Prognosis Of Geriatric Patients Research Articles

Surgical options and survival prognosis in geriatric patients beyond average lifespan with locally advanced gastric cancer: a propensity score-matched analysis.

The appropriateness of laparoscopic gastrectomy (LG) for super-geriatric patients with locally advanced gastric cancer (LAGC) is inconclusive, and the prognostic factors are also yet to be elucidated. Herein, we aimed to investigate the surgical and oncological outcomes of LG versus open gastrectomy (OG) for geriatric patients with LAGC who have outlived the average lifespan of the Chinese population (≥ 78years). This is a monocentric, retrospective, comparative study. A 1:1 propensity score matching (PSM) was performed to minimize selection bias and ensure well-balanced characteristics. The primary endpoint of interest was 3-year overall survival, while secondary endpoints included procedure-related variables, postoperative recovery indices, and complications. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify unfavorable prognostic factors. Of 196 eligible individuals, 107 underwent LG and 89 underwent OG, with a median age (interquartile range [IQR]) of 82 [79, 84] years. PSM yielded 61 matched pairs, with comparable demographic and tumor characteristics. The LG group had a significantly lower overall complication rate than the OG group (31.1% vs. 49.2%, P = 0.042), as well as shorter duration of postoperative hospital stay [12 (11, 13) vs. 13 (12, 15.5) d, P < 0. 001], less intraoperative blood loss [95 (75, 150) vs. 230 (195, 290) mL, P < 0.001], but a longer operative time [228 (210, 255.5) vs. 196 (180, 219.5) min, P < 0.001]. The times to first aerofluxus, defecation, liquid diet, and half-liquid diet were comparable. Kaplan-Meier analyses revealed no significant difference in 3-year overall survival between the groups, either in the entire cohort or in subgroups with different TNM staging. Moreover, Age-adjusted Charlson Comorbidity Index scores of > 6 [hazard ratio (HR) 4.003; P = 0.021] and pathologic TNM stage III (HR 3.816, P = 0.023) were independent unfavorable prognostic factors for long-term survival. LG performed by experienced surgeons offers the benefits of comparable or better surgical and oncological safety profiles than OG for super-geriatric patients with LAGC.

The importance of prognosis in geriatric patients attending the emergency department: a comparison between two common short geriatric assessment tools

BackgroundThe use of short geriatric tools in the emergency department (ED) is increasing, but the literature is still conflicting. The aim of this study is to compare the precision and the accuracy of two short geriatric assessment tools to predict mortality in a cohort of older patients attending the ED.MethodsA retrospective study was conducted including patients ≥ 65 years, attending the ED and transferred to a medical assessment unit from February to July 2022. Clinical Frailty Scale (CFS) and Brief Multidimensional Prognostic Index (Brief MPI) were administered. The association between Brief MPI and CFS and mortality was analysed via area under the curve (AUC) with its 95% confidence intervals (CIs), the C-statistics and a multivariate Cox’s regression analysis, in the latter case reporting the data as hazard ratios (HRs) with their 95% CI.ResultsAmong the 579 patients enrolled (mean age: 77 years), both Brief MPI and CFS showed a good accuracy in predicting mortality (AUC: 0.72; 95% CI: 0.61–0.83 for Brief MPI; 0.754; 95% CI: 0.65–0.83 for CFS). The discrimination of Brief MPI and CFS in predicting mortality was excellent, since the C-index of the Brief MPI was 0.85 and of CFS = 0.84. In the multivariate analysis, the risk for mortality was significantly increased for frailer subjects (HR 4.65; 95% CI: 1.45–15.00 for Brief MPI > 0.66; HR = 9.24; 95% CI: 1.16–76.90 for CFS > 6).ConclusionsBrief MPI and CFS showed a good accuracy/precision to predict mortality in older patients attending the ED. Considering that they are quick to perform, their introduction in ED clinical practice could be extremely helpful.

Changes of gut microbiota under different nutritional methods in elderly patients with severe COVID-19 and their relationship with prognosis.

