Short-term Prognosis In Elderly Patients Research Articles

Pulse pressure variation guided goal-direct fluid therapy decreases postoperative complications in elderly patients undergoing laparoscopic radical resection of colorectal cancer: a randomized controlled trial

ObjectiveThe use of goal-directed fluid therapy (GDFT) has been shown to reduce complications and improve prognosis in high-risk abdominal surgery patients. However, the utilization of pulse pressure variation (PPV) guided GDFT in laparoscopic surgery remains a subject of debate. We hypothesized that utilizing PPV guidance for GDFT would optimize short-term prognosis in elderly patients undergoing laparoscopic radical resection for colorectal cancer compared to conventional fluid therapy.MethodsElderly patients undergoing laparoscopic radical resection of colorectal cancer were randomized to receive either PPV guided GDFT or conventional fluid therapy and explore whether PPV guided GDFT can optimize the short-term prognosis of elderly patients undergoing laparoscopic radical resection of colorectal cancer compared with conventional fluid therapy.ResultsThe incidence of complications was significantly lower in the PPV group compared to the control group (32.8% vs. 57.1%, P = .009). Additionally, the PPV group had a lower occurrence of gastrointestinal dysfunction (19.0% vs. 39.3%, P = .017) and postoperative pneumonia (8.6% vs. 23.2%, P = .033) than the control group.ConclusionUtilizing PPV as a monitoring index for GDFT can improve short-term prognosis in elderly patients undergoing laparoscopic radical resection of colorectal cancer.Registration numberChiCTR2300067361; date of registration: January 5, 2023.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Important Indicators for Predicting in-Hospital Death in Elderly AMI Patients.

To investigate the role of neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte(PLR) in predicting the risk of in-hospital mortality in elderly acute myocardial infarction(AMI) patients. This study was a single-center, retrospective and observational study. From December 2015 to December 2021, a total of 1550 elderly patients (age ≥ 60 years) with AMI with complete clinical history data were enrolled in the Second Hospital of Dalian Medical University. Routine blood tests were performed on admission, and NLR and PLR were calculated based on neutrophil, platelet, and lymphocyte counts. Outcome was defined as all-cause mortality during hospitalization. Cox regression and restricted spline cubic(RCS) models were used to evaluate the association of NLR and in-hospital mortality risk and the association of PLR with in-hospital mortality risk, respectively. (1) A total of 132 (8.5%) patients died during hospitalization. From the results of blood routine, the white blood cell, neutrophil, NLR and PLR in the death group were higher than those in the non-death group, while the lymphocyte was lower than that in the non-death group, and the difference was statistically significant (P < 0.05). (2) The results of receiver operating characteristic(ROC) curves analysis showed that the predictive ability of NLR (AUC = 0.790) for in-hospital death was better than that of PLR (AUC = 0.637). (3) Multivariate Cox proportional regression hazard models showed that high NLR was associated with the risk of in-hospital mortality in elderly AMI patients (HR = 3.091, 95% CI 2.097-4.557, P < 0.001), while high PLR was not. (4) RCS models showed a nonlinear dose-response relationship between NLR and in-hospital death (P for nonlinear = 0.0007). High NLR (> 6.69) is associated with the risk of in-hospital mortality in elderly patients with AMI and can be an independent predictor of poor short-term prognosis in elderly patients with AMI.

Prognostic value of Doppler echocardiographic coronary flow velocity assessment at rest in elderly patients

