Status In Elderly Patients Research Articles

Prognostic significance of malnutrition scores in elderly patients for the prediction of contrast-induced acute kidney injury.

Malnutrition reflects the general condition of a patient including physical condition, protein turnover, and immune competence. Contrast-induced acute kidney injury (CI-AKI) is a disorder that adversely affects the prognosis of older adults. In our study, we aimed to show the relationship between CI-AKI and malnutrition status in elderly patients over 65years of age with chronic coronary artery disease (CAD). Study enrolled 360 consecutive patients with coronary angiography performed because of chronic coronary artery disease. Patients pre-procedural and post-procedural blood samples were taken and prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, and geriatric nutritional risk index (GNRI) malnutrition scores were calculated. The median age of the patients included in the study was 69 (67-72, IQR) and CI-AKI was seen in 91 (25.2%) patients. Univariate regression analysis showed that age, diabetes mellitus, baseline creatinine, body weight-adapted contrast agent, haemoglobin, left ventricular ejection fraction, CONUT score, PNI score, and GNRI score were independent predictors of CI-AKI. In model 1, increase in CONUT score (2 to 5) (OR: 3.21 (2.11-4.88), in model 2, increase in PNI score (37.4 to 45) (OR: 0.34, (0.24-0.49)), and in model 3, increase in GNRI score (89.5 to 103.8) (OR: 0.55, (0.38-0.81)) were independently associated with the presence of CI-AKI. PNI showed better results than other models in discriminating the predictable capability for CI-AKI. Malnutrition assessment of elderly patients before performing diagnostic or interventional coronary procedures could help clinicians to identify patients with elevated risk for CI-AKI.

789 Improving Compliance of The MUST Tool Through Multiple Interventions, Improves Documentation and Assessment of Nutritional Status in Trauma and Orthopaedic Patients Undergoing Surgery

Abstract Introduction The Malnutrition Universal Screening Tool (MUST) is a nationally validated risk tool, used to identify adults who are malnourished. 40% of surgical patients are malnourished which significantly impacts the outcomes of elderly patients. The primary aim of this study was to ascertain its utilisation in elderly patients undergoing trauma and orthopaedic surgery in a district general hospital. Method We completed a closed-loop audit from October2019-June2020 over two, three-week periods Inclusion criteria was age ≥65 years, and patients undergoing surgery. Data collected included MUST score, nutritional support, pre-operative fasting time, and prescription of fluids. Our intervention included departmental teaching sessions, posters, and the addition of the MUST tool to clerking proformas. Results We included analysis of 70 patients. Following our intervention, admission MUST score calculation improved by 8%, and providing nutritional support increased by 21%. However, there was no improvement in reducing pre-operative fasting time and prescription of pre-operative fluids. Conclusions Through our intervention’s documentation and assessment of nutritional status in elderly patients has improved. However further work must be completed to reduce time spent ‘nil-by-mouth’ and prescribe fluids for maintenance before surgery. This requires better pre-operative planning and communication between the surgical and ward-based teams.

Dental implant status in elderly individuals requiring domiciliary dental care in Japan

BackgroundThe presence of implants is a significant burden not only for dentists but also for caregivers and families of elderly individuals requiring nursing and domiciliary dental care. However, few reports have assessed the status of domiciliary dental care or measures employed to deal with related issues. Hence, we aimed to evaluate the dental implant status in elderly patients requiring nursing and domiciliary dental care and to determine the suitable measures for overcoming the associated limitations. A questionnaire was mailed to 1000 dentists who provided domiciliary dental care in the Tokyo metropolitan area of Japan. The questions were classified into three categories: basic information of the dentists, actual implant status of patients requiring domiciliary dental care, and implants in an aging society.ResultsThe response rate was 36.5%. Approximately 2% of patients requiring domiciliary dental care were implant patients. Many implant-related problems were associated with insufficiency or difficulty in cleaning around the implant, resulting in peri-implantitis. Prosthetic and more serious complications such as implant body fracture or loss were reported and frequently managed by routine follow-ups, cleaning the area around the implant, scaling and polishing, and/or pharmacological modalities. Oral care mainly involved simple toothbrushing instructions, which was not adequate.ConclusionsOur findings suggest the necessity of simplifying the oral environment and making oral care a simple task before aging individuals require nursing and domiciliary dental care.

