Prognosis Of Elderly Patients Research Articles

Comparison of Bone-setting Robots and Conventional Reduction in the Treatment of Intertrochanteric Fracture: A Retrospective Study.

Intertrochanteric fracture of the femur is a common fracture in older people. Due to the poor systemic condition and prognosis of elderly patients, it is prone to more complications. We introduce the bone-setting concept in the design of the robots, which are used for intertrochanteric fracture of the femur reduction. The purpose of this study is to compare the effect of bone-setting robots and conventional reduction in the treatment of intertrochanteric fracture of the femur (IFF). From June 2021 to January 2023, 60 patients with IFF who were treated surgically were assigned to bone-setting robots group and conventional reduction methods group in this retrospective study. The reduction time, operation time, total time, intraoperative blood loss, incision length, fluoroscopy time, and the follow-up time were reviewed. The visual analogue scale (VAS) and Harris scores were used for functional assessment. For continuous variables, independent t-tests were applied; for categorical data, the chi-square test was applied. The significance level as p < 0.05. Among the 60 patients with IFF, 31 were assigned to the bone-setting robots group, and 29 were assigned to the conventional reduction methods group. Both groups with a similar baseline in the number, gender, age, and classification (p > 0.05). The reduction time, operation time, total time, intraoperative blood loss, and fluoroscopy time were less than those in the bone-setting robots reduction group compared to the conventional reduction group. In the bone-setting robots reduction group, the preoperative VAS score was 6.2 ± 1.3, the Harris score was 35.3 ± 3.1, 1 week after surgery VAS score was 3.3 ± 1.2, the Harris score was 57.3 ± 3.7, and at the last follow-up VAS score was 2.4 ± 0.8, and the Harris score was 88.7 ± 3.4. While in the conventional reduction group, the preoperative VAS score was 6.3 ± 1.3, the Harris score was 35.9 ± 2.9, 1 week after surgery VAS score was 4.8 ± 1.4, the Harris score was 46.8 ± 2.8, and at the last follow-up VAS score was 2.6 ± 0.8, and the Harris score was 87.3 ± 3.3. There were no significant differences between the two groups at the preoperative and 6-month postoperative follow-ups in VAS score and Harris score (p > 0.05, p > 0.05, respectively). But the difference was statistically significant at the one-week postoperative follow-up in VAS and Harris scores (p < 0.001). The bone-setting robots can better protect the "fracture environment" and have the advantages of being precise, minimally invasive, simple, short time, low radiation, and rapid fracture recovery. The clinical effect of closed repair of IFF is ideal.

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

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

Monoclonal Antibodies Targeting LIGHT Block Ltbr Signalling and Eliminate Acute Myeloid Leukemia Stem Cells

Introduction Acute myeloid leukemia (AML) is a molecular heterogeneous disease that originates from the malignant transformation of a hematogenic stem- or progenitor cells resulting in a leukemia stem cell (LSC). LSCs are a main cause of resistance to therapy and relapse. Despite recent advances in targeted therapy and immunotherapy, prognosis for elderly patients not fit do undergo intensive therapy remains poor. We recently documented that targeting CD70, the ligand of the tumor necrosis factor receptor (TNFR) CD27, by the antibody-dependent cell-mediated cytotoxicity (ADCC)-enhanced monoclonal antibody (mAb) cusatuzumab eliminates LSC. We now studied the role of the related TNFR lymphotoxin b receptor (LTbR) with its ligand LIGHT in the pathogenesis of AML in mice and humans and developed a LIGHT targeting mAb to specifically eliminate LSCs. Experimental design We investigated the impact of LIGHT/LTbR signalling in AML development by using the retrovirally-induced MLL-AF9 syngeneic AML mouse model. Light-, Ltbr -deficient and control MLL-AF9 transduced LSCs were injected intravenously into non-irradiated BL/6 recipient mice. AML development was evaluated by analysing MLL-AF9-GFP-positive leukemic cells in blood, spleen, and bone marrow (BM). BM LSC were phenotypically characterized by FACS and functionally by performing colony forming unit (CFU) assays in vitro and by secondary transplantations of LSCs including limited dilution assays (LDA) in vivo. Correlative survival analysis for LIGHT and LTbR expression was performed on a publicly available gene dataset (GSE6891). LIGHT and LTBR protein expression was analysed on primary AML CD34 + leukemic stem and progenitor cells (LSPCs) and control human CD34 + hematopoietic stem cell and progenitor cells (HSCPs). LIGHT/LTbR signalling was blocked by either siRNA treatment or by treatment with novel LIGHT-targeting mAb. The effect of blocking LIGHT/LTbR-signalling was analysed in vitro by CFU assays, RNA-sequencing and xenotransplant experiments in vivo. LIGHT-targeting mAbs were generated by immunization of llamas and phage display selections followed by cloning of FABs into a human backbone (hIgG1). Clones were selected based on their blocking potency of receptor/ligand interaction using competition ELISA and FACS-based cell binding affinity assays. ADCC-enhanced anti-LIGHT mAbs were generated via POTELLIGENT® technology. Anti-LIGHT mAbs that specifically block the interaction of LIGHT/LTBR with deficiency in effector functions (Fc-death) were produced by amino acid substitutions in the CH2 domain of the parental clone. Results LTbR was expressed by HSCs and AML LSCs. In contrast, LIGHT was only expressed on murine and human LSCs but not normal HSCs. The absence of LIGHT or its receptor LTbR on LSCs resulted in significantly prolonged survival and decreased numbers of LSC in BM of AML mice. Light -/- and Ltbr -/- LSCs had a reduced CFU capacity compared to control LSCs. Similarly, inhibition of LIGHT-signalling on LSCs via LTbR-Ig significantly reduced colony formation. Moreover, secondary transplantation of Light -/-LSCs resulted in prolonged survival compared to Light-proficient LSCs. An LDA analysis revealed a 11-fold reduction of the LSC frequency in BM in the absence of LIGHT or LTBR. Similarly, inhibiting LIGHT signalling by siLIGHT RNA in human AML LSPCs resulted in reduced CFU capacity compared to control siRNA treatment. In addition, a GEO analysis revealed that low LIGHT or LTbR mRNA levels correlated with improved overall survival in AML patients. After immunizations of llamas and phage-display selection three humanized anti-LIGHT mAbs with high blocking and high binding efficiency were selected (mAb10F11 and 12C2 specific for human LIGHT and the cross-reactive murine/human 9F6 mAB). Incubation of LSCs with the blocking mAbs significantly reduced CFU capacity. HSPCs from healthy donors remained unaffected by the treatment. A gene expression analysis revealed that blocking LIGHT/LTbR-signalling in LSCs reduced stemness and promoted differentiation. In addition, ADCC-enhanced mAbs activated NK cells to eliminate LIGHT-expressing LSCs. Our findings reveal that LIGHT/LTbR-signalling is crucial for the pathogenesis of AML and especially for the maintenance and expansion of LSCs. We developed and validated novel LIGHT targeting mAbs in vitro and in vivo for further development in clinical trials.