Background Atherosclerosis and coronary artery disease (CAD) are a common condition and cause of death in the elderly population. There are difficulties with risk assessment in the elderly as the objectification of their symptomatic status can be challenging due to neuromuscular weakness, physical deconditioning or neurological, orthopaedic, peripheral vascular, or respiratory limitations. Non-invasive coronary artery velocity assessment by Doppler method at rest could be helpful in the elderly population. To evaluate the prognostic role of coronary artery ultrasound assessment in a non-selected elderly population in everyday clinical practice. Methods One hundred forty-five patients, aged ≥75years (99 women; 80 ± 4 years), formed the study group. Left coronary artery flows were scanned in addition to conventional echocardiography. During a median follow-up of 26 months, 16 deaths and 2 non-fatal MI occurred. Results In multivariable analysis, maximal coronary velocity was the only independent predictor for mortality (heart rate [HR]: 1.02, 95%, CI: 1.01–1.04, p < .0005) and for mortality/MI (HR: 1.02, 95%, CI: 1.01–1.03, p < .0001). The value of 110 cm/s maximal coronary flow velocity (CFL) in the proximal segments of left arteries was the best predictor for death, sensitivity 50%, specificity 90%, p < .005. The annual mortality rate was 16.6% persons/year for patients with elevated CFL ≥110 cm/s. The value 81 cm/s was the best predictor for death/MI, sensitivity 61%, specificity 80%, p < .0005; annual mortality rate was 11.2% persons/year for patients with elevated CFL ≥81 cm/s (p < .0001). Conclusion Doppler CFL scanning during routine echocardiography is a feasible and valuable tool for assessment of short-term prognosis in elderly patients.

Short-term coronary risk assessment in the elderly population

Abstract Funding Acknowledgements Type of funding sources: None. Background. Atherosclerosis and coronary artery disease (CAD) are a common condition and cause of death in the elderly population. There are difficulties with risk assessment in the elderly as the of their symptomatic status can be challenging due to neuromuscular weakness, physical deconditioning or neurological, orthopaedic, peripheral vascular, or respiratory limitations. Non-invasive coronary artery velocity assessment by Doppler method at rest could be helpful in the elderly population. Aim To evaluate the prognostic role of coronary artery ultrasound assessment in a non-selected elderly population in everyday clinical practice. Methods: 145 patients, aged ≥75years (99 women; 80 ± 4 years), formed the study group. Left coronary artery flows were scanned in addition to conventional echocardiography. During a median follow-up of 26 months, 16 deaths and 2 non-fatal MI occurred. Results: In multivariable analysis, maximal coronary velocity was the only independent predictor for mortality (HR: 1.02, 95%, CI: 1.01-1.04, p &amp;lt; 0.0005), and for mortality/MI (HR: 1.02, 95%, CI: 1.01-1.03, p &amp;lt; 0.0001). The value of 110 cm/s maximal coronary flow velocity in the proximal segments of left arteries was the best predictor for death, sensitivity 50%, specificity 90%, p &amp;lt; 0.005. The annual mortality rate was 16.6% persons/year for patients with elevated coronary flow velocity ≥110 cm/s. The value 81 cm/s was the best predictor for death/MI, sensitivity 61%, specificity 80%, p &amp;lt; 0.0005; annual mortality rate was 11.2% persons/year for patients with elevated coronary flow velocity ≥81 cm/s (p &amp;lt; 0.0001). Conclusion Doppler coronary flow velocity scanning during routine echocardiography is a feasible and valuable tool for assessment of short-term prognosis in elderly patients. Abstract Figure.

Prediction of short-term prognosis in elderly patients with spontaneous intracerebral hemorrhage.

The incidence of spontaneous intracerebral hemorrhage (SICH) increases with age. Data on SICH mortality in the very old are sparse. We aimed to describe the predictors of 30-day SICH mortality in the very elderly in southern Portugal. A total of 256 community representative SICH patients aged ≥ 75years (2009-2016) were included. Multiple logistic regression was used to identify predictors of 30-day mortality. Mean age was 82.1years; 57.4% males. The 30-day case fatality was 38.7%. The frequency of patients taking anticoagulants (29.3% vs. 11.5%); comatose (46.9% vs. 2.5%); with hematoma volume ≥ 30mL (64.6% vs. 13.4%); intraventricular dissection (78.8% vs. 27.4%) was higher in deceased patients (p < 0.05). Survivors were more often admitted to stroke unit (SU) (68.2 vs. 31.3%) and had lower mean admission glycaemia values (p < 0.05). The likelihood of death was increased in patients with higher admission hematoma volume (≥ 30mL) (OR: 8.817, CI 1.753-44.340, p = 0.008) and with prior to SICH history of ≥ 2 hospitalizations OR = 1.022, CI 1.009-1.069, p = 0.031). Having higher Glasgow coma scale score, OR: 0.522, CI 0.394-0.692, p < 0.001, per unit was associated with reduced risk of death. Age was not an independent risk factor of short-term death. The short-term mortality is high in very elderly SICH. Prior to SICH history of hospitalization, an indirect and gross marker of coexistent functional reserve, not age per se, increases the risk of short-term death. Other predictors of short-term death are potentially manageable reinforcing the message against any defeatist attitude toward elderly patients with SICH.

Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI.

This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI). Seventy-eight STEMI patients with age >65 years who underwent emergency PCI were consecutively enrolled. These patients received conventional PCI and were randomly divided into a control group and a treatment group (n=39 per group). The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery. The treatment group received intracoronary injection of tirofiban and nicorandil, and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery. The following parameters were measured: TIMI grade, corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), ST-segment resolution (STR) rate 2 hours post-operatively, resolution of ST-segment elevation (STR) at 2 hours postoperatively, peak level of serum CK-MB, left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) at 7-10 days postoperatively, and major adverse cardiac events (MACEs) in-hospital and within 30 days post-operatively. Compared with the control group, more patients in the treatment group had TIMI 3 and TMPG 3, and STR after PCI was significantly higher. The treatment group also had significantly lower cTFC, lower infarction relative artery (IRA), lower peak CK-MB, and no reflow ratio after PCI. The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group. The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve short-term prognoses.

Predicting 6-Month Mortality in Incident Elderly Dialysis Patients: A Simple Prognostic Score

Aim: Mortality in end-stage renal disease (ESRD) remains high, particularly among elderly, who represents the most rapidly growing segment of the ESRD population in wealthier countries. We developed and validated a risk score in elderly patients to predict 6-month mortality after dialysis initiation. Methods: We used data from a cohort of 421 patients, aged 65 years and over who started dialysis between 2009 and 2016, in our Nephrology department. The predictive score was developed using a multivariable logistic regression analysis. A bootstrapping technique was used for internal validation. Results: The overall mortality within 6 months was 14.0%. Five independent predictors were identified, and a points system was constructed: age 75 years or older (2 points), coronary artery disease (2), cerebrovascular disease with hemiplegia (2), time of nephrology care before dialysis (<3.0 months [2]; ≥3 to <12 months [1]), and serum albumin levels (3.0–3.49 g/dL [1]; <3.0 g/dL [2]). A score of 6 identified patients with a 70% risk of 6-month mortality. Model performance was good in both discrimination (area under the curve of 0.793; [95% CI 0.73–0.86]) and validation (concordance statistics of 0.791 [95% CI 0.73–0.85]). Conclusions: We developed a simple prediction score based on readily available clinical and laboratory data that can be a practical and useful tool to assess short-term prognosis in elderly patients starting dialysis. It may help to inform patients and their families about ESRD treatment options and provide a more patient-centered overall approach to care.

Analysis of risk factors affecting short-term prognosis in elderly patients with aspiration pneumonia

Objective To explore the effects of nutritional status and severity of infection on short-term prognosis in elderly patients with aspiration pneumonia (AP), and to evaluate the risk factors of the disease. Methods Total of 116 elderly AP patients were retrospectively analyzed who were treated in emergency of Beijing Tongren Hospital between January 2015 and March 2018. Nutrition index, PSI and BMI of the patients were assessed on admission, while white blood cell count(WBC), neutrophil ratio, high sensitivity C-reactive protein (CRP), procalcitonin(PCT), total lymphocyte count, serum albumin, hemoglobin, cholesterol , triglycerides and cholinesterase were assessed during hospitalization. All 116 patients were divided into survival group or death group after admission 30 days. Results Totally 116 elderly AP patients treated in Emergency Department of Beijing Tongren Hospital between January 2015 and March 2018 were retrospectively analyzed. Nutrition index, PSI and body mass index (BMI) of the patients were assessed on admission, while white blood cell count (WBC), neutrophil ratio, high sensitivity C-reactive protein (CRP), procalcitonin (PCT), total lymphocyte count, serum albumin, hemoglobin, cholesterol, triglycerides and cholinesterase were assessed during hospitalization. All 116 patients were divided into the survival group or the death group according to the prognosis on 30 days after admission. Conclusions Nutrition status and the severity of infection have significant impact on the prognosis of elderly patients with AP, and for indicators, nutrition index, WBC, PSI and cholinesterase levels were crucial. The effective anemia amelioration, nutrition improvement and infection control are essential components for reducing mortality of elderly patients with AP. Key words: Aged; Aspiration pneumonia; Prognosis; Nutrition; Risk factors

Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism: A prospective validation study.

