Mortality In Elderly Patients Research Articles

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.

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.

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.

Comorbidities, acute kidney injury and long-term mortality in elderly patients hospitalized because of hip fracture: a moderation analysis

IntroductionFemoral fractures in elderly individuals present significant health challenges, often leading to increased morbidity and mortality. Acute kidney injury (AKI) during hospitalization further complicates outcomes, yet the interaction between AKI severity and comorbidities, as quantified by the Charlson Comorbidity Index (CCI), remains poorly understood in this population. This study aimed to assess the associations between AKI severity and the CCI and between AKI severity and one-year mortality postfemoral fracture in elderly patients.MethodologyThis study utilized data from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database and focused on elderly patients (> 65 years) admitted with hip fractures. Patients were categorized based on AKI stage according to the KDIGO criteria and CCI scores. The primary outcome assessed was all-cause mortality one year after hospital discharge. The statistical analyses included logistic regression, Cox proportional hazards regression and moderation analysis with the Johnson–Neyman technique to evaluate associations between AKI and long-term mortality and between the CCI and long-term mortality.ResultsThe analysis included 1,955 patients and revealed that severe AKI (stages 2 and 3) was independently associated with increased one-year mortality. Notably, the CCI moderated these associations significantly. A lower CCI score was significantly correlated with greater mortality in patients with severe AKI. The impact of severe AKI was greater for those with a CCI as low as 3, more than doubling the observed one-year mortality rate. In contrast, higher CCI scores (≥8) did not significantly impact mortality. Sensitivity analyses supported these findings, underscoring the robustness of the observed associations.ConclusionThis study elucidates the complex interplay between AKI severity and comorbidities and long-term mortality in elderly hip fracture patients. These findings underscore the importance of considering both AKI severity and comorbidity burden in prognostic assessments and intervention strategies for this vulnerable population. Targeted interventions tailored to individual risk profiles may help mitigate the impact of AKI on mortality outcomes, ultimately improving patient care and outcomes. Further research is warranted to explore the underlying mechanisms involved and refine risk stratification approaches in this population.

Development and validation of a nomogram model for all-cause mortality risk in patients with chronic heart failure and atrial fibrillation

BackgroundAs the global aging process continues to accelerate, heart failure (HF) has become an important cause of increased morbidity and mortality in elderly patients. Chronic atrial fibrillation (AF) is a major risk factor for HF. Patients with HF combined with AF are more difficult to treat and have a worse prognosis. The aim of this study was to explore the risk factors for 1-year mortality in patients with HF combined with AF and to develop a risk prediction assessment model.MethodsWe recruited hospitalized patients with HF and AF who received standardized care in the Department of Cardiology at Shengjing Hospital of China Medical University from January 2013 to December 2018. The patients were randomly divided into modeling and internal validation groups using a random number generator at a 1:1 ratio. Multivariate Cox regression analysis was used to identify risk factors for all-cause mortality during a one-year follow-up period. Then, a nomogram was constructed based on the weights of each index and validated. Receiver operating characteristic curve, the area under the curve (AUC), decision curve, and calibration curve analyses for survival were used to evaluate the model’s predictive and clinical validities and calibration.ResultsWe included 3,406 patients who met the eligibility criteria; 1,703 cases each were included in the modeling and internal validation groups. Eight statistically significant predictors were identified: age, sex, New York Heart Association cardiac function class III or IV, a history of myocardial infarction, and the albumin, triglycerides, N-terminal pro-b-type natriuretic peptide, and blood urea nitrogen levels. The AUCs were 0.793 (95% confidence interval: 0.763–0.823) and 0.794 (95% confidence interval: 0.763–0.823) in the modeling and validation cohorts, respectively.ConclusionsWe present a predictive model for all-cause mortality in patients with coexisting HF and AF comprising eight key factors. This model gives clinicians a simple assessment tool that may improve the clinical management of these patients.

Guideline-Directed Medical Therapy for Elderly Patients With Acute Myocardial Infarction Who Undergo Percutaneous Coronary Intervention - Insights From a Retrospective Observational Study.

