Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study

Abstract Background The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (> 70 years old) with COVID-19 admitted in the intensive care unit (ICU). Methods Characteristics, management, and prognosis of critically ill old patients (> 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality. Results The analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72–78] years). Fifty-three percent, 31%, and 16% were 70–74, 75–79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2–3). Upon admission, the PaO2/FiO2 ratio was 154 (105–222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO2/FiO2 ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24–2.27; p < 0·001). Conclusion Patients over 70 years old represented more than a quarter of the COVID-19 population admitted in the participating ICUs during the first wave. Day-90 mortality was 46%, with dismal outcomes reported for patients older than 80 years or those intubated upon ICU admission.

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Compound Sarcopenia in Hospitalized Patients with Cirrhosis Worsens Outcomes with Increasing Age

Nutrients ◽

10.3390/nu13020659 ◽

2021 ◽

Vol 13 (2) ◽

pp. 659

Author(s):

Nicole Welch ◽

Amy Attaway ◽

Annette Bellar ◽

Hayder Alkhafaji ◽

Adil Vural ◽

...

Keyword(s):

Chronic Diseases ◽

Older Patients ◽

Hospitalized Patients ◽

Muscle Loss ◽

Term Care ◽

Old Patients ◽

Younger Patients ◽

Age Related ◽

Number Of Patients ◽

The Impact

Background: There are limited data on outcomes of older patients with chronic diseases. Skeletal muscle loss of aging (primary sarcopenia) has been extensively studied but the impact of secondary sarcopenia of chronic disease is not as well evaluated. Older patients with chronic diseases have both primary and secondary sarcopenia that we term compound sarcopenia. We evaluated the clinical impact of compound sarcopenia in hospitalized patients with cirrhosis given the increasing number of patients and high prevalence of sarcopenia in these patients. Design: The Nationwide Inpatients Sample (NIS) database (years 2010–2014) was analyzed to study older patients with cirrhosis. Since there is no universal hospital diagnosis code for “muscle loss”, we used a comprehensive array of codes for “muscle loss phenotype” in the international classification of diseases-9 (ICD-9). A randomly selected 2% sample of hospitalized general medical population (GMP) and inpatients with cirrhosis were stratified into 3 age groups based on age-related changes in muscle mass. In-hospital mortality, length of stay (LoS), cost of hospitalization (CoH), comorbidities and discharge disposition were analyzed. Results. Of 517,605 hospitalizations for GMP and 106,835 hospitalizations for treatment of cirrhosis or a cirrhosis-related complication, 207,266 (40.4%) GMP and 29,018 (27.7%) patients with cirrhosis were >65 years old, respectively. Muscle loss phenotype in both GMP and inpatients with cirrhosis 51–65 years old and >65 years old was significantly (p < 0.001 for all) associated with higher mortality, LoS, and CoH compared to those ≤50 years old. Patients >65 years old with cirrhosis and muscle loss phenotype had higher mortality (adjusted OR: 1.06, 95% CI [1.04, 1.08] and CoH (adjusted odds ratio (OR): 1.10, 95% confidence interval (CI) [1.04, 1.08])) when compared to >65 years old GMP with muscle loss phenotype. Muscle loss in younger patients with cirrhosis (≤50 years old) was associated with worse outcomes compared to GMP >65 years old. Non-home discharges (nursing, skilled, long-term care) were more frequent with increasing age to a greater extent in patients with cirrhosis with muscle loss phenotype for each age stratum. Conclusion: Muscle loss is more frequent in older patients with cirrhosis than younger patients with cirrhosis and older GMP. Younger patients with cirrhosis had clinical outcomes similar to those of older GMP, suggesting an accelerated senescence in cirrhosis. Compound sarcopenia in older patients with cirrhosis is associated with higher inpatient mortality, increased LoS, and CoH compared to GMP with sarcopenia.