The clinical progression of individuals afflicted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exhibits significant heterogeneity, particularly affecting the elderly population to a greater extent. Consequently, the association between nutrition and microbiota has garnered considerable interest. Hence, the objective of this study was to gather clinical data pertaining to the influence of diverse nutritional support interventions on the prognosis of geriatric patients with COVID-19, while additionally examining the fecal microbiota of these individuals to assess the repercussions of microecological alterations on their prognostic outcomes. A total of 71 elderly patients diagnosed with severe COVID-19 were included in this study. These patients were subsequently divided into two groups, namely the enteral nutrition (EN) group and the parenteral nutrition (PN) group, based on the type of nutritional support therapy they received after admission. The occurrence of complications was observed in 10.4% of patients in the EN group, whereas it was significantly higher at 69.6% in the PN group (P<0.001). Furthermore, the 60-day mortality rate was 2.1% (1/48) in the EN group, while it was notably higher at 30.4% (7/23) in the PN group (P=0.001). To identify the independent predictors of 60-day mortality, stepwise logistic regression analysis was employed. Among different bacterial groups, Enterococcus_faecium (18.19%) and Pseudomonas_aeruginosa (1.91%) had higher average relative abundance in the PN group (P<0.05). However, the relative abundance of Ruminococcus was higher in the EN group. Further Spearman correlation analysis showed that Enterococcus_faecium was positively correlated with poor clinical prognosis, while Ruminococcus was negatively correlated with poor clinical prognosis. This study shows that the changes in the composition of intestinal flora in elderly COVID-19 patients receiving different nutritional support strategies may be related to different clinical outcomes. The abundance of Enterococcus_faecium in elderly COVID-19 patients receiving PN is significantly increased and is closely related to poor clinical outcomes. It highlights the potential of microbiome-centric interventions to mitigate and manage COVID-19 in older adults with different nutritional support options.

Investigation of Factors Affecting Prognosis in Geriatric Patients with Head Injury

Objective: Head trauma is one of the most common causes of emergency admission in elderly patients. The risk of intracranial pathology increases after trauma due to the weakening of bone structures, deterioration in blood parameters, and use of anticoagulants. This study aimed to examine the factors affecting mortality after head trauma in geriatric patients. Material and Methods: Geriatric patients who were admitted to the emergency department with head trauma between 01.01.2015 and 31.12.2015 and underwent cranial computed tomography (cCT) were included in the study. Patient data were analyzed according to gender, age groups, trauma causes, hematological parameters and hospitalization-discharge status. Results: 320 patients were included in the study, 169 were female (52.8%), and 142 were in the 65-74 age group (%44). Intracranial pathology was detected in 34 patients. The most common causes of trauma were falls and traffic accidents. The most common CT pathology was subdural hemorrhage. 76 (24%) of 320 patients were hospitalized. As their final status, 307 patients were discharged (96%), 6 were transferred (1.9%), 7 died (2.2%). Conclusion: In the study, there is no significant correlation between age, gender, mechanism of trauma, hematological parameters and mortality in geriatric head trauma. Geriatric head traumas must be evaluated seriously regardless of the mechanism of injury, age and gender groups, even simple traumas can be dangerous.

Clinical course and features of soft tissue sarcomas in geriatric patients: a single-center experience.

This study was performed to examine the disease course in geriatric patients with soft tissue sarcoma and determine the risk factors for mortality. We retrospectively analyzed patients who were treated at Istanbul University Oncology Institute from January 2000 to August 2021. Eighty patients were included in the study. The patients' median age was 69 years (range, 65-88 years). The median overall survival of patients diagnosed between the ages of 65 and 74 years was 70 months, and that of patients diagnosed at the age of ≤75 years was significantly lower at 46 months. The median survival of patients who did and did not undergo surgical resection was 66 and 11 months, respectively, with a significant difference. The median overall survival of patients with positive and negative surgical margins was 58 and 96 months, respectively, also with a significant difference. Age at diagnosis and recurrence/metastasis significantly affected mortality. A 1-year increase in the age at diagnosis increased mortality by 1.147 times. Age of >75 years, inability to undergo surgery, positive surgical margins, and head and neck location may be associated with a poor prognosis in geriatric patients with soft tissue sarcoma.