The efficacy of guideline-directed medical therapy (GDMT) in the elderly remains unclear. This study evaluated the impact of GDMT (aspirin or a P2Y12inhibitor, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, β-blocker, and statin) at discharge on long-term mortality in elderly patients with acute myocardial infarction (AMI) who had undergone percutaneous coronary intervention (PCI).Methods and Results: Of 2,547 consecutive patients with AMI undergoing PCI in 2009-2020, we retrospectively analyzed 573 patients aged ≥80 years. The median follow-up period was 1,140 days. GDMT was prescribed to 192 (33.5%) patients at discharge. Compared with patients without GDMT, those with GDMT were younger and had higher rates of ST-segment elevation myocardial infarction and left anterior descending artery culprit lesion, higher peak creatine phosphokinase concentration, and lower left ventricular ejection fraction (LVEF). After adjusting for confounders, GDMT was independently associated with a lower cardiovascular death rate (hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.16-0.81), but not with all-cause mortality (HR 0.77; 95% CI 0.50-1.18). In the subgroup analysis, the favorable impact of GDMT on cardiovascular death was significant in patients aged 80-89 years, with LVEF <50%, or with an estimated glomerular filtration rate ≥30 mL/min/1.73 m2. GDMT in patients with AMI aged ≥80 years undergoing PCI was associated with a lower cardiovascular death rate but not all-cause mortality.

#2561 Association of acute kidney injury stage with in-hospital mortality in elderly patients with hip fractures

Abstract Background and Aims Elderly individuals often experience hip fractures and acute kidney injury (AKI), both of which are associated with higher rates of morbidity and mortality. This study aimed to evaluate whether the severity of AKI is associated with higher mortality rates in elderly patients with hip fractures. Method Patients aged 65 years and older, who underwent surgery for hip fracture between October 2015 and October 2020, were retrospectively evaluated. Those with known chronic kidney disease stages 4, 5, or end-stage kidney disease were excluded. AKI was defined and categorized into stages 1, 2, and 3 according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Results In the study, 780 elderly patients with hip fractures were included, with a median age of 82.0 years (interquartile range 77.0–87.0) and 22.4% of them being men. Of these, 172 patients (22.1%) experienced AKI, with 125 (72.7%), 26 (15.1%), and 21 (12.2%) of these patients categorized as having stage 1, 2, and 3 AKI, respectively. Higher AKI stages were independently associated with increased in-hospital mortality compared to patients without AKI (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.18–6.55, P=0.940 for AKI stage 1; OR 14.09, 95% CI 1.47–135.52, P=0.022 for AKI stage 2; and OR 413.79, 95% CI 45.84–3735.28, P&amp;lt;0.001 for AKI stage 3). Furthermore, compared to patients without AKI, those with AKI stage 3 had a significantly increased risk of mortality (hazard ratio 15.30, 95% CI 2.65–88.48, P=0.002). Conclusion A higher stage of AKI is independently associated with increased in-hospital mortality in elderly patients with hip fractures. Prevention and prompt treatment of AKI, especially higher AKI stages, is important in elderly patients with hip fractures.

Time to Operation and Mortality Risk in Elderly Patients with Intestinal Fistula: Not Too Early and Not Too Late.

This study aimed to ascertain the risk factors contributing to in-patient mortality in elderly patients 65 years and older who were admitted emergently, diagnosed with intestinal fistula, and underwent surgery. Data were extracted from the National Inpatient Sample (NIS) spanning the years 2005-2014. Multivariable logistic regression and a generalized additive model (GAM) were employed to investigate predictors of mortality. Continuous variables are presented as mean values with standard deviations (SD). The study encompassed 34,853 patients with a mean age of 77.7 years-56.5% were female and 79.4% were White. Patients were categorized into three groups based on the time elapsed between admission and surgery: less than two days (17,761), two to three days (8,407), and more than three days (4,233). Mortality rates were 2.7%, 6%, and 6.1% for patients who underwent surgery within two to three days, within two days, and after more than three days of admission, respectively. Notably, the group that operated more than three days from admission experienced nearly double the hospital length of stay (12 days, SD: 7.2) compared to the other two groups (6.3, SD: 6 and 6.1, SD: 4.8). Furthermore, the association between mortality and time to operation, as indicated by the GAM model, revealed a significant non-linear relationship after adjusting for age, gender, race, zip code, hospital location, and comorbidities (p<0.001). Elderly patients diagnosed with intestinal fistula should undergo operative treatment as soon as possible, once they are resuscitated. Delaying the operation more than three days after admission substantially increases the risk of mortality.

Impact of Controlling Nutritional Status Score on Mortality in Elderly Patients with Idiopathic Pulmonary Fibrosis.

