scholarly journals Predictors of short- and long-term mortality among acutely admitted older patients: role of inflammation and frailty

2021 ◽  
Author(s):  
Michela Zanetti ◽  
Giovanna Marzaro ◽  
Paolo De Colle ◽  
Gabriele Toigo ◽  
Dario Bianchini ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Older Patients ◽  
Prognostic Score ◽  
Prognostic Index ◽  
Glasgow Prognostic Score ◽  
Hydration Status ◽  
Predictive Tool ◽  
Serum Osmolarity ◽  
Long Term Mortality

Abstract Background Frailty, demographic and clinical variables linked to incident diseases (e.g., dehydration, inflammation) contribute to poor outcomes in older patients acutely hospitalized. Their predictivity on short-, intermediate- and long-term mortality in a comprehensive model has been scarcely investigated. Aims To test the performance of a predictive tool considering frailty and inflammation as well as age, sex and impaired hydration status on 1-year mortality in acutely admitted older patients. Methods Retrospective observational study including 529 medical patients (age 84.6 ± 7.3 years). At hospital admission, frailty was assessed by the Multidimensional Prognostic Index (MPI). The Glasgow Prognostic Score (GPS) was used to grade systemic inflammation. Serum osmolarity was calculated to assess hydration. Results After adjusting for age, sex, GPS and osmolarity, the severe-risk MPI was a strong predictor for 1-year mortality (OR 4.133; 95% CI 2.273–7.516; p < 0.001). Age > 85 years, male sex, GPS-2 and serum osmolarity > 300 mOsm/L were independent predictors of mortality in the same multivariable model. The MPI alone showed a moderate discrimination power (AUC 0.678; 95% CI 0.628–0.729; p < 0.001) on 1-year mortality, which increased by 12.5% after the addition of the above predictors in the fully adjusted regression model (AUC 0.763; 95% CI 0.719–0.807; p < 0.001). The severe-risk MPI adjusted for the same factors was also an independent predictor of mortality after 60 and 180 days since hospital admission. Discussion Inflammation and impaired hydration are potentially modifiable risk factors for severe outcomes in older acutely hospitalized patients. A model combining GPS, age, gender, and plasma osmolarity improved the accuracy of MPI at admission in predicting long-term mortality.

Impaired hydration status in acutely admitted older patients: prevalence and impact on mortality

2020 ◽  
Author(s):  
Gianfranco Sanson ◽  
Ilaria Marzinotto ◽  
Daniela De Matteis ◽  
Giuliano Boscutti ◽  
Rocco Barazzoni ◽  
...  
Keyword(s):  
Older People ◽  
Serum Sodium ◽  
Older Patients ◽  
Nutritional Risk ◽  
Early Warning Score ◽  
Hydration Status ◽  
Early Assessment ◽  
Serum Osmolarity ◽  
Short And Long Term

Abstract Background impaired hydration is common in the older people, however studies of its effects on outcome in the acute setting are limited. Objectives to assess (i) the prevalence of impaired hydration, (ii) its relationship with laboratory markers of altered hydration and with (iii) short- and long-term mortality. Design retrospective cohort study. Setting University Hospital-Internal Medicine Department. Subjects a total of 5,113 older patients consecutively acutely admitted from October 2015 to July 2016. Methods according to calculated serum osmolarity at admission hydration status was stratified in: low osmolarity (&lt;275 mmol/L), euhydration (275–295 mmol/L), impending (296–300 mmol/L) and current dehydration (&gt;300 mmol/L). Relationships with serum sodium, potassium, glucose, urea, estimated glomerular filtration rate (eGFR), haematocrit, urea/creatinine ratio (Urea/Cr) and urine specific gravity (USG) were determined. Charlson Comorbidity Index, Modified Early Warning Score, Glasgow Prognostic Score, Norton score and Nutritional Risk Screening-2002 were calculated. Results current and impending dehydration, euhydration and low-osmolarity were detected in 51.7, 17.1, 28.5 and 2.7% of the patients, respectively. Osmolarity correlated with urea (r = 0.846). Associations with serum sodium, creatinine, eGFR and urea/Cr were low but significant, being negligible that with USG and haematocrit. Serum sodium and urea increased in the transition from low- to high-osmolarity (P &lt; 0.001 in all pairwise comparisons). In multivariate modelling current dehydration, functional dependence, clinical instability and high nutritional risk were associated (P &lt; 0.001) with reduced short- and long-term survival. Conclusions impaired hydration is common in older people acutely admitted to medical care and is associated with poor outcome. Early assessment of calculated serum osmolarity is mandatory to target dehydration and hypoosmolar disorders.