Investigation of the relationship between emergency department applications and prognoses of geriatric patients

The World Health Organization (WHO) stated that the elderly population constituted 12% of the population of people over 60 years old in 2015. In the coming years, by 2030, 1 out of 6 people in the world will be 60 years or older, and this ratio will increase to 22% in 2050. In addition, it is estimated that the proportion of the elderly population will be 11.0% in 2025, 12.9% in 2030, 16.3% in 2040, 22.6% in 2060 and 25.6% in 2080. The number of admissions to the emergency services of geriatric patients, the hospital treatment process, and even the mortality and morbidity rates increase in elderly patients. In this direction, it was aimed to retrospectively analyze the data of patients over 65 who applied to a tertiary hospital emergency department and determine the factors affecting the mortality of geriatric patients. The presented study is a cross-sectional and retrospective study. All patients over the age of 65 who applied to the emergency department of Ordu University Medical Faculty Training and Research Hospital between 01 July 2022 and 31 2022 were retrospectively analyzed. Demographic features of the cases, the way they applied to the emergency room (112 Emergency Service Ambulance, others: with their own vehicle, by taxi, etc.), the last diagnosis in the emergency department (neurological, cardiovascular, respiratory, metabolic, trauma and others), treatment methods (outpatient, inpatient, intensive care), their motility and the relationship of these data with each other were examined. Between the specified dates, a total of 28459 patients over the age of 18 were admitted to the emergency department. It was determined that 10.16% (n=2894) of these patients consisted of patients over 65 years of age. The relationship between the treatment modalities and mortality according to the way the patients came to the hospital was found to be statistically significant (p&lt;0.005). The relationship between hospitalization, treatment modalities and mortality was statistically significant according to the clinical diagnosis of the cases (p&lt;0.005). In the presented study, it was determined that the mortality of patients who applied to the emergency department due to metabolic problems and who used the ambulance system as a referral tool was high. In fact, the prognosis of geriatric patients who apply to the emergency department for any reason, especially by using the emergency ambulance system, is worse than those who do not use the emergency ambulance system. For this reason, the use of an emergency ambulance system alone affects the prognosis negatively and it is necessary to evaluate such geriatric patients more carefully.

Prediction of Prognosis in Geriatric Palliative Care Patients with Diagnosed Malnutrition: A Comparison of Nutritional Assessment Parameters.

Malnutrition is very commonly encountered in palliative care centers (PCC), especially in geriatric patients. It is known that development of malnutrition increases morbidity and mortality. In this study, we aimed to investigate the effectiveness of commonly used nutritional assessment parameters in predicting prognosis in geriatric patients diagnosed in PCC with malnutrition. Our study included 1451 patients aged ≥65 years, who were diagnosed with malnutrition in PCC between 2016-2020 and did not yet start receiving nutritional support. Demographic data, comorbidities, The Nutritional Risk Screening 2002 (NRS-2002), body mass index (BMI), albumin, prealbumin and C-reactive protein (CRP) values of the patients were recorded. Prognostic course was evaluated by dividing the patients into 3 groups, namely mortal patients during PCC follow-up, patients transferred from PCC to Intensive Care (ICU) and patients discharged to home from PCC. Logistic Regression analysis showed that low albumin levels affected transfer to ICU (P<0.05). Elevated NRS-2002 and low albumin and prealbumin levels were found to be factors affecting mortality (P<0.05). Areas under the ROC Curve were calculated to attain patients' differential diagnosis. The area under the ROC Curve of low albumin in patients transferred to ICU was found to be significant (P<0.05). In the differential diagnosis of patients with mortal course, the area under the ROC Curve of low albumin and prealbumin and high CRP was found to be significant (P<0.05). We found that BMI had no prognostic predictive effects in geriatric PCC patients with malnutrition. We concluded that NRS-2002 and high CRP and low albumin and prealbumin can be used to predict mortality. In addition, we found that low albumin indicates a poor prognosis and predicts patients to be transferred to ICU.