Background: There are only a few reports on the nutritional status and mortality of patients with idiopathic pulmonary fibrosis (IPF). As such, this study aims to investigate the relationship between controlling nutritional status (CONUT) and the mortality of elderly patients with IPF. Methods: A total of 170 IPF patients aged ≥65 years old who visited the rehabilitation department of our hospital between July 2014 and July 2021 (mean age: 75.7 ± 6.3 years, sex (male/female): 138/32, %FVC: 78.3 ± 18.3%) were retrospectively analyzed. The Kaplan-Meier method and log-rank test were applied. Furthermore, using a Cox proportional hazards model with multivariate analysis, we analyzed the relationship between all-cause mortality and baseline characteristics including CONUT. Results: Based on the CONUT score, the normal group included 101 cases, the mild group included 58 cases, the moderate group included 11 cases, and the severe group had 0 cases. There were 49 cases of all-cause mortality events, suggesting that the mortality of the moderate group was significantly poorer than that of the normal and mild groups (p < 0.05). Furthermore, multivariate analysis identified GAP stage (HR: 5.972, 95%CI: 2.901~12.291, p < 0.0001), mMRC scale (HR: 0.615, 95%CI: 0.389~0.971, p = 0.009), and CONUT (HR: 2.012, 95%CI: 1.192~3.395, p = 0.037) as factors significantly influencing mortality. Conclusions: Severe malnutrition was not observed in elderly patients with IPF. Moderate malnutrition was associated with a significantly higher risk of all-cause mortality, suggesting that CONUT is an important indicator for predicting mortality.

Abstract PO3-03-02: Effect of Surgery on Breast Cancer-Specific Mortality in Elderly Patients with Hormone Receptor-Positive, HER2-Negative Breast Cancer

Abstract Background: The number of elderly patients with breast cancer has been increasing in Japan. Although standard treatment including surgery is desirable if the expected life expectancy is sufficient, not all elderly patients with breast cancer are eligible for surgery due to frailty and comorbidities. Endocrine therapy (ET) alone is an alternative option if surgery is not considered adequate in patients with hormone receptor-positive breast cancer. We evaluated whether ET alone was associated with inferior overall and breast cancer-specific survival compared to standard treatment including surgery in elderly patients. Methods: This study included all patients aged 75 years and over who were diagnosed with non-metastatic primary invasive hormone receptor-positive, HER2-negative breast cancer and treated at Hiraka General Hospital from July 2006 to March 2022. Patients were divided as those who received ET alone (ET alone group) and those who received surgery with other therapies (Surgery group). Survival status as on March 31, 2023 and cause of death were determined. Overall survival and breast cancer-specific survival were estimated using the Kaplan–Meier method and compared using the log-rank test. Univariate analysis and multivariate Cox proportional hazards regression model including age, Eastern Cooperative Oncology Group performance status (PS) score, clinical stage, and treatment were used to identify survival-associated factors. Propensity score matching was used to reduce the effect of selection bias on treatment type during survival comparison of the groups. Results: The study cohort comprised 128 patients, including 33 and 95 patients in the ET alone group and Surgery group, respectively. The median ages were 84.6 and 80.4 years in the ET alone group and Surgery group, respectively (p &amp;lt; 0.05). Ten patients (30%) in the ET alone group had poor PS (3 or 4), and no patient in the Surgery group had poor PS (p &amp;lt; 0.01). Also, 24.2%, 54.5%, and 21.2% of the patients in the ET alone group and 48.4%, 43.2%, and 8.4% of the patients in the Surgery group had clinical stage I, II, and III disease at diagnosis, respectively (p &amp;lt; 0.05). Survival status was confirmed in all patients, and the cause of death was confirmed in 52 of the 53 patients who died (98%) during the study period, including 24 and 29 patients in the ET alone group and Surgery group, respectively. Breast cancer was the cause of death in 3 patients (13%) in the ET alone group and 5 patients (17%) in the Surgery group. By univariate analysis, overall survival was significantly better in the Surgery group than in the ET alone group (median, 12.5 vs. 4.1 years; p &amp;lt; 0.0001). Similarly, breast cancer-specific survival was better in the Surgery group than in the ET alone group (p &amp;lt; 0.05). By multivariate Cox proportional hazards regression analysis, age was associated with shorter overall survival time (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.00–1.15; p = 0.04) and surgery was associated with longer overall survival (HR 0.24, 95% CI 0.12–0.47; p &amp;lt; 0.001). Breast cancer-specific survival was associated with age (HR 1.18, 95% CI 1.03–1.36; p = 0.02) and clinical stage (HR 8.89, 95% CI 1.05–75.5; p &amp;lt; 0.05) but not with treatment (HR 0.66, 95% CI 0.73–5.85; p = 0.71). After propensity score matching, overall survival was significantly better in the Surgery group than in the ET alone group (HR 0.26, 95% CI 0.09–0.73; p = 0.01) whereas breast cancer-specific survival was not significantly different between the two groups (HR 0.82, 95% CI 0.08–8.27; p = 0.86). Conclusion: Even in elderly patients, surgery should be considered if sufficient life expectancy is expected. However, most of the deaths were not related to breast cancer in the present study cohort. Therefore, for elderly patients without sufficient life expectancy, endocrine therapy alone would be an appropriate option. Citation Format: Misako Yatsuyanagi, Tomoyuki Shimada, Yuko Takeishi, Yukiko Matsuzaka, Chika ohsawa. Effect of Surgery on Breast Cancer-Specific Mortality in Elderly Patients with Hormone Receptor-Positive, HER2-Negative Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-03-02.