Clipping and coiling of intracranial aneurysms in the elderly patients: clinical features and treatment outcomes.

In recent years, more and more cases of intracranial aneurysms (IAs) have been found in elderly patients, and neurosurgical interventions have increased, but there is still no consensus on the best treatment strategy for elderly patients. In elderly patients, endovascular coiling (EC) is more popular than surgical clipping (SC) due to its advantages of less trauma and faster recovery. However, SC has made great progress in recent years, significantly improving the prognosis of elderly patients. Therefore, it is necessary to further explore the effects of different treatment modalities on clinical prognosis, hospital stay, and hospital cost of elderly IA patients, and select the most appropriate treatment modalities. The authors retrospectively analyzed 767 patients with intracranial aneurysms admitted to the facility between August 2017 and December 2022. Prognostic risk factors and multivariate logistic regression were analyzed for elderly patients treated with EC or SC. The area under the receiver operating characteristic (ROC) curve was used to calculate the predictive power of each independent predictor between the treatment groups. Our study included 767 patients with aneurysms, of whom 348 (45.4%) were elderly, 176 (22.9%) underwent endovascular coiling, and 172 (22.4%) underwent microsurgical clipping. A comparison of elderly patients treated with EC and SC showed a higher prevalence of hypertension in the EC group (P = 0.011) and a higher Hunt-Hess score on admission in the SC group (P = 0.010). Patients in the EC group had shorter hospital stays but higher costs (P = 0.000 and P = 0.000, respectively). Patients treated with SC had a higher incidence of postoperative cerebral infarction and poor prognosis (P = 0.002 and P = 0.008, respectively). Through multi-factor logistic analysis, it was found that age (OR 1.209, 95% CI 1.047-1.397, P = 0.010), length of stay (LOS) (OR 1.160, 95 CI% 1.041-1.289, P = 0.007), and complications (OR 31.873, 95 CI% 11.677-320.701, P = 0.000) was an independent risk factor for poor prognosis in elderly patients with EC. In elderly patients treated with SC, age (OR 1.105, 95% CI 1.010-1.209, P = 0.029) was an independent risk factor for poor prognosis. EC and SC interventions in elderly adults carry higher risks compared to non-older adults, and people should consider these risks and costs when making a decision between intervention and conservative treatment. In elderly patients who received EC or SC treatments, EC showed an advantage in improving outcomes in elderly patients although it increased the economic cost of the patient's hospitalization.

The senescence-associated secretome for prediction of mortality in patients with aortic valve stenosis undergoing TAVR

Abstract Background Cellular senescence is an essential mechanism in the process of aging. The senescence-associated secretory phenotype (SASP) includes mainly pro-inflammatory cytokines, proteases, soluble signalling factors, and growth modulators. Degenerative aortic valve stenosis (AVS) is the prototypical inflammatory age-related cardiovascular disease. Purpose Our aim was to assess whether circulating concentrations of SASP factors are associated with prognosis in elderly patients with AVS undergoing transcatheter aortic valve replacement (TAVR), the current standard therapy for severe cases. Methods A total of 24 SASPs were measured using the Luminex Multiplex ELISA Assay (Biotechene, GmbH) in 120 AVS patients undergoing TAVR between February 2017 and February 2020 with a prospective follow-up of up to 4 years. Receiver operating characteristic (ROC) curves were created for each SASP protein in order to identify predictive markers. SASPs were considered positive if their baseline value was above the cut-off value derived from ROC-curves. The only 3 independent predictive factors were selected to develop an easy-to-calculate score based on the number of positive SASP proteins (0 to 3). Primary endpoint was long-term all-cause mortality. Results Median (IQR) age of the population was 83.2 (78.9-87.0) years, 56.7% were women. According to ROC curves, 9 out of 24 SASPs showed a significant area under the curve (AUC), with values above 0.623 (see Table). Only 3 of the markers reflecting potentially different underlying mechanisms remained independent predictors, after including all SASP factors in a Cox Regression analysis: GDF-15, ICAM-1 and Osteoprotegerin (all, p&amp;lt;0.03). A score based on the number of baseline factors being above the AUC-derived threshold level showed an excellent discrimination ability to predict survival, with long-term all-cause mortality substantially increasing for each additional positive marker (see Kaplan-Meier curves). Conclusion In conclusion, the presence of elevated baseline levels for 0, 1, 2, or 3 of the independent SASP factors reflecting different underlying pathophysiological mechanisms predicts increased long-term all-cause mortality with profoundly improved discrimination power in AVS patients undergoing TAVR. If confirmed in further prospective studies, a combination of these 3 SASP markers could serve as a highly useful risk stratification tool in the elderly population with AVS.