Evaluation of the effects of kidney function tests on prognosis and mortality in geriatric patients with a pulmonary embolism

&lt;b&gt;Aim:&lt;/b&gt; The instant study’s aim is to investigate the effect that BUN and creatinine values have on a prognosis in geriatric patients that are diagnosed with pulmonary embolism. &lt;b&gt;Material and methods:&lt;/b&gt; Our study was planned as a retrospective data review and included patients over the age of 65 with a diagnosis of pulmonary embolism who were admitted applied to Ümraniye Training and Research Hospital between March 1, 2020, and March 1, 2022. Statistical analysis was performed using SPSS version 26.0.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; The study included 148 patients, and 66.89% of them were women. The mortality rate was 28.38%. Considering the blood gas parameters, there was a statistically significant relationship between PH and low saturation and mortality (p=0.029, p=0.001, respectively). Although creatinine values were higher in non-surviving patients than in surviving patients, it was not statistically significant (p=0.252). Blood urea nitrogen was statistically significantly higher in patients who died (p=0.001). Sodium and potassium values were also not associated with mortality (p=0.991, p=0.886, respectively).&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; The effect of kidney function tests on the prognosis is very important in managing pulmonary embolism. BUN will be more beneficial to the clinician than creatinine and plasma electrolytes in the management of patients with pulmonary embolism.

Inflammatory Indexes as Prognostic Factors of Survival in Geriatric Patients with Hepatocellular Carcinoma: A Case Control Study of Eight Slovak Centers.

Background and Aims: Hepatocellular cancer (HCC) often occurs in geriatric patients. The aim of our study was to compare overall survival and progression-free survival between geriatric patients (>75 years) and patients younger than 75 years and to identify predictive factors of survival in geriatric patients with HCC. Material and Methods: We performed a retrospective analysis of patients with HCC diagnosed in Slovakia between 2010–2016. Cases (HCC patients ≥75 years) were matched to controls (HCC patients <74 years) based on the propensity score (gender, BCLC stage and the first-line treatment). Results: We included 148 patients (84 men, 57%) with HCC. There were no differences between cases and controls in the baseline characteristics. The overall survival in geriatric patients with HCC was comparable to younger controls (p = 0.42). The one-, two-, and three-year overall survival was 42% and 31%, 19% and 12%, and 12% and 9% in geriatric patients and controls, respectively (p = 0.2, 0.4, 0.8). Similarly, there was no difference in the one- and two-year progression-free survival: 28% and 18% vs. 10% and 7% in geriatric HCC patients and controls, respectively (p = 0.2, 1, -). There was no case–control difference between geriatric HCC patients and younger HCC controls in the overall survival in the subpopulation of patients with no known comorbidities (p = 0.5), one and two comorbidities (p = 0.49), and three or more comorbidities (p = 0.39). Log (CRP), log (NLR), log (PLR), and log (SII) were all associated with the three-year survival in geriatric HCC patients in simple logistic regression analyses. However, this time, only log (NLR) remained associated even after controlling for the age and BCLC confounding (OR 5.32, 95% CI 1.43–28.85). Conclusions. We found no differences in overall survival and progression-free survival between older and younger HCC patients. Parameters of subclinical inflammation predict prognosis in geriatric patients with HCC. A limitation of the study is small number of the treated patients; therefore, further investigation is warranted.

Preoperative leukocytosis and postoperative outcomes in geriatric hip fracture patients: a retrospective cohort study