OR6-1 | Association of Complete Revascularization with Mortality in Elderly Patients with Multi-Vessel Coronary Artery Disease: A Systematic Review and Meta-Analysis

OR6-1 | Association of Complete Revascularization with Mortality in Elderly Patients with Multi-Vessel Coronary Artery Disease: A Systematic Review and Meta-Analysis

Machine Learning for Predicting Risk and Prognosis of Acute Kidney Disease in Critically Ill Elderly Patients During Hospitalization: Internet-Based and Interpretable Model Study.

Acute kidney disease (AKD) affects more than half of critically ill elderly patients with acute kidney injury (AKI), which leads to worse short-term outcomes. We aimed to establish 2 machine learning models to predict the risk and prognosis of AKD in the elderly and to deploy the models as online apps. Data on elderly patients with AKI (n=3542) and AKD (n=2661) from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were used to develop 2 models for predicting the AKD risk and in-hospital mortality, respectively. Data collected from Xiangya Hospital of Central South University were for external validation. A bootstrap method was used for internal validation to obtain relatively stable results. We extracted the indicators within 24 hours of the first diagnosis of AKI and the fluctuation range of some indicators, namely delta (day 3 after AKI minus day 1), as features. Six machine learning algorithms were used for modeling; the area under the receiver operating characteristic curve (AUROC), decision curve analysis, and calibration curve for evaluating; Shapley additive explanation (SHAP) analysis for visually interpreting; and the Heroku platform for deploying the best-performing models as web-based apps. For the model of predicting the risk of AKD in elderly patients with AKI during hospitalization, the Light Gradient Boosting Machine (LightGBM) showed the best overall performance in the training (AUROC=0.844, 95% CI 0.831-0.857), internal validation (AUROC=0.853, 95% CI 0.841-0.865), and external (AUROC=0.755, 95% CI 0.699-0.811) cohorts. In addition, LightGBM performed well for the AKD prognostic prediction in the training (AUROC=0.861, 95% CI 0.843-0.878), internal validation (AUROC=0.868, 95% CI 0.851-0.885), and external (AUROC=0.746, 95% CI 0.673-0.820) cohorts. The models deployed as online prediction apps allowed users to predict and provide feedback to submit new data for model iteration. In the importance ranking and correlation visualization of the model's top 10 influencing factors conducted based on the SHAP value, partial dependence plots revealed the optimal cutoff of some interventionable indicators. The top 5 factors predicting the risk of AKD were creatinine on day 3, sepsis, delta blood urea nitrogen (BUN), diastolic blood pressure (DBP), and heart rate, while the top 5 factors determining in-hospital mortality were age, BUN on day 1, vasopressor use, BUN on day 3, and partial pressure of carbon dioxide (PaCO2). We developed and validated 2 online apps for predicting the risk of AKD and its prognostic mortality in elderly patients, respectively. The top 10 factors that influenced the AKD risk and mortality during hospitalization were identified and explained visually, which might provide useful applications for intelligent management and suggestions for future prospective research.

Nomogram predictive model for in-hospital mortality risk in elderly ICU patients with urosepsis