Association between Chronic Liver Disease and Atherosclerosis: An Inflammation as Common Pathway

Atherosclerosis status as an inflammatory disease has been suggested and anti-inflammatory therapy with canakinumab for atherosclerotic disease has been recently reported. The author previously described the relationship between APRI (aspartate aminotransferase to platelet ratio index) and endothelial function assessed by Flow-Mediated Vasodilation (FMD), thereby suggesting that APRI may reflect systemic atherosclerosis condition in elderly patients without hepatic-related causes. Some reports of the relationship between NAFLD/NASH and atherosclerosis status and between chronic Hepatitis C Virus (HCV) infection and atherosclerotic state have been described. As both chronic liver disease and atherosclerosis involve severe inflammatory processes, at least common pathway may be present for the development and treatment of these inflammatory diseases. The current knowledge of the relationship between chronic liver diseases (NAFLD/NASH and HCV infection) and atherosclerosis and a novel therapeutic strategy is reviewed. Based on the several evidences, the author suggests that an association between chronic liver disease and systemic atherosclerosis may be present due to the presence of the inflammation as a common pathway. It is plausible that direct acting antivirus therapy is a potential strategy for not only liver disease but also endothelial dysfunction and atherosclerosis in patient with HCV infection. It has been suggested that momelotinib as a novel treatment may play a potential therapeutic benefit to a high-risk patients with NAFLD/NASH.

Impact of frailty and atrial fibrillation in elderly patients with acute coronary syndromes.

There is scarce information on the prognostic role of frailty and atrial fibrillation (AF) in elderly patients with acute coronary syndrome (ACS). The aim was to analyse the management of elderly patients with frailty and AF who suffered an ACS using data of the prospective multicentre LONGEVO-SCA registry. We evaluated the predictive performance of FRAIL, Charlson scores and AF status for adverse events at 6-month follow-up. A total of 531 unselected patients with ACS and above 80years old [mean age 84.4 (SD=3.6) years; 322 (60.6%) male] were enrolled, of whom 128 (24.1%) with AF and 145 (27.3%) with frailty. Mutually exclusive number of patients were as follows: non-frail and sinus rhythm (SR) 304 (57.2%); frail and SR 99 (18.6%); non-frail and AF 82 (15.4%); and frail and AF 46 (8.7%). Frail and AF patients compared with non-frail and SR patients had higher risk of all-cause mortality [HR 2.61, (95% CI 1.28-5.31; P=.008)], readmissions [HR 2.28, (95%CI 1.37-3.80); P=.002)] and its composite [HR 2.28, (95% CI 1.44-3.60); P<.001)]. After multivariate adjustment, FRAIL score [HR 1.41, (95% CI 1.02-1.97); P=.040] and Charlson index [HR 1.32, (95% CI 1.09-1.59); P=.003] were significantly associated with mortality. AF status was not independently related with adverse events. Frailty but not AF status was independently associated with follow-up adverse events. Frailty status and high Charlson index were independent conditions associated with adverse events during the follow-up. The impact of functional status has a bigger prognostic role over AF status in elderly patients with ACS.

Palliative radiotherapy to maintain outpatient status in elderly patients with esophageal carcinoma.