Background: A growing amount of evidence has suggested an association between preoperative leukocytosis and postoperative complications across a variety of surgeries. The aim of this study was to evaluate the impact of preoperative leukocytosis on the prognosis of geriatric patients with hip fracture after surgery. Methods: This retrospective cohort included 1007 patients age 65 yr and older who underwent surgery for hip fracture between January 2016 and December 2019 at a district general hospital. Outcomes measured included surgical-site infection and 30-day and 1-year mortality. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality in patients with hip fracture. Results: After adjustment for covariates, leukocytosis was not found to be a significant independent predictor of poor outcome after geriatric hip-fracture surgery. Delay of surgery longer than 48 hr and dementia were found to be independent variables associated with increased risk of surgical-site infection. The predictors of 30-day mortality were male gender and the use of anticoagulant or antiaggregant medications, whereas male gender, delay of surgery more than 48 hr, dementia and hypoalbuminemia were associated with increased 1-year mortality. Conclusions: Preoperative leukocytosis was not associated with adverse postoperative outcome after geriatric hip-fracture surgery. The more reliable variables for prediction of surgical outcome in geriatric patients with hip fracture were delay in surgery, gender, hypoalbuminemia, dementia, and use of anticoagulant or antiaggregant medications. Level of Evidence: Level III.

The role of erythrocyte distribution width in predicting poor outcomes in geriatric patients with acute pancreatitis

Introduction and aim. In our study, our aim was to evaluate the relationship between red cell distribution width (RDW) values and prognosis in geriatric patients with acute pancreatitis. Material and methods. Patients over the age of 65 and diagnosed with acute pancreatitis who applied to the Emergency Department of Umraniye Training and Research Hospital between 16.07.2021 and 15.05.2022 were included in our retrospective study. RDW levels were recorded using the hospital data system. Results. Our study included 184 patients, 19 (10.3%) of which died. Sixty-five percent of our patients were women. The mean hospital stay was 5 days (from 3 to 9). A statistically significant relationship was also observed between high RDW and mortality (p=0.006). The diagnostic test performance analyses of CRP, and RDW in predicting mortality revealed that they were statistically significant in predicting mortality, with the AUC value being calculated as 0.66 (0.6061–0.7368) for CRP, with a cut-off value of 22; and 0.69 (0.6909–0.7368) for RDW, with a cut-off value of 14.5 (p=0.019, p=0.006, respectively). Conclusion. Hematological parameters can help predict a prognosis in patients with acute pancreatitis. Although RDW is not statistically more significant than CRP, it can be used as a prognostic marker in patients with acute pancreatitis.

Determinants of prognosis in geriatric patients followed in respiratory ICU; either infection or malnutrition.

Severity of illness, age, malnutrition, and infection are the important factors determining intensive care unit (ICU) survival.The aim of the study is to determine the relations between Geriatric Nutritional Risk Index (GNRI), C-reactive protein/albumin (CAR), and prognosis-mortality of geriatric patients (age of ≥65 years) admitted to intensive care unit.The study with 10/15/2020, 697 approval date, and number retrospectively registered. Between January 1, 2018 and December 31, 2019, 413 geriatric patients admitted to ICU. The patients were divided into three groups according to their age.The age group, gender, Charlson comorbidity index, intensive care scores (Acute Physiology And Chronic Health Evaluation II and Sequential Organ Failure Assessment), the infection markers (white blood cell, procalcitonin, CAR levels), malnutrition tools for each patient (body mass index, Nutrition Risk in Critically ill score, and GNRI scores) were analyzed retrospectively. Also length of stay (LOS) ICU, length of stay hospital, and 30-day mortality were recorded.Geriatric patients number of 403 was included in the study. Forty-nine (12.3%) patients had a history of malignancy, 272 (67.5%) patients had Chronic Obstructive Pulmonary Disease comorbidity. There was no difference in mortality between age groups.In patients with mortality, body mass index, had being Chronic Obstructive Pulmonary Disease history, GNRI, length of stay hospital, and albumin were significantly lower; malignancy comorbidity rate, inotrope use, modified Nutrition Risk in Critically ill score, mechanical ventilation duration, LOS ICU, Sequential Organ Failure Assessment, Acute Physiology And Chronic Health Evaluation II, Charlson comorbidity index, C-reactive protein, procalcitonin, and CAR were significantly higher.Both malnutrition and infection affect mortality in geriatric patients in intensive care. The GNRI is better than CAR at predicting mortality.

Prognostic values of geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) in elderly patients with Diffuse Large B-Cell Lymphoma.