IntroductionComputed tomography pulmonary angiography (CTPA) has not only become the method of choice for diagnosing acute pulmonary embolism (PE), it also allows for risk stratification of patients with PE. To date, no study has specifically examined the predictive value of CTPA findings to assess short-term prognosis in elderly patients with acute PE who are particularly vulnerable to adverse outcomes.MethodsWe studied 291 patients aged ≥65 years with acute symptomatic PE in a prospective multicenter cohort. Outcomes were 90-day overall and PE-related mortality, recurrent venous thromboembolism (VTE), and length of hospital stay (LOS). We examined associations of the computed tomography obstruction index (CTOI) and the right ventricular (RV) to left ventricular (LV) diameter ratio with mortality and VTE recurrence using survival analysis, adjusting for provoked VTE, Pulmonary Embolism Severity Index (PESI), and anticoagulation as a time-varying covariate.ResultsOverall, 15 patients died within 90 days. There was no association between the CTOI and 90-day overall mortality (adjusted hazard ratio per 10% CTOI increase 0.92; 95% confidence interval [CI] 0.70–1.21; P = 0.54), but between the CTOI and PE-related 90-day mortality (adjusted sub-hazard ratio per 10% CTOI increase 1.36; 95% CI 1.03–1.81; P = 0.03). The RV/LV diameter ratio was neither associated with overall nor PE-related 90-day mortality. The CTOI and the RV/LV diameter ratio were significantly associated with VTE recurrence and LOS.ConclusionsIn elderly patients with acute PE, the CTOI was associated with PE-related 90-day mortality but not with overall 90-day mortality. The RV/LV diameter ratio did not predict mortality. Both measures predicted VTE recurrence and LOS. The evaluated CTPA findings do not appear to offer any advantage over the PESI in terms of mortality prediction.

The clinical characteristics and short-term prognosis in elderly patients with Guillain-Barré syndrome.

To investigate the clinical characteristics and short-term prognosis of elderly patients with Guillain–Barré syndrome (GBS).We retrospectively analyzed the clinical data of adult GBS. According to the age, the enrolled subjects were divided into 2 groups, that is, patients ≥60 years (elderly group) and those aged 18 to 59 years (nonelderly group). The clinical characteristics and short-term prognosis of the patients in the 2 groups were compared.In total, 535 patients were enrolled. There were 67 patients fell into the elderly group with a mean age of 69 years old; while 468 patients fell into the nonelderly group with a mean age of 39 years old. We found that the elderly patients had significantly lower incidence of antecedent infections (49.3% vs 66.2%, P < 0.01). The time from onset to admission (5 vs 4 days, P < 0.05) and time from onset to nadir (7 vs 6 days, P < 0.05) were significantly longer in the elderly patients. It was noteworthy that more elderly patients were found with lymphocytopenia (55.4% vs 37.3%, P < 0.01), hyponatremia (25.0% vs 10.2%, P < 0.01), hypoalbuminemia (9.0% vs 2.6%, P < 0.05), and hyperglycemia (34.3% vs 15.2%, P < 0.01). Importantly, the elderly patients had longer duration of hospitalization (17 vs 14 days, P < 0.05), higher incidence of pneumonia (29.9% vs 18.8%, P < 0.05), and poorer short-term prognosis (58.2% vs 42.7%, P < 0.05). In patients with severe GBS, no significant differences were observed in disease severity, treatment modality, incidence of pneumonia, and duration of hospitalization between the 2 groups. However, more patients in the elderly group showed poor short-term prognosis (84.1% vs 63.8%, P < 0.01). Further, old age (≥60 years) (OR = 2.906, 95% CI: 1.174–7.194, P < 0.05) and lower Medical Research Council (MRC) score at nadir (OR = 0.948, 95% CI: 0.927–0.969, P < 0.01) were risk factors for poor short-term prognosis in severe GBS patients.The clinical characteristics and short-term prognosis of elderly patients with GBS are distinct from nonelderly adults. Old age (≥60 years) and lower nadir MRC score serve as predictor for poor short-term prognosis in severe GBS patients.