Radiation monotherapy effectively relieves symptoms of esophageal cancer. Many studies have reported relief from dysphagia with this treatment; however, the degree of the dysphagia is subjective. On the other hand, the length of outpatient management is objective. In this study, we investigated how radiation monotherapy can contribute to helping elderly patients with esophageal cancer remain as outpatients. Between January 2010 and December 2017, we followed 42 patients aged >75 years who underwent radiation monotherapy for esophageal carcinoma. Of these patients, 36 were included in the study. We retrospectively collected data on the patients' characteristics, tumor extension around the circumference of the esophagus, medical procedures, prognosis, cause of death, and outpatient management period. We also analyzed the relationships between the outpatient management period, the clinical stage, and the circumferential extension of the tumor. Of the 36 patients (26 males, 10 females), 27 were treated using doses of 60 or 66 Gy, and 9 received 40 or 50 Gy. The median survival period of the patients who died during the study was 14 months, and their median period of outpatient management was 9 months. Eight of the 12 patients with tumors extending across four-fifths or the entire circumference of the esophagus required medical intervention to administer nutrition. There were no significant differences in the period of outpatient management among the patients who died during the study in terms of clinical stage and horizontal location. Radiation monotherapy may facilitate outpatient management; however, patients with tumors extending all or most of the circumference of the esophagus required an additional medical procedure.

The Value of National Early Warning Score in Predicting the Condition and Prognosis of Elderly Patients in Emergency Department

To investigate the value of national early warning score for predicting the condition and prognosis of elderly patients in the emergency department. 1034 elderly patients admitted to our hospital from January 2019 to December 2019 were divided into general ward group and intensive care unit group according to the direction of emergency treatment; meanwhile after 1 mo, patients were divided into death and survival groups according to their actual conditions. All patients were evaluated using the modified early warning score and the national early warning score and the prognostic value of the national early warning score for elderly patients was assessed using the receiver operating characteristic curve. Comparison of gender, age, systolic blood pressure and body temperature between the general ward group and intensive care unit group, the differences were not statistically significant (p>0.05), the differences in consciousness, respiratory support, mode of admission and renal failure between the two groups were statistically significant (p<0.05). The pulse rate, respiratory rate, modified early warning score and national early warning score were significantly higher and oxygen saturation was significantly lower in the intensive care unit group than that of in the general ward group (p<0.05). In the death group and the survival group, the differences in sex, age, systolic blood pressure, pain and temperature were not statistically significant (p>0.05); the differences in consciousness, respiratory support, mode of admission and renal failure were statistically significant (p<0.05). The pulse rate, respiratory rate, modified early warning score and national early warning score were significantly higher and oxygen saturation was significantly lower in the death group than that of in the survival group (p<0.05). Frequency, modified early warning score and correction modified early warning score were all higher than those in the surviving group and oxygen saturation was lower than those in the surviving group. The results of receiver operating characteristic curve showed that the index and sensitivity of national early warning score was significantly higher than that of modified early warning score. Both modified early warning score and national early warning score can predict the condition and prognosis of elderly patients in the emergency department. The national early warning score is closer to the actual situation of elderly patients, more accurate and comprehensive than the modified early warning score score in reflecting the criticality and changes in the condition of elderly patients and has a greater ability to predict the prognosis of patientsis.

Effects of neuromuscular blocking agents on the clinical performance of i-gel® and surgical condition in elderly patients undergoing hand surgery: a prospective randomized controlled trial.

Background: The effects of neuromuscular blocking agents on the clinical performance of supraglottic airway devices and surgical condition in elderly patients undergoing hand surgery have not been established. We evaluated the effects of rocuronium on the clinical performance of an i-gel® supraglottic device and surgical condition in elderly patients undergoing orthopedic hand surgery.Methods: Patients aged 65-85 years were randomized to receive either rocuronium (rocuronium group) or saline (control group). We compared the rates of successful insertion of the i-gel on the first attempt as a primary outcome and also assessed the adequacy of i-gel maintenance during controlled ventilation, anesthetic requirement, surgical condition, and recovery time.Results: The rates of successful insertion of the i-gel on a first attempt were 93.1% in the rocuronium group versus 82.1% in the control group (P = 0.423). Peak inspiratory pressure (PIP) was lower in the rocuronium group than in the control group (15.2 vs. 17.9 cmH2O, respectively, P = 0.028). Spontaneous breathing was less common in the rocuronium group (24.1% vs. 57.1%, respectively, P = 0.011). The requirement of additional fentanyl to suppress spontaneous breathing or patient movement was less in the rocuronium group than in the control group (24.1% vs. 50.0%, respectively, P = 0.043). Surgical condition did not differ between the two groups. Recovery time was shorter in the rocuronium group than in the control group (8.4 vs. 9.9 min, respectively, P = 0.030).Conclusions: Rocuronium did not enhance the success rate of inserting the i-gel® or the surgical condition in elderly patients. However, using rocuronium reduced PIP, the frequency of spontaneous breathing, the requirement for additional fentanyl and patients' recovery time.