Real-Word Analysis of Clinical Characteristics and Outcomes Among Elderly Patients (pts) with Multiple Myeloma (MM)

Multiple Myeloma (MM) occurs commonly among older adults and the median age at diagnosis is 70 years old. While modern MM therapeutic agents have increased overall survival (OS), the prognosis of elderly patients (pts) (defined as age &amp;gt;75 yo) has been trailing behind younger pts (age &amp;lt;65 yo). This gap has been ascribed to frailty. However, it is unknown if older MM pts have different disease biology compared with younger pts. The MMRF CoMMpass study is a longitudinal international, multicentric prospective study of 1143 pts with newly diagnosed MM. We interrogated this dataset to describe the disease characteristics and to identify prognostic factors for OS amongst pts. The MMRF CoMMpass IA19 dataset was used for all analyses. Pts were followed for a minimum of 8 years after diagnosis. One hundred forty-six patients were &amp;gt; 75 yo, referred to as the elderly patient group (EPG), (12.8% of the cohort). Patient and disease characteristics are described in Table 1. Overall, 59% are male, and 41% are female; 79.5% were white, and 18.5% were black. At presentation, 63% of pts have anemia, 15.1% have hypercalcemia, and 9.6% have renal insufficiency (defined as Cr&amp;gt;2mg/dL). The EPG more commonly presented with advanced staging (ISS III: 46.6% vs. 22.9%, p&amp;lt;0.001), anemia (63.0% vs. 52.6%, p&amp;lt;0.001), lower performance status (ECOG ≥2: 26% vs. 8.9% (p&amp;lt;0.001) compared to the &amp;lt;65 yo group. Regarding treatment, the EPG are more likely to receive only PI-based first-line treatment (45.2%), followed by PI/IMIDs-based combined therapy (36.3%). Only 10 elderly pts (6.9%) underwent high-dose melphalan and autologous stem cell transplant (ASCT). In terms of best overall response to any line of therapy, the EPG is much less likely to achieve deep responses (sCR or better: 22.2 vs. 3.5%, p &amp;lt; 0.001) and had worse OS compared to the &amp;lt;65 and 65-75 yo groups (47 months vs. NR vs. 80 months, respectively). The cause of death in the three age groups (disease progression vs. others was not statistically different, p=0.278). Notably, elderly pts who received triplet therapy versus double therapy at diagnosis have improved clinical outcomes with deeper responses (≥ sCR of 22.2 vs. 3.5%, p &amp;lt; 0.001) and increased median OS (47.6 months vs. 20.3 months, p &amp;lt; 0.001). We performed Cox regression analysis to evaluate prognostic factors for OS (Figure 1). Triplet therapy in the first line is associated with better OS (p=0.004). Conversely, decreased performance status (ECOG &amp;gt;1) and advanced ISS stage at presentation portend a worse prognosis (p=0.049 and p=0.044, respectively). Noteworthy, there is a higher attrition rate (defined as death or lost to follow-up) in the EPG. The attrition rate was 50.7% after first-line therapy, compared to 34.0% and 33.3% for the under 65 and 65-75 age groups, respectively (p&amp;lt;0.001). The attrition rate for elderly pts remained significantly higher after second and third-line therapies (p&amp;lt;0.001 and p=0.004, respectively). We analyzed if the clinical characteristics of the EPG differ based on race. We found that non- white patients were more likely to present with advanced stage (p=0.039) and target organ damage: anemia, p&amp;lt;0.001), hypercalcemia (p=0.046), and renal insufficiency (p&amp;lt;0.001). We did not find other differences in clinical characteristics, treatment received, attrition rates, and overall survival. In conclusion, our study adds to the knowledge that elderly pts are more likely to present with advanced disease and diminished functional status. They are less likely to receive combined PI/IMIDs therapy and ASCT as first-line treatment and to obtain deeper treatment responses. Moreover, our data showed high attrition rates in this population. These factors could result in the shorter overall survival seen in the elderly population and underscore the importance of prompt initiation of effective and safe therapies in the elderly population. Further clinical studies are needed to characterize disease heterogeneity better and to identify interventions to improve clinical outcomes of older adults with myeloma.