Sarcopenia with modified Glasgow prognostic score as a predictor of long-term survival in patients with gastric cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 27-27
Author(s):  
Masaaki Nishi ◽  
Mitsuo Shimada ◽  
Kozo Yoshikawa ◽  
Jun Higashijima ◽  
Toshihiro Nakao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Score ◽  
Prognostic Index ◽  
Glasgow Prognostic Score ◽  
Disease Free Survival ◽  
Term Survival ◽  
Poor Prognostic Factor ◽  
Long Term Survival ◽  
Neutrophil Lymphocyte Ratio

27 Background: Recent reports suggested that the Glasgow prognostic score (GPS), which is a preoperatively determined inflammation-based score, correlated with long -term survival in several types of cancers. The aim of this study is to create new prognostic index which is superior to modified GPS (mGPS) in gastric cancer. Methods: Seventy five patients with gastric cancer who underwent gastrectomy were enrolled in this study. Prognostic factors were searched for among clinocopathological factors and nutritional- or immune- parameters, including mGPS (J Gastoenterol 2011), neutrophil lymphocyte ratio (NLR), prognostic nutritional index (PNI), or sarcopenia. Cut of value were 3.0: NLR, 40: PNI, respectively. Sarcopenia was assessed by the following CT-based methods (Lancet 2011). Sarcopenia with mGPS (SarcoGPS) were defined as CRP was changed to sarcopenia. Results: The overall survival (OS) rate was significantly lower in mGPS:0 group than in mGPS:1,2 group (p < 0.05). The disease-free survival (DFS) rate didn’t differ in mGPS (N.S). The OS and DFS rate of high NLR group or sarcopenia group were significantly lower than those of low NLR group or non- sarcopenia group (p < 0.05). PNI did not differ significantly both in OS and DFS. SarcoGPS was the poor prognostic factor both in OS and DFS (p < 0.01) Conclusions: SarcoGPS is the new prognostic index, which is superior to mGPS, in gastric cancer.

scholarly journals Role of Inflammatory and Immune-Nutritional Prognostic Markers in Patients Undergoing Surgical Resection for Biliary Tract Cancers

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3594
Author(s):  
Simone Conci ◽  
Tommaso Campagnaro ◽  
Elisa Danese ◽  
Ezio Lombardo ◽  
Giulia Isa ◽  
...  
Keyword(s):  
Biliary Tract ◽  
Cox Regression ◽  
Prognostic Score ◽  
Prognostic Index ◽  
Glasgow Prognostic Score ◽  
Postoperative Mortality ◽  
Prognostic Nutritional Index ◽  
Term Survival ◽  
Lymphocyte Ratio

The relationship between immune-nutritional status and tumor growth; biological aggressiveness and survival, is still debated. Therefore, this study aimed to evaluate the prognostic performance of different inflammatory and immune-nutritional markers in patients who underwent surgery for biliary tract cancer (BTC). The prognostic role of the following inflammatory and immune-nutritional markers were investigated: Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI), Neutrophil to Lymphocyte ratio (NLR), Platelet to Lymphocyte ratio (PLR), Lymphocyte to Monocyte ratio (LMR), Prognostic Nutritional Index (PNI). A total of 282 patients undergoing surgery for BTC were included. According to Cox regression and ROC curves analysis for survival, LMR had the best prognostic performances, with hazard ratio (HR) of 1.656 (p = 0.005) and AUC of 0.652. Multivariable survival analysis identified the following independent prognostic factors: type of BTC (p = 0.002), T stage (p = 0.014), N stage (p < 0.001), histological grading (p = 0.045), and LMR (p = 0.025). Conversely, PNI was related to higher risk of severe morbidity (p < 0.001) and postoperative mortality (p = 0.005). In conclusion, LMR appears an independent prognostic factor of long-term survival, whilst PNI seems associated with worse short-term outcomes.

scholarly journals Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score

2021 ◽  
Vol 9 (3) ◽  
pp. e002277 ◽  
Author(s):  
Gino M Dettorre ◽  
Saoirse Dolly ◽  
Angela Loizidou ◽  
John Chester ◽  
Amanda Jackson ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Cancer Progression ◽  
Systemic Inflammation ◽  
Prognostic Score ◽  
Prognostic Index ◽  
Glasgow Prognostic Score ◽  
Prognostic Nutritional Index ◽  
Adverse Outcomes ◽  
Patients With Cancer ◽  
Inflammatory Score

BackgroundPatients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study.MethodsIn a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets.ResultsWe evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p<0.01), recovering in survivors to pre-COVID-19 levels. Patients in poorer risk categories for each index except the PLR exhibited higher mortality rates (p<0.001) and shorter median overall survival in the training and validation sets (p<0.01). Multivariable analyses revealed the OIS to be most independently predictive of survival (validation set HR 2.48, 95% CI 1.47 to 4.20, p=0.001; adjusted concordance index score 0.611).ConclusionsSystemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used as a bedside predictor of adverse outcome. Lymphocytopenia and hypoalbuminemia as computed by the OIS are independently predictive of severe COVID-19, supporting their use for risk stratification. Reversal of the COVID-19-induced proinflammatory state is a putative therapeutic strategy in patients with cancer.