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A Pilot Study of the Clinical Frailty Scale to Predict Frailty Transition and Readmission in Older Patients in Vietnam

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17051582 ◽

2020 ◽

Vol 17 (5) ◽

pp. 1582

Author(s):

Tan Van Nguyen ◽

Thuy Thanh Ly ◽

Tu Ngoc Nguyen

Keyword(s):

Pilot Study ◽

Older Patients ◽

Rural And Remote ◽

Clinical Frailty Scale ◽

Frailty Status ◽

Phone Calls ◽

Increased Risk ◽

Rural And Remote Areas ◽

The Impact

Background. The Clinical Frailty Scale (CFS) is gaining increasing acceptance due to its simplicity and applicability. Aims. This pilot study aims to examine the role of CFS in identifying the prevalence of frailty, frailty transition, and the impact of frailty on readmission after discharge in older hospitalized patients. Methods. Patients aged ≥60 admitted to the geriatric ward of a hospital in Vietnam were recruited from 9/2018–3/2019 and followed for three months. Frailty was assessed before discharge and after three months, using the CFS (robust: score 1–2, pre-frail: 3–4, and frail: ≥5). Multivariate logistic regression was applied to investigate the associated factors of frailty transition and the impact of frailty on readmission. Results. There were 364 participants, mean age 74.9, 58.2% female. At discharge, 4 were robust, 160 pre-frail, 200 frail. Among the 160 pre-frail participants at discharge, 124 (77.5%) remained pre-frail, and 36 (22.5%) became frail after 3 months. Age (adjusted OR1.09, 95% CI 1.03–1.16), number of chronic diseases (adjusted OR 1.37, 95% CI 1.03–1.82), and polypharmacy at discharge (adjusted OR 3.68, 95% CI 1.15–11.76) were significant predictors for frailty after 3 months. A frailty status at discharge was significantly associated with increased risk of readmission (adjusted OR2.87, 95% CI 1.71–4.82). Conclusions. Frailty was present in half of the participants and associated with increased risk of readmission. This study suggests further studies to explore the use of the CFS via phone calls for monitoring patients’ frailty status after discharge, which may be helpful for older patients living in rural and remote areas.

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Different aspects of frailty and COVID-19: points to consider in the current pandemic and future ones

BMC Geriatrics ◽

10.1186/s12877-021-02316-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hani Hussien ◽

Andra Nastasa ◽

Mugurel Apetrii ◽

Ionut Nistor ◽

Mirko Petrovic ◽

...

Keyword(s):

Older Adults ◽

Poor Response ◽

Adverse Outcomes ◽

Exclusion Criterion ◽

Clinical Frailty Scale ◽

Time Saving ◽

Acute Setting ◽

Icu Admission ◽

The Impact ◽

Microbiota Diversity

Abstract Background Older adults at a higher risk of adverse outcomes and mortality if they get infected with Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). These undesired outcomes are because ageing is associated with other conditions like multimorbidity, frailty and disability. This paper describes the impact of frailty on coronavirus disease 2019 (COVID-19) management and outcomes. We also try to point out the role of inflamm-ageing, immunosenescence and reduced microbiota diversity in developing a severe form of COVID-19 and a different response to COVID-19 vaccination among older frail adults. Additionally, we attempt to highlight the impact of frailty on intensive care unit (ICU) outcomes, and hence, the rationale behind using frailty as an exclusion criterion for critical care admission. Similarly, the importance of using a time-saving, validated, sensitive, and user-friendly tool for frailty screening in an acute setting as COVID-19 triage. We performed a narrative review. Publications from 1990 to March 2021 were identified by searching the electronic databases MEDLINE, CINAHL and SCOPUS. Based on this search, we have found that in older frail adults, many mechanisms contribute to the severity of COVID-19, particularly cytokine storm; those mechanisms include lower immunological capacity and status of ongoing chronic inflammation and reduced gut microbiota diversity. Higher degrees of frailty were associated with poor outcomes and higher mortality rates during and after ICU admission. Also, the response to COVID-19 vaccination among frail older adults might differ from the general population regarding effectiveness and side effects. Researches also had shown that there are many tools for identifying frailty in an acute setting that could be used in COVID-19 triage, and before ICU admission, the clinical frailty scale (CFS) was the most recommended tool. Conclusion Older frail adults have a pre-existing immunopathological base that puts them at a higher risk of undesired outcomes and mortality due to COVID-19 and poor response to COVID-19 vaccination. Also, their admission in ICU should depend on their degree of frailty rather than their chronological age, which is better to be screened using the CFS.