BackgroundUrinary tract infection (UTI) is a common cause of sepsis. Elderly patients with urosepsis in intensive care unit (ICU) have more severe conditions and higher mortality rates owing to factors such as advanced age, immunosenescence, and persistent host inflammatory responses. However, comprehensive studies on nomograms to predict the in-hospital mortality risk in elderly patients with urosepsis are lacking. This study aimed to construct a nomogram predictive model to accurately assess the prognosis of elderly patients with urosepsis and provide therapeutic recommendations.MethodsData of elderly patients with urosepsis were extracted from the Medical Information Mart for Intensive Care (MIMIC) IV 2.2 database. Patients were randomly divided into training and validation cohorts. A predictive nomogram model was constructed from the training set using logistic regression analysis, followed by internal validation and sensitivity analysis.ResultsThis study included 1,251 patients. LASSO regression analysis revealed that the Glasgow Coma Scale (GCS) score, red cell distribution width (RDW), white blood count (WBC), and invasive ventilation were independent risk factors identified from a total of 43 variables studied. We then created and verified a nomogram. The area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) of the nomogram were superior to those of the traditional SAPS-II, APACHE-II, and SOFA scoring systems. The Hosmer-Lemeshow test results and calibration curves suggested good nomogram calibration. The IDI and NRI values showed that our nomogram scoring tool performed better than the other scoring systems. The DCA curves showed good clinical applicability of the nomogram.ConclusionsThe nomogram constructed in this study is a convenient tool for accurately predicting in-hospital mortality in elderly patients with urosepsis in ICU. Improving the treatment strategies for factors related to the model could improve the in-hospital survival rates of these patients.

The impact of triglyceride glucose-body mass index on all-cause and cardiovascular mortality in elderly patients with diabetes mellitus: evidence from NHANES 2007–2016

BackgroundThe relationship between triglyceride glucose-body mass index (TyG-BMI) index and mortality in elderly patients with diabetes mellitus (DM) are still unclear. This study aimed to investigate the association between TyG-BMI with all-cause and cardiovascular mortality among elderly DM patients in the United States (US).MethodsPatients aged over 60 years with DM from the National Health and Nutrition Examination Survey (2007–2016) were included in this study. The study endpoints were all-cause and cardiovascular mortality and the morality data were extracted from the National Death Index (NDI) which records up to December 31, 2019. Multivariate Cox proportional hazards regression model was used to explore the association between TyG-BMI index with mortality. Restricted cubic spline was used to model nonlinear relationships.ResultsA total of 1363 elderly diabetic patients were included, and were categorized into four quartiles. The mean age was 70.0 ± 6.8 years, and 48.6% of them were female. Overall, there were 429 all-cause deaths and 123 cardiovascular deaths were recorded during a median follow-up of 77.3 months. Multivariate Cox regression analyses indicated that compared to the 1st quartile (used as the reference), the 3rd quartile demonstrated a significant association with all-cause mortality (model 2: HR = 0.64, 95% CI 0.46–0.89, P = 0.009; model 3: HR = 0.65, 95% CI 0.43–0.96, P = 0.030). Additionally, the 4th quartile was significantly associated with cardiovascular mortality (model 2: HR = 1.83, 95% CI 1.01–3.30, P = 0.047; model 3: HR = 2.45, 95% CI 1.07–5.57, P = 0.033). The restricted cubic spline revealed a U-shaped association between TyG-BMI index with all-cause mortality and a linear association with cardiovascular mortality, after adjustment for possible confounding factors.ConclusionsA U-shaped association was observed between the TyG-BMI index with all-cause mortality and a linear association was observed between the TyG-BMI index with cardiovascular mortality in elderly patients with DM in the US population.

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.

Comparison of Clinical Manifestation and Mortality-Related Risk Factors Between Elderly and Middle-Aged COVID-19 Patients

Given that the risk factors associated with mortality and morbidity of Coronavirus Disease (COVID-19) vary among age groups, this study aimed to describe the differences in clinical characteristics and mortality-related risk factors between elderly and middle-aged COVID-19 patients. A total of 1061 patients were included in this retrospective cohort study. Patients’ radiology reports and laboratory data were extracted from the available data on the Hospital Information System (HIS), and clinical findings were added in special forms. We followed up cases until death or discharge to evaluate patients’ outcomes. Chronic obstructive pulmonary disease (COPD) (95% CI, HR 2.73 (0.97-6.62)), need for antibiotics (95% CI, HR 2.26 (1.20-4.26)), and diabetes (95% CI, HR 1.77 (0.97-3.24)) were associated with a higher risk of mortality among middle-aged COVID-19 patients; while, age (95% CI, HR 1.04 (1.01-1.06)) was associated with increased mortality rate in elderly patients. We found that the need for antibiotics was associated with a worse outcome of COVID-19. Additionally, we described the differences between elderly and middle-aged COVID-19 patients regarding their comorbidities, laboratory findings, and clinical manifestation.

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

Can Geriatric Nutrition Risk Index Predict Postoperative 90-Day Complications and Mortality in Elderly Patients with Hip Fracture?

Can Geriatric Nutrition Risk Index Predict Postoperative 90-Day Complications and Mortality in Elderly Patients with Hip Fracture?