Home enteral nutrition for postoperative elderly patients with esophageal cancer.

The clinical value of enteral nutrition (EN) after radical resection of esophageal cancer (EC) has been well recognized during hospital stay; however, whether using EN agents should be continued at home after the patient is discharged remains unclear, especially for the elderly postoperative patients. Here we investigated the effects of continued EN on nutrition and immune status in elderly patients who had undergone radical EC surgery. Sixty eligible elderly patients undergoing surgical treatment for EC in our center during the period from October 2016 to October 2018 were randomly divided into EN group and control groups, with 30 patients in each group. Among them, the EN group continued to take an orally administered EN agent (Ensure®) daily in addition to daily routine diets after discharge; however, patients in the control group only received regular diets after discharge. The nutritional status and immune indicators were evaluated at discharge and 4 and 8 weeks after discharge (weeks 4 and 8) and compared between EN and control groups. Body mass index (BMI), Patient-Generated Subjective Global Assessment (PG-SGA) score, hemoglobin, serum albumin, serum prealbumin, CD4 and CD8 T cell counts, CD4/CD8 ratio, IgA, IgG, and IgM showed no significant difference between EN group and control group at discharge (all P>0.05). In week 4, the serum prealbumin level was significantly higher in the EM group than in the control group (P<0.05). In week eight, the EM group had significantly higher BMI, PG-SGA score, serum albumin, serum prealbumin, CD4 and CD8 T cell counts, CD4/CD8 ratio, IgA, IgG, and IgM than the control group (all P<0.05). Home EN helps improve immune function in elderly patients who have undergone radical surgery for EC and is worthy of clinical promotion. To optimize its efficacy, a home EN should last no less than eight weeks after discharge.

Dermatoses in the Elderly: Clinico-Demographic Profile of Patients Attending a Tertiary Care Centre.

Background:Elderly population is vulnerable to develop a multitude of dermatological diseases, owing to comorbidities and polypharmacies.Objective:To know the prevalence of dermatological conditions in elderly patients attending outpatient department, determine the pattern and relative frequency of skin diseases, and find the relation with associated comorbidities.Materials and Methods:We performed a cross-sectional study on 250 patients, aged ≥60 years. Clinical diagnosis was done, followed by appropriate investigations when required. Descriptive data was analyzed on the parameters of range, mean ± S.D., frequencies, etc., Continuous variables were analyzed using unpaired t-test/Mann–Whitney U test and categorical data by Fisher's exact test/Chi-square test. Statistical software Medcalc version 10.2.0.0 for Windows vista was used. P value =0.05 was considered statistically significant.Results:250 patients were evaluated, 164 males (65.5%) and 86 females (34.4%). Mean age was 67.87 ± 7.29 years. Commonest disease category was infection (30%), followed by dermatitis (29.6%), papulo-squamous (18.4%), and immunobullous (6.4%). Difference in acute and chronic disease was significant (P = 0.0001). 30% had infections; fungal (50.66%), bacterial (32%), and viral (17.33%). 74 patients had dermatitis (29.6% of study population). Commonest systemic disease was hypertension (23.2%), followed by diabetes mellitus (19.6%). Association of diabetes mellitus was significant (P = 0.0014), more in infective dermatoses (P = 0.0007). All had signs of aging; idiopathic guttate hypomelanosis (51.2%), xerosis (45.2%), seborrheic keratosis (42.6%), cherry angioma (33.2%), senile acne (6.6%). Photoaging was noted as wrinkling (98.8%), freckles (35.6%), purpura (10.8%), telangiectasia (5.6%). People involved in outdoor activity had higher Glogau scale (3.01 ± 0.69) compared to those indoors (2.44 ± 0.74), statistically significant difference (P = 0.001).Conclusion:Our study is the first of its kind, in Eastern India, where we evaluated and explored the disease pattern and extent of geriatric dermatoses among patients attending dermatology OPD of a tertiary care hospital.