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The impact of delirium on outcomes for older adults hospitalised with COVID-19

Age and Ageing ◽

10.1093/ageing/afaa189 ◽

2020 ◽

Vol 49 (6) ◽

pp. 923-926 ◽

Cited By ~ 6

Author(s):

Alessandra Marengoni ◽

Alberto Zucchelli ◽

Giulia Grande ◽

Laura Fratiglioni ◽

Debora Rizzuto

Keyword(s):

Hospital Mortality ◽

Direct Effect ◽

Older Patients ◽

Total Sample ◽

Prognostic Indicator ◽

Multivariate Logistic Regression Model ◽

Clinical Frailty Scale ◽

Acute Geriatric Ward ◽

The Central Nervous System ◽

The Impact

Abstract Introduction Delirium is a frequent condition in hospitalized older patients and it usually has a negative prognostic value. A direct effect of SARS-COV-2 on the central nervous system (CNS) has been hypothesized. Objective To evaluate the presence of delirium in older patients admitted for a suspected diagnosis of COVID-19 and its impact on in-hospital mortality. Setting and subjects 91 patients, aged 70-years and older, admitted to an acute geriatric ward in Northern Italy from March 8th to April 17th, 2020. Methods COVID-19 cases were confirmed by reverse transcriptase-polymerase chain reaction assay for SARS-Cov-2 RNA from nasal and pharyngeal swabs. Delirium was diagnosed by two geriatricians according to the Diagnostic and Statistical Manual of Mental Disorders V (DMS V) criteria. The number of chronic diseases was calculated among a pre-defined list of 60. The pre-disease Clinical Frailty Scale (CFS) was assessed at hospital admission. Results Of the total sample, 39 patients died, 49 were discharged and 3 were transferred to ICU. Twenty-five patients (27.5%) had delirium. Seventy-two percent of patients with delirium died during hospitalization compared to 31.8% of those without delirium. In a multivariate logistic regression model adjusted for potential confounders, patients with delirium were four times more likely to die during hospital stay compared to those without delirium (OR = 3.98;95%CI = 1.05–17.28; p = 0.047). Conclusions Delirium is common in older patients with COVID-19 and strongly associated with in-hospital mortality. Regardless of causation, either due to a direct effect of SARS-COV-2 on the CNS or to a multifactorial cause, delirium should be interpreted as an alarming prognostic indicator in older people.

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Safety of parathyroidectomy in older vs. younger patients with primary hyperparathyroidism

Endocrine Connections ◽

10.1530/ec-21-0363 ◽

2021 ◽

Author(s):

Marlena Mueller ◽

Fahim Ebrahimi ◽

Emanuel Christ ◽

Christian Andreas Nebiker ◽

Philipp Schuetz ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Older Patients ◽

Large Population ◽

Age Groups ◽

Length Of Hospital Stay ◽

Population Based ◽

Old Patients ◽

Prolonged Length ◽

Icu Admission ◽

Increased Risk

Background: Primary hyperparathyroidism is a prevalent endocrinopathy for which surgery is the only curative option. Parathyroidectomy is primarily recommended in younger and symptomatic patients, while there are still concerns regarding surgical complications in older patients. We therefore assessed the association of age with surgical outcomes in patients undergoing parathyroidectomy in a large population in Switzerland. Methods: Population-based cohort study of adult patients with primary hyperparathyroidism undergoing parathyroidectomy in Switzerland between 2012 and 2018. The cohort was divided into four age groups (<50 years, 50-64 years, 65-74 years, ≥75 years). The primary outcome was a composite of in-hospital postoperative complications. Secondary outcomes were intensive care unit (ICU) admission, unplanned 30-day-readmission, and prolonged length of hospital stay. Results: We studied 2642 patients with a median (IQR) age of 62 (53 – 71) years. Overall, 111 patients had complications including surgical re-intervention, hypocalcemia, and vocal cord paresis. As compared to <50 year-old patients, older patients had no increased risk for in-hospital complications after surgery (50-64 years: OR 0.51 [95% CI 0.28 to 0.92]; 65-74 years: OR 0.72 [95% CI 0.39 to 1.33]; ≥75 years: OR 1.03 [95% CI 0.54 to 1.95]), respectively. There was also no association of age and rates of ICU-admission and unplanned 30-day-readmission, but oldest patients had longer hospital stays (OR 2.38 [95% CI 1.57 – 3.60]). Conclusion: ≥50 year-old patients undergoing parathyroidectomy had comparable risk of in-hospital complications as compared with younger ones. These data support parathyroidectomy in even older patients with primary hyperparathyroidism as performed in clinical routine.