A Randomized, Open-Label, Phase 3 Study of Acalabrutinib in Combination with Rituximab and Reduced Dose CHOP (R-miniCHOP) in Older Adults with Untreated Diffuse Large B-Cell Lymphoma (ARCHED / GLA 2022-1)

Background Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype, and its incidence increases with age. Approximately 40% of patients with DLBCL are older than 70 years. Since the addition of the anti-CD20 antibody rituximab to CHOP regime (cyclophosphamide, doxorubicin, vincristine, and prednisone) prognosis in elderly patients has improved but still remains worse compared to their younger counterparts. Adequate dosage of chemotherapy in older adults is limited by comorbidities/frailty, especially in patients &amp;gt;80 years of age. An attenuated chemotherapy regimen, R-miniCHOP, has been evaluated in prospective trials and seems to provide a good balance between safety and efficacy in this vulnerable patient population (Peyrade et al, 2011). However, even with this regime, outcomes remain modest with 2-year overall survival at 50-60%, underlining the need for more effective treatment in this population. Acalabrutinib is a selective, irreversible, second-generation small molecule inhibitor of Bruton Tyrosine Kinase (BTK) with a more favorable safety profile compared to first generation BTK inhibitors. Although, not yet approved for the treatment of DLBCL, acalabrutinib showed promising results both as a single agent (Strati et al, Haematologica 2021) and in combination with full dose R-CHOP (Davies et al, ASH 2022), in patients aged up to 80 years. Furthermore, acalabrutinib carries the potential of improved efficacy in specific subgroups. The activated B-cell like (ABC) DLBCL subtype has been shown to depend on chronic active B-cell receptor signaling involving many downstream kinases including BTK. Additionally, the genetically defined subgroups MCD/C5, N1, and BN2/C1 and also may serve as potential predictive biomarkers for acalabrutinib. Study design and endpoints ARCHED is an investigator initiated, randomized, multicenter, open-label, phase III trial of R-miniCHOP with or without acalabrutinib in older adults with untreated DLBCL. Patients in the standard arm will receive 6 cycles of R-miniCHOP every 21 days followed by 2 cycles of rituximab alone, while patients in the experimental arm will receive the same regimen and additionally acalabrutinib 100 mg p.o. twice daily from day 1 to day 21 for 8 cycles (Figure 1). The primary endpoint of the study is investigator assessed progression-free survival (PFS). Secondary endpoints include overall survival, PFS per blinded independent review, event-free survival, outcomes according to cell of origin and molecular genotype, response rates, duration of response, progression, relapse and central nervous system (CNS) relapse rates as well as toxicity. Key eligibility criteria Patients are eligible for enrolment if they are &amp;gt;80 years old or &amp;gt;60 years old and ineligible for full-dose R-CHOP according to investigator assessment after standardized simplified geriatric evaluation and are diagnosed with untreated CD20+ DLBCL according to the 2017 WHO classification. Primary mediastinal lymphoma, high grade B-cell lymphoma and follicular lymphoma 3B as well as concurrent diagnosis of indolent lymphoma is allowed, but Richter's transformation is an exclusion criterion. Ann Arbor stage I patients can be included only in the presence of concomitant bulky disease (≥ 7.5 cm). Further exclusion criteria are CNS involvement, stroke or intracranial hemorrhage in the past 6 months and relevant organ dysfunction. An ECOG performance status score of 0 - 2 is required for enrolment but an ECOG score of 3 is acceptable if lymphoma associated. Statistical analysis With an expected 5% drop out rate, we aim to recruit 330 patients (165 in each arm) to achieve 80 % power at a 5 % significance level (two-sided) to observe a PFS difference of 15 % in favor of the experimental arm. An interim analysis for efficacy comparing PFS between the two treatment arms will be performed with n=200 patients and 1 year follow-up for the last patient, with approximately 50% of events. Additionally, an interim analysis for safety regarding treatment completion rates and all-cause mortality will take place when 92nd patient in each group has completed the sixth R-mini-CHOP cycle or died. ARCHED is an academic study of the German Lymphoma Alliance and is coordinated by the Saarland University Clinical Trials Unit. This study is funded by AstraZeneca GmbH. The trial is approved in the EU and is open for recruitment in Germany. (EU-CTN: 2022-501187-18-00, NCT05820841).

Characteristics of Preoperative Acute Myocardial Infarction in Elderly Hip Fracture Patients and Construction of a Clinical Prediction Model: A Retrospective Cohort Study.

The prognosis of elderly patients with acute myocardial infarction (AMI) is poor, and this study aimed to investigate the characteristics and predictors of preoperative AMI in elderly hip fracture patients and to propose a valid clinical prediction model. We collected clinical data of older hip fracture patients from January 2019 to December 2020. The data collected include demographic and clinical characteristics, underlying diseases and laboratory results. In AMI patients, we further collected type of myocardial infarctions, clinical symptoms, electrocardiogram (ECG), Killip class and diagnosis method. The prediction model was constructed by using Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses. In addition, the constructed prediction model was transformed into a nomogram. The performance of the model was evaluated using the area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrapping was used for validation. There are 40 (4.2%) cases developed AMI in all 958 patients. There were 685 (71.5%) female patients and 273 (28.5%) male patients. Among 40 AMI patients, 38 (95.0%) had Type 2 myocardial infarction (T2MI) and 2 (5.0%) had Type 1 myocardial infarction (T1MI). The majority of these ECG were ST segment depression (57.5%). Most elderly AMI patients (67.5%) presented asymptomatic. Predictors for preoperative AMI were higher age (OR 2.386, 95% CI 1.126-5.057), diabetes (OR 5.863, 95% CI 2.851-12.058), Hb≤100 g/L (OR 3.976, 95% CI 1.478-10.695), CRP≥40 mg/L (OR 6.998, 95% CI 2.875-17.033), and ALB≤35 g/L (OR 2.166, 95% CI 1.049-4.471). Good discrimination and calibration effect of the model was showed. Interval validation could still achieve the C-index value of 0.771. DCA demonstrated this nomogram has good clinical utility. This model has a good predictive effect on preoperative AMI in elderly patients with hip fracture, which can help to better plan clinical evaluation.