Analysis of Quality of Life and Nutritional Status in Elderly Patients with Dysphagia in Order to Prevent Hospital Admissions in a COVID-19 Pandemic.

(1) Background: Oropharyngeal dysphagia (OD) is currently recognized as one of the geriatric syndromes due to its high frequency in older people and its associated complications, which have a direct impact on quality of life. The main objective is to determine the effectiveness of telehealth consultation for the re-evaluation of nutritional status and quality of life assessment in older people diagnosed with OD associated with active use of thickeners to prevent hospital admissions in a COVID-19 pandemic. (2) Methods: an observational, descriptive, and longitudinal study that included a sample of 33 subjects with age equal or superior to 65 years diagnosed with OD with conserved cognitive capacity. The nutritional status was evaluated through the Mini-Nutritional Assessment (MNA) questionnaire and biochemical parameters and, the quality of life was determined through the Swallowing Quality of Life (SWAL-QOL) questionnaire. (3) Results: Thirty-three older patients with OD were recruited (54.5% women), with a mean age of 83.5 ± 7.6 years. The main cause of OD in the study population was neurodegenerative disease (51.5%), followed by cerebrovascular disease (33.3%), and other causes (15.2%). Sixty point six percent of patients were found to be at risk of malnutrition. The MNA score was significantly correlated to albumin (r: 0.600, p < 0.001) and total proteins (r: 0.435, p = 0.015), but not to total cholesterol (r: −0.116, p = 0.534) or lymphocytes (r: −0.056, p = 0.758). The mean total score of the SWAL-QOL was 75.1 ± 16.4 points. (4) Conclusions: the quality of life of the subjects related to the use of a thickener is good. Although the body mass index (BMI) and average biochemical, nutritional parameters of the subjects are within the range of normality, the MNA has detected a high percentage of subjects with the risk of malnutrition, which suggests the need for continuous re-evaluation in these patients, demonstrating the viability of the telematic route in this research.

Психоэмоциональный статус пожилых пациентов с катарактой

Психоэмоциональный статус пожилых пациентов с катарактой

The Future of the Elderly Population Health Status: Filling a Knowledge Gap

The ageing process in OECD countries calls for a better understanding of the future disease prevalence, life expectancy and patterns of inequalities in health outcomes. In this paper we present the results obtained from several dynamic microsimulation models of the Future Elderly Model (FEM) family for thirteen OECD countries, with the aim of reproducing for the first time comparable longterm trends in individual health status across OECD. The FEM is a multi-risk multi-morbidity dynamic microsimulation model to project health status and health demand. Given the dynamic structure of the model, we allow individual health status to evolve over time according to individual characteristics. Our model provides forecasts of the evolution of life expectancy and prevalences of major chronic conditions and disabilities, overall, by gender and by education. We find a catch-up of the considered European countries main chronic conditions prevalence with the US and a relevant and persistent educational gradient in the health status of elderly patients. Our findings represent a valid contribution to support policy makers in designing and implementing effective interventions in the healthcare sector.

Impact of polypharmacy on oral health status in elderly patients admitted to the recovery and rehabilitation ward.