Blood Platelet Count at Hospital Admission Impacts Long-Term Mortality in Patients with Acute Coronary Syndrome

Cardiology ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. 148-154 ◽  
Author(s):  
Artur Małyszczak ◽  
Agata Łukawska ◽  
Izabela Dyląg ◽  
Weronika Lis ◽  
Andrzej Mysiak ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Platelet Count ◽  
Mortality Rate ◽  
Hospital Admission ◽  
Cox Proportional Hazards Model ◽  
Distribution Width ◽  
Platelet Indices ◽  
Coronary Syndrome ◽  
Long Term Mortality

Introduction: Platelets play a fundamental role in the pathogenesis of acute coronary syndrome (ACS). The platelet count (PC) at hospital admission is easy to obtain, but whether thrombocytopenia or/and thrombocytosis impact long-term mortality (LTM) after ACS is unclear. Objective: To evaluate the effect of PC at hospital admission on LTM in patients with ACS. Methods: This retrospective cohort study included patients with the ICD-10 codes for unstable angina (I.20) and acute myocardial infarction (I.21, I.22). Thrombocytopenia was defined as a blood PC <150 G/L and thrombocytosis as a PC >450 G/L. Additional platelet indices which were tested included plateletcrit (PCT), the mean platelet volume (MPV), the platelet distribution width (PDW), and the platelet larger cell ratio (P-LCR). Data on all-cause death were obtained from the National Health Fund database. Results: The study included 3,162 patients with a median follow-up of 27.2 months (interquartile range 12.5–46.8 months; max 68.7 months). Patients with thrombocytopenia and thrombocytosis yielded a higher maximal analyzed 5-year mortality rate in comparison with normal PC patients (45.8 and 47.7 vs. 24.2%, respectively; p < 0.00001) which was mainly driven by higher deaths at 1–2 years after ACS. The 5-year LTM was also significantly higher in patients with abnormal PCT and MPV levels in comparison with patients with PCT and MPV within the normal range. Other platelet indices (PDW, P-LCR) were not associated with a worse outcome. The Cox proportional hazards model revealed that thrombocytopenia at admission was independently associated with higher LTM after ACS (RR 1.83; 95% CI 1.1–3.0; p = 0.01). Conclusions: Both thrombocytopenia and thrombocytosis at hospital admission in post-ACS patients are associated with a significant almost two times higher 5-year mortality rate.

scholarly journals The prognostic significance of inflammation-based scores in patients with ampullary carcinoma after pancreaticoduodenectomy

2020 ◽  
Author(s):  
Shuxin Sun ◽  
Chaobin He ◽  
Jun Wang ◽  
Xin Huang ◽  
Jiali Wu ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Prognostic Score ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Glasgow Prognostic Score ◽  
Prognostic Nutritional Index ◽  
Significant Prognostic Factor ◽  
Entire Cohort ◽  
Lymphocyte Ratio ◽  
Survival Differences

Abstract Background Growing evidence indicates that systemic inflammatory response plays an important role in cancer development and progression. Several inflammatory markers have been reported to be associated with the clinical outcomes in patients with various types of cancer. This study was designed to evaluate the prognostic value of the inflammatory indexes in patients suffering from ampullary cancer (AC) who underwent pancreaticoduodenectomy (PD). Methods We retrospectively reviewed a database of 358 patients with AC who underwent PD between 2009 and 2018. R software was used to compare the area under the time-dependent receiver operating characteristic (ROC) curves (AUROCs) of the inflammation-based indexes, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), prognostic nutritional index (PNI) and prognostic index (PI), in terms of their predictive value of survival. The survival differences of these indexes were compared by Kaplan-Meier method and univariate and multivariate analyses were performed to determine the prognostic factors of progress-free survival (PFS) and overall survival (OS). Results The estimated 1-, 2-, and 3-year OS and PFS rates were 83.9%, 65.8%, 55.2% and 58.0%, 42.8%, 37.8%, respectively, for the entire cohort. The survival differences were significant in terms of OS and PFS when they were stratified by these inflammation-based indexes. The comparisons of AUROCs of these inflammation-based indexes illustrated that NLR and PI displayed highest prognostic value, compared to other indexes. When NLR and PI were combined, NLR-PI showed even higher AUROC values and was identified as a significant prognostic factor in terms of OS and PFS. Conclusion Specific inflammatory indexes, such as NLR, PLR and PI, were found to be able to predict the OS or PFS of patients. As a novel inflammatory index, the level of NLR-PI, which can be regarded as a more useful prognostic index, exhibited strong predictive power for predicting prognosis of patients with AC after PD procedure.

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