Oncological prognosis and morbidity of hepatectomy in elderly patients with hepatocellular carcinoma: a propensity score matching and multicentre study

PurposeWith increasing life expectancy, the number of elderly patients (≥ 65 years) with hepatocellular carcinoma (HCC) has steadily increased. Hepatectomy remains the first-line treatment for HCC patients. However, the prognosis of hepatectomy for elderly patients with HCC remains unclear.MethodsClinical and follow-up data from 1331 HCC patients who underwent surgery between 2008 and 2020 were retrospectively retrieved from a multicentre database. Patients were divided into elderly (≥ 65 years) and non-elderly (< 65 years) groups, and PSM was used to balance differences in the baseline characteristics. The postoperative major morbidity and cancer-specific survival (CSS) of the two groups were compared and the independent factors that were associated with the two study endpoints were identified by multivariable regression analysis.ResultsOf the 1331 HCC patients enrolled in this study, 363 (27.27%) were elderly, while 968 (72.73%) were not. After PSM, 334 matched samples were obtained. In the propensity score matching (PSM) cohort, a higher rate of major morbidity was found in elderly patients (P = 0.040) but the CSS was similar in the two groups (P = 0.087). Multivariate analysis revealed that elderly age was not an independent risk factor associated with high rates of major morbidity (P = 0.117) or poor CSS (P = 0.873). The 1-, 3- and 5-year CSS rates in the elderly and non-elderly groups were 91.0% versus 86.2%, 71.3% versus 68.8% and 55.9% versus 58.0%, respectively. Preoperative alpha fetoprotein (AFP) level, Child‒Pugh grade, intraoperative blood transfusion, extended hemi hepatectomy, and tumour diameter could affect the postoperative major morbidity and preoperative AFP level, cirrhosis, Child‒Pugh grade, macrovascular invasion, microvascular invasion (MVI), satellite nodules, and tumor diameter were independently and significantly associated with CSS.ConclusionAge itself had no significant effect on the prognosis of elderly patients with HCC after hepatectomy. Hepatectomy can be safely performed in elderly patients after cautious perioperative management.

Correlation between malnutrition and delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation

To investigate the relationship between malnutrition and delirium and its effect on prognosis in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. A prospective observational study was conducted. Patients with severe pneumonia aged ≥ 60 years old who underwent invasive mechanical ventilation admitted to department of critical care medicine of the Second People's Hospital of Lianyungang from January 2021 to December 2022 were enrolled. The confusion assessment method (CAM) was used to evaluate the delirium of the patients in intensive care unit (ICU). The score of CAM ≥ 1 was defined as delirium. Mini nutritional assessment short-form (MNA-SF) was used to assess the nutritional status of patients, and MNA-SF score ≤ 7 was defined as malnutrition. Patients were divided into delirium group and non-delirium group according to whether delirium occurred. The differences in clinical indicators, length of ICU stay, duration of mechanical ventilation and wake-up time after drug withdrawal were compared between the two groups. After 28 days of short-term follow-up, the patients were divided into death group and survival group, and the differences in the incidence of delirium and malnutrition between the two groups were compared. Binary multivariate Logistic regression analysis was used to screen the risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. Kaplan-Meier survival curve was used to analyze the effect of delirium on prognosis. A total of 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation were enrolled, of whom 98 survived and 34 died within 28 days, with a mortality of 25.76%. The incidence of malnutrition and delirium in the death group was significantly higher than that in the survival group (61.76% vs. 37.76%, 64.71% vs. 26.53%, both P < 0.05), and the MNA-SF score was significantly lower than that in the survival group (6.32±1.80 vs. 8.72±2.23, P < 0.01). Procalcitonin (PCT), interleukin-6 (IL-6) and blood lactic acid (Lac) in the death group were significantly higher than those in the survival group [PCT (μg/L): 4.47 (2.69, 10.39) vs. 2.77 (1.28, 5.94), IL-6 (ng/L): 204.08 (126.12, 509.85) vs. 120.46 (60.67, 290.99), Lac (mmol/L): 5.14 (2.75, 8.60) vs. 3.13 (2.16, 4.30), all P < 0.05], and the wake-up time after drug withdrawal was significantly longer than that in the survival group (minutes: 33.94±8.51 vs. 28.92±7.03, P < 0.01). Among 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation, 48 patients had delirium during ICU stay, and 84 patients did not have delirium. The incidence of delirium was 36.36%. The 28-day mortality in the delirium group was significantly higher than that in the non-delirium group (45.83% vs. 14.29%, P < 0.01), and the MNA-SF score was significantly lower than that in the non-delirium group (6.46±1.77 vs. 9.05±2.15, P < 0.01), the length of ICU stay, duration of mechanical ventilation, and wake-up time after drug withdrawal were also significantly longer than those in the non-delirium group [length of ICU stay (days): 13.40±9.59 vs. 10.06±7.81, duration of mechanical ventilation (hours): 197.06±89.80 vs. 138.81±82.30, wake-up time after drug withdrawal (minutes): 35.85±7.01 vs. 26.99±6.12, all P < 0.05]. Binary multivariate Logistic regression analysis showed that malnutrition [odds ratio (OR) = 7.527, 95% confidence interval (95%CI) was 2.585-21.917], Lac (OR = 5.345, 95%CI was 1.733-16.483), wake-up time after drug withdrawal (OR = 6.653, 95%CI was 2.021-21.904) were independent risk factors for delirium during ICU stay in elderly patients with severe pneumonia undergoing invasive mechanical ventilation (all P < 0.01). Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate of patients in the delirium group was significantly lower than that in the non-delirium group (54.17% vs. 85.71%), and the difference was statistically significant (Log-Rank test: χ2 = 16.780, P < 0.001). The risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation during ICU stay include malnutrition, Lac, and wake-up time after drug withdrawal. The occurrence of delirium is closely related to poor prognosis.

