment of lung pathologies, reducing mortality rates, unnecessary imaging and consultations. Its advantages include easy and rapid bedside application and simultaneous results. Keywords: Geriatrics, ultrasonography, lung, prognosis, mortality

The association between prealbumin concentration at admission and mortality in elderly patients with hip fractures: a cohort study.

To evaluate the association between prealbumin concentration at admission and mortality in elderly patients with hip fractures. Elderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between prealbumin concentration at admission and mortality. All analyses were performed using EmpowerStats and the R software. This cohort study included 2387 patients who met the study criteria. The mean follow-up was 37.64months. The prealbumin concentration was 162.67 ± 43.2mg/L. Multivariate Cox regression showed that prealbumin concentration was associated with mortality in geriatric patients with hip fracture (hazard ratio [HR] = 0.95, 95% confidence intervals [CI]: 0.93-0.97, P < 0.0001). In addition, an inflection point effect was observed in the nonlinear association. The inflection point was 162.2mg/L. If it is less than this inflection point, then every 10mg/L increase in prealbumin was associated with a 7% reduction in the risk of death (HR = 0.93, 95%CI: 0.90-0.96, P < 0.0001). Whengreater than the inflection point,there was nodifference in the risk of death (HR = 0.99, 95%CI: 0.95-1.03, P = 0.5127). The prealbumin concentrations at admission were nonlinearly associated with long-term mortality in geriatric hip fractures, and 162.2mg/L could be considered a prognostic factor of mortality risk.

Role of the National Early Warning score and Modified Early Warning score for predicting mortality in geriatric patients with non-traumatic coma

Geriatric patients arriving in a non-traumatic coma (NTC) at the emergency department (ED) present substantial risks and necessitate prompt and appropriate care. The National Early Warning Score (NEWS) is a promising tool that can efficiently evaluate this vulnerable population. Current study was designed to assess the effectiveness of the NEWS for predicting the severity of illness in geriatric patients with NTC and identifying those at highest risk. Current study was performed involving geriatric patients (aged ≥65 years) with NTC who visited Chonnam National University Hospital between January and December 2022. NEWS and Modified Early Warning Scores (MEWS) were calculated at ED visits. The association of NEWS and MEWS for in-hospital death was evaluated by multivariable analysis. Out of 683 patients, 202 were non-survivors (29.6%). The NEWS and MEWS values of non-survivors were higher than those of survivors (NEWS, 7 [5–10] vs. 10 [8–12]; MEWS, 5 [4–6] vs. 7 [5–8]). The NEWS (adjusted odds ratio [aOR]; 1.253, 95% confidence interval [CI]: 1.181–1.329) and MEWS (aOR; 1.323, 95% CI: 1.206–1.451) were also significantly associated with in-hospital death. The area under the curve for the NEWS and MEWS was 0.721 (95% CI: 0.685–0.754) and 0.695 (95% CI: 0.659–0.730), respectively. The NEWS can be an effective tool for predicting severity of illness via in-hospital death in geriatric patients with NTC.

Prognostic Value of Symptoms and Signs in Geriatric Acute Pulmonary Embolism—An Analytical Study

Abstract Objective The aim of this study was to evaluate the relationship between symptoms and short-term mortality in geriatric patients presenting to the emergency department with acute pulmonary embolism. Materials and Methods This retrospective cohort study was conducted to evaluate the data of geriatric patients admitted to the emergency department between September 01, 2022, and March 01, 2023. The study population comprised patients who presented with acute pulmonary embolism signs and symptoms. Demographic data, vital parameters, and symptoms were noted. Results Of the 176 patients included in the final analysis, 55 (31.2%) were female. The median of age was 76 (25th–75th percentile: 72–82.5) years. The most common symptoms were dyspnea (61.9%), fatigue (27.2%), and syncope (23.8%). There was no statistically significant difference between the survivor and nonsurvivor groups in terms of symptoms (p-values for dyspnea, syncope, chest pain, back pain, hemoptysis, extremity pain, and fatigue: 0.804, 0.765, 0.154, 0.543, 0.675, 0.342, and 0.943, respectively) (chi-squared test). Conclusion In patients presenting to the emergency department with acute pulmonary embolism, clinicians should not prioritize based on symptoms but should evaluate patients according to clinical severity scores.

Prognostic nutritional index (PNI) is an independent risk factor for the postoperative mortality in geriatric patients undergoing hip arthroplasty for femoral neck fracture? A prospective controlled study.

Hip fracture is very common in advanced ages, and it is very likely that this condition is accompanied by nutritional deficiencies. The aim of this study was to investigate the effect of prognostic nutritional index (PNI) on postoperative mortality in geriatric patients who underwent hip arthroplasty for femoral neck fracture. Geriatric patients (aged ≥ 70years) who underwent hip arthroplasty for femoral neck fracture were prospectively recruited. The patients' demographic data, time until surgery, total hospital stay, perioperative blood transfusion, duration of surgery and anesthesia, serum albumin level, total lymphocyte count, PNI value, and first-year mortality were examined. They were divided into two groups as patients who died and those who did not die within the 1st year, and between-group comparisons for continuous and categorical variables were made using independent t test and Chi-square test, respectively. Receiver operating characteristic (ROC) curve was constructed, and a cutoff value for PNI was determined based on sensitivity and specificity values. The total number of participants was 124. The mean age was 80.40 ± 7.19years: 77 (62.1%) were female and 47 (37.9%) were male. PNI was statistically significant for 1-year mortality in multivariate Cox regression analysis (p < 0.05). According to ROC curve analysis, the area under the curve for PNI level was found to be 0.764 (95% CI 0.670-0.857), and this value was statistically significant (p < 0.001). The sensitivity and specificity for the 38.4 cutoff value were 83.9% and 39.8%, respectively. The mean age, time after surgery, total hospital stay, and preoperative blood transfusion need were found to be statistically higher in the patients with low PNI levels (≤ 38.4) than those in the other patients (> 38.4) (p < 0.05 for all). PNI seems to be an independent risk factor on mortality after hip fracture surgery in geriatric patients. PNI is a preventable and correctable risk factor that affects patient survival.