Background: Geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) are associated with prognosis of various malignancies. Although GNRI and PNI indicates prognosis in some clinical settings, the values of GNRI and PNI on the prognosis of geriatric patients with Diffuse Large B‐Cell Lymphoma (DLBCL) is unclear. This retrospective analysis aimed to explore the prognostic values of GNRI and PNI in elderly DLBCL patients.Methods: A total of 133 geriatric patients with DLBCL were recruited from Affiliated Hospital of Xuzhou Medical University, and clinicopathological variables were analyzed. X-Tile program, restricted cubic spline (RCS) and time-dependent receiver operating characteristic (ROC) analysis were used to determine optimal cut-off points of GNRI, PNI and other continuous variables; univariate and multivariate Cox proportional hazards analyses were used for variables selection; Kaplan‐Meier curve was utilized to analyze the influence of variables on prognosis; log-rank test was performed for difference evaluation between groups.Results: The optimal cut-off points for GNRI and PNI were 106.26 and 47 by using RCS. Multivariate analysis showed that PNI, age, hemoglobin, liver invasion and central nervous system invasion were independent prognostic factors for elderly patients with DLBCL, and PNI was (P = 0.001, HR = 0.413, 95% CI (0.240-0.710) a stronger predictor. Low PNI could predict worse prognosis independently of elderly patients of DLBCL and could re-stratify patients in GCB group, CD5 positive group BCL-2 positive group, and BCL-6 positive group.Conclusions: PNI was an independent adverse factor for elderly DLBCL and patients with low PNI in GCB group, CD5 positive group and BCL-6 positive group were with poor survival.

Type 2 myocardial infarction: is it a geriatric syndrome?

Type 2 myocardial infarctions (T2-MI) is a type of necrosis that results from reduced oxygen supply and/or increased demand secondary to other causes unrelated to acute coronary atherothrombosis. The development and implementation of sensitive and high-sensitivity cardiac necrosis marker and the age-related increase of comorbidity lead to a boost of the frequency of T2-MI. T2-MI is often a complication of a high degree of clinical frailty in older adults, emerging as a "geriatric syndrome". Age-related non-cardiovascular causes may be the triggering factors and are strongly associated with the diagnosis, treatment, and prognosis of T2-MI. To date, there are no guidelines on management of this pathology in advancing age. Patient-centered approach and comprehensive geriatric assessment play a key role in the diagnosis, therapy and prognosis of geriatric patients with T2-MI.

Inflammation-based markers can predict the prognosis of geriatric patients with metastatic colorectal cancer receiving first-line chemotherapy

Background: Relationship between inflammatory factors and survival or efficacy of first-line treatment in elderly patients with metastatic colorectal cancer (MCRC) who received first-line chemotherapy has not been clarified. Methods: A total of 186 MCRC patients aged ≥65 years, receiving chemotherapy between January 1, 2004 and October 1, 2015 were identified. Pretreatment levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), lactate dehydrogenase (LDH), C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) were measured. Effect of these inflammatory factors on overall survival (OS) and first-line progression-free survival were analyzed. Results: Median age was 72 years. Median PFS and OS were 6.70 months and 25.62 months. CEA ≥85 ng/mL (P=0.010), CA 19-9 ≥32.97 U/mL (P=0.010), LDH ≥325 U/L (P=0.015), CRP ≥11 mg/L (P=0.004) and NLR ≥2.12 (P=0.045) were associated with poor OS. Furthermore, LDH (P=0.025) was demonstrated as an independent prognostic factor of OS for all patients, so did the combination of CEA with CA 19-9 (P=0.009). When predicting the one, three and five-year survival, combination of CEA with CA 19-9 had higher sensitivity compared with CEA alone or CA 19-9 alone respectively. For right-sided colon cancer, CEA (P Conclusions: CEA, CA 19-9, LDH, CRP and NLR were related with OS in geriatric patients with MCRC. Right-sided and left-sided groups had different independent prognostic markers, CEA and CRP respectively.