Establishment and Validation of Models for the Risk of Multi-Drug Resistant Bacteria Infection and Prognosis in Elderly Patients with Pulmonary Infection: A Multicenter Retrospective Study.

The aim of this study was to establish risk prediction and prognosis models for multidrug-resistant bacterial infections (MDRB) in elderly patients with pulmonary infections in a multicenter setting. This study is a retrospective cohort analysis in Anhui province of China. Data dimension reduction and feature selection were performed using the lasso regression model. Multifactorial regression analysis to identify risk factors associated with MDRB infection and prognosis. The relevant risks of each patient in the prognostic training cohort were scored based on prognostic independent risk factors. Subsequently, patients were classified into high-risk and low-risk groups, and survival differences were compared between them. Finally, models were established based on independent risk factors for infection, risk groups, and independent prognostic factors, and were presented on nomograms. The predictive accuracy of the model was assessed using corresponding external validation set data. The study cohort comprised 994 elderly patients with pulmonary infection. Multivariate analysis revealed that endotracheal intubation, previous antibiotic use beyond 2 weeks, and concurrent respiratory failure or cerebrovascular disease were independent risk factors associated with the incidence of MDRB infection. Cox regression analysis identified respiratory failure, malnutrition, an APACHE II score of at least 20, and higher blood creatinine levels as independent prognostic risk factors. The models were validated using an external validation dataset from multiple centers, which demonstrated good diagnostic ability and a good fit with a fair benefit. In conclusion, our study provides an appropriate and generalisable assessment of risk factors affecting infection and prognosis in patients with MDRB, contributing to improved early identification of patients at higher risk of infection and death, and appropriately guiding clinical management.

The relationship between GLIM-malnutrition, post-operative complications and long-term prognosis in elderly patients undergoing colorectal cancer surgery

The relationship between GLIM-malnutrition, post-operative complications and long-term prognosis in elderly patients undergoing colorectal cancer surgery

Survival of elderly patients with glioblastoma after hypofractionated radiation therapy

Background. Glioblastoma (GB) is the most common primary brain tumor that is malignant, and its incidence increases with age. The prognosis for elderly patients with GB (GBe) is significantly worse than that of younger patients. Due to the global trend of aging population and age-related features of the GB cohort, the number of GBe patients is expected to increase. Although there is no full consensus regarding the clinical management of GBe, hypofractionated radiation therapy (RT) has become a common therapeutic option for elderly and/or poor prognosis GB patients.&#x0D; Purpose. To analyze the survival of patients with glioblastoma in the age group ≥60 years old after standard and hypofractionated regimens of adjuvant radiation therapy.&#x0D; Materials and methods. A retrospective single-center non-randomized study based on a total cohort of 53 patients (≥60 years old) with histogically verified diagnosis of GB was performed at the State Institution «Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine» over the period of 6 years, from 2014 to 2020. According to the RT regimen, patients were stratified into 2 groups: standard RT (SRT group) – 16 (30.2%) patients (30 fractions, 2.0 Gy per fraction, total radiation dose – 60.0 Gy) and hypofractionated RT (HRT group) – 37 (69.8%) patients (15 fractions, 3.5 Gy per fraction, total dose – 52.5 Gy). Cancer-specific survival (CSS) and progression-free survival (PFS) were analyzed in the total cohort and both groups separately.&#x0D; Results. With a median follow-up of 21.9 months (95% CI (confidence interval) 20.7 – 32.3), the median CSS in the total cohort was 15.0 (95% CI 13.3 – 17.3) months; the median PFS – 9.0 (95% CI 8.0 – 10.6) months. In the HRT group, the median CSS was 14.7 (95% CI 10.5 – 18.5) months; in the SRT group – 15.0 (95% CI 12.4 – 19.3) months. In the HRT group, the median PFS was 9.0 (95% CI 7.0 – 11.9) months; in the SRT group – 9.0 (95% CI 8.0 – 11.0) months. Before and after the stratification point of 15 months, the HRT and SRT groups did not differ significantly in CSS (Log-rank test p = 0.0588 and p = 0.2009, respectively). There was no significant difference in PFS between the HRT and SRT groups before and after the stratification point of 9 months (Log-rank test p = 0.0653 and p = 0.0722, respectively). Conclusions. Improving survival of GBe pts is an urgent issue, especially taking into account global trends in population aging and age-specific features of GB. The proposed hypofractionated RT regime can be considered as an optional approach in the complex treatment of GBe pts.

The significance of autologous hematopoietic stem cell transplantation on immunoglobulin reconstitution and prognosis in elderly patients with multiple myeloma

ABSTRACTObjectivesAutologous hematopoietic stem cell transplantation (ASCT) is a crucial method used in patients with multiple myeloma (MM). This study aims to evaluate the role of ASCT in immunoglobulin (Ig) reconstitution and long-term outcomes in patients aged ≥ 60 years.MethodsFrom March 2008 to May 2019, 93 patients aged ≥ 60 years who were diagnosed with MM and underwent ASCT were retrospectively analyzed. All patients underwent follow-ups and the deadline for follow-up was October 31, 2022. The Ig levels were measured using the immune turbidimetry method at 3, 6, and 12 months after transplantation. Patients who died or experienced relapse were excluded from the analysis. The prognostic value of Ig levels was estimated using the Kaplan-Meier survival curve and Cox regression method.ResultsNo patients died, and all patients with complications showed improvements after treatment. Patients in the Ig reconstitution group had a lower international staging system (ISS) stage, whereas those in the immunoparesis group had a higher ISS stage. The median duration of follow-up was 36 (range, 13–120) months. The Ig reconstitution within 12 months indicated a longer overall survival and progression-free survival outcomes. The detection of Ig levels was an independent indicator for the prognosis of MM.Discussion and conclusionThe Ig reconstitution within 12 months of ASCT could predict the overall outcomes of patients with MM aged ≥ 60 years.