The oral health status of elderly adults has implications for general health problems. Polypharmacy for elderly adults is associated with an increased risk of potentially inappropriate medicines and many adverse drug events; however, no report has shown that polypharmacy itself is associated with complex oral problems. This study aimed to determine the association between polypharmacy and oral health status in patients admitted to the recovery and rehabilitation ward. This cross-sectional study included 471 patients (age: 81.9 ± 7.7 years, women: n = 346). Oral health status was measured using the Oral Health Assessment Tool and poor oral health status was defined as a score of ≥3. Cases of patients taking six or more medications were defined as polypharmacy. Logistic regression analysis was performed to examine the relationship between polypharmacy and oral health status. Age, sex, body mass index, number of comorbidities, cognitive and motor functions, and potentially inappropriate medicines were set as confounding factors. Using the Oral Health Assessment Tool, 51.0% (n = 240) of patients scored ≥3. The prevalence of patients with polypharmacy was 56.9% (n = 268). Polypharmacy was significantly associated with poor oral health status (odds ratio = 1.65, 95% confidence interval = 1.14-2.39, P = 0.007; adjusted odds ratio = 1.65, 95% confidence interval = 1.12-2.43, P = 0.011). This study showed that polypharmacy was associated with poor oral health status. Focusing on the number of medications may be helpful in detecting oral problems. Geriatr Gerontol Int 2021; 21: 66-70.

Serum Gamma Glutamyltransferase Is Associated with 25-Hydroxyvitamin D Status in Elderly Patients with Stable Coronary Artery Disease.

Background: No previous study has investigated the association between gamma glutamyltransferase (GGT) and vitamin D in patients with stable coronary artery disease (CAD). We investigated the cross-sectional associations between vitamin D status as assessed by serum 25(OH)D and GGT. Methods: 169 patients were enrolled. Study population was divided into three groups: 1: 25(OH)D < 10 ng/mL (n = 59); 2: 25(OH)D 10–20 ng/mL (n = 82), and 3: 25(OH)D > 20 ng/mL (n = 28). Based on a cut-off GGT value identified in ROC analysis, we also divided the study population to compare the following groups: GGT ≤19 (n = 66) and GGT >19 (n = 103). Results: GGT activity was the highest in vitamin D severely deficient patients and the lowest in vitamin D insufficient patients. GGT was inversely correlated with 25(OH)D concentrations (R = −0.23; p = 0.002). The receiver operating characteristics curve identified the discrimination threshold of GGT of >19 U/L in predicting vitamin D deficiency. Higher leukocyte and neutrophil counts and lower 25(OH)D concentration were found in patients with GGT > 19 U/L. Conclusions: We identified an interaction between declining 25(OH)D levels and rising GGT levels with increasing age, which resulted in an unfavorable 25(OH)D-to-GGT ratio in stable CAD patients. These results suggest that these changes might further contribute to a high cardiovascular risk in the elderly.

MULTIPLE SCLEROSIS AND AGING

The aim of this article is to study the aging of patients with multiple sclerosis (MS), as well as the clinical course, neurological status, comorbidities, and therapeutic aspects in elderly people with MS. Materials and research methods. The study was carried out by 356 patients, whose examination and treatment was carried out by a special expert commission at the Neurological Center of the Ministry of Health of the Republic of Azerbaijan at the Republican Clinical Hospital named after academician M.Mirgasimov for one year (01.07.2013-30.06.2014) within the framework of the “State Program for the Treatment, Prevention and Control of Multiple Sclerosis” (SPTPCMS). Results and discussion. 7.3% (26 patients) with MS were ≥50 years of age. The average age of patients was 53.04±2.89 years, and the average age at which the first MS attack occurred was 38.73±9.47 years. At the time of diagnosis, the average age of the patients was 47.54±4.76 years. In patients included in the study, the mean duration of MS was 14.31±10.10 years. Secondary progressive MS was detected in half of the patients (50.0%), relapsing remmiting MS was observed in 38.46% of patients. It was demonstrated that secondary progressive MS in patients over 50 years of age prevailed over relapsing remmiting MS. As MS developed, there was an increase in the frequency of disturbances of the pelvic functions, sensory, motor and coordination disturbances. 15.4% of patients suffered from type 2 diabetes mellitus and 11.5% from ischemic heart disease. In single cases, gastrointestinal pathologies, degenerative diseases of the spine, and gynecological diseases were detected. Conclusions. Given the increasing incidence of other age-related pathologies, special attention should be paid to the timely detection and treatment of comorbid conditions in elderly patients with MS. After the implementation of the SPTPCMS, attention to MS patients and measures for the timely detection of the disease increased. At the same time, significant advances have been made in the treatment and rehabilitation of elderly patients with long-term MS.