Clinical significance of serum TK1 and PNI in the prognosis of geriatric patients with advanced non-small cell lung cancer: a retrospective study

Clinical significance of serum TK1 and PNI in the prognosis of geriatric patients with advanced non-small cell lung cancer: a retrospective study

Prognosis of geriatric patients with severe kidney disease.

Patients 75 years of age and older, with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 (chronic kidney disease epidemiology CKD-EPI) were recruited. A comprehensive geriatric assessment was performed at hospital discharge. Comprehensive geriatric assessment was performed: Activities of daily livings and Instrumental activities of daily livings scores, of the risk of pressure sore with Exton-Smith scale, the cognitive status with MMSE score, nutritional status according to Mini-nutritional assessment short form and albuminemia, comorbidities with Cumulative illness rating scale, number of drugs in presciption and living status. Six months follow-up was performed to assess vital status and evolution of the eGFR. Sixty-seven patients were included, mean age 88.6±4.82 years with a mean eGFR of 21.3±6 mL/min. Mortality rate at six months was 36%. Multivariate analysis showed that a high CIRS score (RR=1.52; IC 95% 1.05-2.19) and a decline of creatinine clearance≥ 2 mL/min (4.72; 1.27-17.52) were predictive of mortality. On the opposite, a high MNA-SF score was protective (0.76; 0.62-0.94). Prognosis of geriatric patients with severe chronic kidney disease is poor. Comprehensive geriatric assessment helps to assess short-term prognosis, in a focus of person-centered care.

Decline in anthropometric evaluation predicts a poor prognosis in geriatric patients.

Malnutrition is frequent in the geriatric population and is often undetected and untreated. Although we often use serum albumin as a nutritional marker, it has limitations in elderly patients in terms of predicting diseases and infections. Anthropometric measurements are not commonly used, despite their simple, easy, and effective characteristics. We evaluated the associations between anthropometric measurements with other nutritional factors and examined its relationship with mortality, decubitus ulcer, length of hospital stay and antibiotic usage. We enrolled 223 patients, performed anthropometric measurements and then followed them for a mean of 24 months. Patients with hypoalbuminemia but with normal body measurements tended to increase serum albumin levels over the next 24 months and had more favorable outcomes including being discharged. Patients with normal albumin but decreased body measurements resulted in a progressive drop in serum albumin and had a higher mortality rate. Additionally, patients with hypoalbuminemia had higher antibiotic usage than patients without hypoalbuminemia. Decreases in anthropometric measurements were related to mortality, length of hospital stay, and decubitus ulcer. Anthropometric measurements are easily obtained and closely associated with mortality, decubitus ulcer, and length of hospital stay. Anthropometric measurements used in conjunction with serum albumin are more predictive of patient outcome then serum albumin alone.

Survival prognosis in geriatric patients admitted to permanent institutional care.

The influence of clinical and laboratory findings on the two-year survival prognosis was investigated in 558 geriatric patients admitted to permanent institutional care. The patients surviving for two years (52%) were somewhat younger (79 vs 82 years, p less than 0.01), and on admission had significantly higher diastolic blood pressure (p less than 0.001), serum thyroxin (p less than 0.05), serum albumin (p less than 0.01) and blood haemoglobin (p less than 0.05), but lower treatment score (p less than 0.001), serum creatinine (p less than 0.001), and fasting plasma glucose (p less than 0.05). Decreased survival prognosis was also found in patients with abnormal serum sodium, chloride, and potassium (p less than 0.05 or less). However, an excess mortality of patients with abnormal laboratory data occurred within the first month after admission. Stepwise logistic regression analysis disclosed that the three-month survival prognosis was significantly impaired by low blood pressure (less than 110/70 mmHg), high treatment score (greater than 22), elevated serum creatinine (greater than 150 mumol/L), use of digitalis and atrial fibrillation. Poor two-year survival was further associated with the use of diuretics, and diabetes mellitus. The risk for death was lowest in patients with elevated blood pressure (greater than 160/95 mmHg). These data verify the significance of the clinically common diseases and indicators of homeostasis in the assessment of geriatric hospital patients, and demonstrate the nature of "terminal decline" in geriatric practice.