Effect of tirofiban on short-term prognosis of elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention

Objective To evaluate the effect of tirofiban on short-term prognosis of elderly patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention(PCI).Methods Totally 325 ACS patients were divided into two groups: Tirofiban group(n = 210) and control group(n= 115).All subjects underwent PCI with drug-eluting stents.Patients in tirofiban group received tirofiban,in addition to aspirin and clopidogrel.Patients in control group received oral administration of aspirin and clopi-dogrel only.The general data,the rate of thrombolysis in myocardial infarction(TIMI) grade 3 flow immediately after PCI,the in-stent thrombosis incidence,mild and severe bleeding rate,platelet decrease rate,mortality,and incidences of myocardial infarction (MI) and target vessel revascularization(TVR) at 30 days after PCI were compared between the two groups.Results The rate of TIMI grade 3 flow immediately after PCI was significantly higher in Tirofiban group than in control group(99.05%vs 94.78%,P0.05).The in-stent thrombosis incidence was lower in Tirofiban group than in control group(0.47%vs 3.47%,P0.01).The mortality and incidences of MI and TVR at 30 days after PCI were lower in Tirofiban group than in control group(0.00%vs 2.61%,0.47%vs 3.47%,and 0.47%vs 1.73%,P0.01).The mild bleeding rate was higher in Tirofiban group than in control group,with no significant difference(7.14%vs 4.35%,P0.05).The rates of severe bleeding and platelets decrease were not significantly different between the two groups(0.00%vs 0.00%,and 0.95%vs 0.87%,P0.05).Conclusion Tirofiban can improve the TIMI grade flow in elderly patients with ACS after PCI.It can also decrease the in-stent thrombosis incidence,mortality,and incidences of MI and TVR at 30 days after PCI,but do not increase the rates of severe bleeding and platelets decrease in these patients.So it can improve the short-term prognosis in elderly patients with ACS undergoing PCI.

Short-term Prognostic Factors in Elderly Patients Seen in Emergency Departments for Acute Heart Failure

To investigate factors associated with short-term mortality in elderly patients seen in emergency departments for an episode of acute heart failure. A prospective, non-interventional, multicenter, cohort study was carried out in patients aged 65 years and older who were treated in the emergency department of one of eight tertiary hospitals in Spain. Twenty-eight independent variables that could influence mortality at 30 days were assessed. They covered epidemiological and clinical factors and daily functioning. Data were obtained by reviewing medical records or by interviewing the patient or a relative. Multivariate logistic regression analysis was performed. The study included 623 patients, 42 of whom (6.7%) died within 30 days of visiting the emergency department. Four variables were significantly associated with higher mortality: functional dependence at baseline (i.e., Barthel index=60; odds ratio [OR]=2.9; 95% confidence interval [CI], 1.2-6.5), New York Heart Association class III-IV (OR=3; 95% CI, 1.3-7), systolic blood pressure <100 mmHg (OR=4.8; 95% CI, 1.6-14.5) and blood sodium <135 mEq/l (OR=4.2; 95% CI, 1.8-9.6). Several factors evaluated on initial assessment in the emergency department, including the level of functional dependence, were found to determine a poor short-term prognosis in elderly patients who present with an episode of acute heart failure.

Risk factors for short-term prognosis in elderly patients with upper gastrointestinal bleeding

Eighty-five elderly patients treated for the upper gastrointestinal bleeding(UGB)in our hospital between January 2000 and December 2002 were divided into death or survival group.Their clinical characteristics,risk factors,treatment and complications were retrospectively analyzed.Eighteen patients died of UGB within 30 days.Univariate analysis indicated that documented diabetes,cardiovascular disease,cerebrovascular disease,gastric ulcer,hemoglobin,arrhythmia,stomach cancer,multiple organ dysfunction syndrome(MODS),and shock were significantly associated with inhospital mortality within 30 days(P＜0.05 or P＜0.01).Stomach cancer,MODS,and shock entered into the Logistic regression model.These findings demonstrate that stomach cancer,MODS,and shock might be independent risk factors for short-term prognosis in elderly UGB patients. Key words: Gastrointestinal Hemorrhage; Prognosis