The fibrinogen-albumin ratio as a novel prognostic factor for elderly patients with osteosarcoma.

To analyze the prognostic value of fibrinogen-albumin ratio (FAR) in predicting the overall survival in elderly osteosarcoma patients. One hundred nineteen elderly osteosarcoma patients (> 40 years old) from 2 centers were retrospectively reviewed and analyzed. The cutoff values of the biomarker were calculated via receiver operating characteristic curves, and the cohort was divided into high FAR group and low FAR group. The association between the FAR and clinical-pathological parameters was analyzed. And the prognosis of elderly osteosarcoma patients and the potential risk factors were analyzed using Kaplan-Meier method and Cox proportional hazards model. Finally, a clinical nomogram was constructed, and its predictive capacity was verified. According to receiver operating characteristic results, the cutoff value for FAR was 0.098, and the enrolled patients were divided into the low FAR group and high FAR group. The FAR was significantly correlated with several clinical-pathological characteristics, including age, tumor size, tumor stage, recurrence, and metastasis. Moreover, the multivariate Cox analyses results showed that the FAR, pathological fracture, and metastasis were independent risk factors for overall survival in elderly osteosarcoma patients. The predictive nomogram was subsequently constructed, representing satisfactory predictive performance for prognosis in elderly patients with osteosarcoma. The FAR value is a promising indicator for elderly osteosarcoma patients, which is correlated with the various clinical characteristics and prognosis. A clinical nomogram integrating FAR and other clinical indicators is a convenient and available tool to assess the prognosis and manage the individualized and precise treatment of elderly patients with osteosarcoma.

An Easy-to-Use Nomogram Based on SII and SIRI to Predict in-Hospital Mortality Risk in Elderly Patients with Acute Myocardial Infarction.

Inflammatory response is closely associated with poor prognosis in elderly patients with acute myocardial infarction (AMI). The aim of this study was to develop an easy-to-use predictive model based on medical history data at admission, systemic immune inflammatory index (SII), and systemic inflammatory response index (SIRI) to predict the risk of in-hospital mortality in elderly patients with AMI. We enrolled 1550 elderly AMI patients (aged ≥60 years) with complete medical history data and randomized them 5:5 to the training and validation cohorts. Univariate and multivariate logistic regression analyses were used to screen risk factors associated with outcome events (in-hospital death) and to establish a nomogram. The discrimination, calibration, and clinical application value of nomogram were evaluated based on receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), respectively. The results of multivariate logistic regression showed that age, body mass index (BMI), previous stroke, diabetes, SII, and SIRI were associated with in-hospital death, and these indicators will be included in the final prediction model, which can be obtained by asking the patient's medical history and blood routine examination in the early stage of admission and can improve the utilization rate of the prediction model. The areas under the ROC curve for the training and validation cohorts nomogram were 0.824 (95% CI 0.796 to 0.851) and 0.809 (95% CI 0.780 to 0.836), respectively. Calibration curves and DCA showed that nomogram could better predict the risk of in-hospital mortality in elderly patients with AMI. The nomogram constructed by combining SII, SIRI, and partial medical history data (age, BMI, previous stroke, and diabetes) at admission has a good predictive effect on the risk of in-hospital death in elderly patients with AMI.

Correlation of neck circumference, coronary calcification severity and cardiovascular events in Chinese elderly patients with acute coronary syndromes

Background and aimsWe aimed to investigate whether neck circumference (NC) can predict metabolic syndrome (MetS), coronary calcification and lesion, and major adverse cardiovascular events (MACEs). MethodsA total of 867 patients with acute coronary syndrome (ACS) over 60 years old from the Second Hospital of Shandong University, who had undergone coronary computed tomography, were randomly selected for a retrospective analysis. The subjects were divided into male and female groups, NC quartile 1–4 groups (Q1-Q4 groups), non-multivessel coronary disease (non-MVCD) and multi-vessel coronary disease (MVCD) groups. ResultsAfter adjusting for potential confounders, NC was associated with risk factors promoting coronary artery disease (CAD) and coronary artery calcification score (CACS). The severity of CAD increased by 0.202 times and 0.372 times for each unit of NC in male and female groups, respectively. Compared with the lower CACS group, the risk of coronary calcification increased by 0.139 times, and MVCD increased 0.268 times, with each unit increase of NC. Except for all-cause death, there were significant differences between the Q1-Q4 groups in the prevalence of all primary endpoints, cardiogenic death, unexpected re-hospitalization of heart failure, ACS recurrence or unplanned revascularization, and non-fatal stroke (p log-rank <0.01). In view of the overall trend, with the increase of NC quartiles, the prevalence of MACEs gradually increased (all p < 0.01). ConclusionsNC is closely associated with MetS and its components, coronary calcification and lesion degree, and MACEs. NC could be used as surrogate of CACS to predict the coronary condition and prognosis of elderly patients with ACS.