Projection of the Number of Elderly in Different Health States in Thailand in the Next Ten Years, 2020-2030.

The objective of this study is to predict the volume of the elderly in different health status categories in Thailand in the next ten years (2020–2030). Multistate modelling was performed. We defined four states of elderly patients (aged ≥ 60 years) according to four different levels of Activities of Daily Living (ADL): social group; home group; bedridden group; and dead group. The volume of newcomers was projected by trend extrapolation methods with exponential growth. The transition probabilities from one state to another was obtained by literature review and model optimization. The mortality rate was obtained by literature review. Sensitivity analysis was conducted. By 2030, the number of social, home, and bedridden groups was 15,593,054, 321,511, and 152,749, respectively. The model prediction error was 1.75%. Sensitivity analysis with the change of transition probabilities by 20% caused the number of bedridden patients to vary from between 150,249 and 155,596. In conclusion, the number of bedridden elders will reach 153,000 in the next decade (3 times larger than the status quo). Policy makers may consider using this finding as an input for future resource planning and allocation. Further studies should be conducted to identify the parameters that better reflect the transition of people from one health state to another.

Ремоделирование сердца и сосудов, особенности тревожно-депрессивного статуса у пациентов пожилого возраста с инфарктом миокарда в сочетании с фибрилляцией предсердий

Ремоделирование сердца и сосудов, особенности тревожно-депрессивного статуса у пациентов пожилого возраста с инфарктом миокарда в сочетании с фибрилляцией предсердий

Prognostic role of nutritional status in elderly patients hospitalized for COVID-19: a monocentric study

BackgroundSymptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection incidence is higher in the elderly patients. Pre-existing geriatric conditions such as comorbidity and frailty seem related to worse hospital outcomes.AimsTo assess the role of nutritional status as an independent prognostic factor for in-hospital death in elderly patients.MethodsConsecutive elderly patients (age > 65 years) hospitalized for novel coronavirus disease (COVID-19) were enrolled. Demographics, laboratory and comorbidity data were collected. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). Uni- and multivariate Cox regression analyses to evaluate predictors for in-hospital death were performed.ResultsOne hundred and nine hospitalized elderly patients (54 male) were consecutively enrolled. At univariate analysis, age (HR 1.045 [CI 1.008–1.082]), cognitive impairment (HR 1.949 [CI 1.045–3.364]), C-reactive protein (HR 1.004 [CI 1.011–1.078]), lactate dehydrogenases (HR 1.003 [CI 1.001–1.004]) and GNRI moderate–severe risk category (HR 8.571 [CI 1.096–67.031]) were risk factors for in-hospital death, while albumin (HR 0.809 [CI 0.822–0.964]), PaO2/FiO2 ratio (HR 0.996 [CI 0.993–0.999]) and body mass index (HR 0.875 [CI 0.782–0.979]) were protective factors. Kaplan–Meier survival curves showed a significative higher survival in patients without GNRI moderate or severe risk category (p = 0.0013).At multivariate analysis, PaO2/FiO2 ratio (HR 0.993 [CI 0.987–0.999], p = 0.046) and GNRI moderate–severe risk category (HR 9.285 [1.183–72.879], p = 0.034) were independently associated with in-hospital death.ConclusionNutritional status assessed by GNRI is a significative predictor of survival in elderly patients hospitalized for COVID-19. The association between GNRI and PaO2/FiO2 ratio is a good prognostic model these patients.

Commentaries on Viewpoint: The interaction between SARS-CoV-2 and ACE2 may have consequences for skeletal muscle viral susceptibility and myopathies.

Commentaries on Viewpoint: The interaction between SARS-CoV-2 and ACE2 may have consequences for skeletal muscle viral susceptibility and myopathies.