Advances in rectal cancer: Real-world evidence suggests limited gains in prognosis for elderly patients

BackgroundRectal cancer treatment has improved considerably due to the introduction of total meso-rectal excision, radio-chemotherapy, and high-resolution imaging. The aim of this observational cohort study was to quantify the effectiveness of these advances using high-quality data from a representative cohort of patients. Methods20 281 non-metastasized cases retrieved from the Munich Cancer Registry database were divided into three time periods corresponding to before (1988–1997), partial (1998–2007), and full implementation (2008–2019) of clinical advances. Early-onset (<50 yrs.), middle-aged, elderly patient subgroups (> 70 yrs.) were compared. The overall effectiveness of evidence-based guideline adherence was also examined. ResultsMedian survival improved by 1.5 yrs. from the first to the last time period. Relative survival increased from 74.9% (5-yr 95%CI[73.3 – 76.6]) to 79.2% (95%CI[77.8 – 80.5]). The incidence of locoregional recurrences was reduced dramatically by more than half (5-yr 17.7% (95%CI[16.5 – 18.8]); 6.7% (95%CI[6.1 – 7.3])). Gains in 5-yr relative survival were limited to early-onset and middle-aged patients with no significant improvement seen in elderly patients (Female 68.6% [63.9 – 73.3] to 67.6% [64.0 – 71.2]; Male 71.7% [65.9 – 77.4] to 74.0% [70.8 – 77.2]). ConclusionsReal-world evidence suggests that recent treatment advances have lead to an increase in prognosis for rectal cancer patients. However, more effort should be made to improve the implementation of new developments in elderly patients. Especially considering, that these cases represent a growing majority of diagnosed patients.

The role of neutrophil percentage to albumin ratio in predicting 1-year mortality in elderly patients with hip fracture and external validation.

This study aimed to investigate the association between the neutrophil percentage to albumin ratio (NPAR) on the day of admission and mortality 1 year after surgery in elderly patients with hip fractures. Clinical characteristics and blood markers of inflammation were retrospectively collected from October 2016 to January 2022 in elderly patients with hip fractures at two different regional tertiary medical centers. It is divided into a training set and an external validation set. Multivariate Nomogram models such as NPAR were constructed using the least absolute shrinkage and selection operator (LASSO) regression results and multi-factor logistic regression analysis. In addition, multivariate Cox regression analysis and Kaplan-Meier survival curves were used to explore the relationship between NPAR values and mortality within 1 year in elderly patients with hip fractures. The predictive performance of the Nomogram was evaluated using the concordance index (C Index) and receiver operating characteristic curve (ROC) and validated by Bootstrap, Hosmer-Lemesow goodness of fit test, calibration curve, decision curve, and clinical impact curve analysis. The study included data from 1179 (mean age, 80.34 ± 8.06 years; 61.4[52.1%] male) patients from the Guangzhou Red Cross Hospital affiliated with Jinan University and 476 (mean age, 81.18 ± 8.33 years; 233 [48.9%] male) patients from the Xiaogan Central Hospital affiliated with Wuhan University of Science and Technology. The results showed that NPAR has good sensitivity and specificity in assessing patients' prognosis 1 year after surgery. Multivariate logistic regression models based on influencing factors such as NPAR have good discrimination and calibration ability (AUC=0.942, 95% CI:0.927-0.955; Hosmer-Lemeshow test: P >0.05). Kaplan-Meier survival curves for the training and validation sets showed that patients in the high NPAR group had a higher mortality rate at 1 year compared to the low NPAR group (P< 0.001). Multivariate Cox regression showed that high NPAR values were an independent risk factor for death within 1 year in elderly hip fracture patients (P< 0.001, HR =2.38,95%CI:1.84-3.08). Our study showed that NPAR levels were significantly higher in patients who died within 1 year after surgery in both the training and validation sets. NPAR has good clinical value in assessing 1-year postoperative prognosis in elderly patients with hip fractures.

Elevated High Sensitivity Cardiac Troponin T is Nonlinearly Associated with Poor Prognosis in Aging COVID-19 Patients: A Retrospective Study.

To evaluate the relationship between high-sensitivity cardiac troponin T (hs-cTnT) and prognosis in elderly patients with coronavirus disease 2019 (COVID-19). This study recruited 1399 COVID-19 patients aged 65 years or older admitted to Taizhou Hospital or Enze Hospital in Zhejiang Province from December 15, 2022, to January 4, 2023. The Cox regression model was used to evaluate the relationship between hs-cTnT level and in-hospital death. The logistic regression model was used to evaluate the relationship between hs-cTnT level and major adverse events. The restricted cubic spline (RCS) model is used for nonlinear analysis. The increase of peak hs-cTnT was associated with the increased risk of death (HR 9.49; 95% CI 1.19-75.48; trend p = 0.012) and major adverse events (OR 20.59; 95% CI 10.41-40.71; trend p < 0.001). RCS model showed the association between peak hs-cTnT and death and major adverse events were nonlinear (P for non-line < 0.001). Starting from the limit of quantification of hs-cTnT (3ng/L), the risk of death and major adverse events had a steep S-shaped increase until hs-cTnT reached the 90th percentile point (hs-cTnT = 131 ng/L), followed by a plateau period. Peak hs-cTnT has good predictive value for death and major adverse events, with AUC of 0.834 and 0.804, respectively. Peak hs-cTnT has high predictive value for the risk of in-hospital death and major adverse events in elderly patients with COVID-19. The association between peak hs-cTnT and death and major adverse events were nonlinear.