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Effects of different antihypertensive medication groups on cognitive function in older patients: A systematic review

European Psychiatry ◽

10.1016/j.eurpsy.2017.07.015 ◽

2017 ◽

Vol 46 ◽

pp. 1-15 ◽

Cited By ~ 13

Author(s):

M. Stuhec ◽

J. Keuschler ◽

J. Serra-Mestres ◽

M. Isetta

Keyword(s):

Systematic Review ◽

Cognitive Function ◽

Episodic Memory ◽

Cognitive Decline ◽

Older Patients ◽

The Elderly ◽

Systematic Search ◽

Chronic Hypertension ◽

Increased Risk ◽

The Impact

AbstractBackground:Chronic hypertension has been associated with an increased risk of cognitive decline. Although a link between hypertension and cognitive decline has been established, there is less evidence supported by systematic reviews. The main aim was to compare different antihypertensive drug groups in relation to their effect on cognition in older patients without established dementia using a systematic review.Method:A systematic search in Medline and Embase through to January 2017 was used to identify randomized controlled clinical trials (RCTs) studying the impact of different antihypertensives on cognition in older patients without dementia. Angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACE-Is), beta-blockers (BBs), diuretics, and calcium channel blockers (CCBs) were included in this review.Results:The systematic search identified 358 studies. The full text of 31 RCTs was reviewed and a total of 15 RCTs were included in the review. Most studies reported an improvement in episodic memory in patients treated with ARBs versus placebo or other types of antihypertensive drugs. No study showed an improvement in cognition in patients who received diuretics, BBs, or CCBs. Heterogeneity was high in most trials (predominantly in the blinding of participants and investigators).Conclusion:This review suggests that ARBs can improve cognitive functions in the elderly, especially episodic memory. ACE-Is, diuretics, BBs and CCBs did not seem to improve cognitive function in the elderly but were similarly effective in blood pressure lowering as ARBs.

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Prognostic Significance of IDH1 and IDH2 mutations in Older Patients with Primary Cytogenetically Normal Acute Myeloid Leukemia

Blood ◽

10.1182/blood.v128.22.5058.5058 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5058-5058 ◽

Cited By ~ 1

Author(s):

Jinghan Wang ◽

Zhixin Ma ◽

Qinrong Wang ◽

Mengxia Yu ◽

Xiufeng Yin ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Older Patients ◽

Myeloid Leukemia ◽

Prognostic Significance ◽

Old Patients ◽

Multivariable Analyses ◽

Idh1 Mutations ◽

Idh1 And Idh2 Mutations ◽

The Impact ◽

Acute Myeloid

Abstract IDH1 and IDH2 mutations are frequently identified in older patients with AML.With the development and application of IDH inhibitor, the prognostic significance of these mutations in old patients is of primary importance. To assess the impact on clinic outcome, we analyzed 224 older (> 60 years) patients with primary cytogenetically normal acute myeloid leukemia (CN-AML) similarly treated with intensive induction chemotherapy. Our analysis identified IDH1 and/or IDH2 (IDH1/2), IDH1 or IDH2 mutations in 63(28%), 29(12.9%) and 35(15.6%) patients, respectively. In general, IDH1 and IDH2 mutations were mutually exclusive, with only one patient having both IDH1 R132C and IDH2 R140Q mutations. IDH2 R172 mutations were exclusive with all other mutations analyzed (NPM1, CEBPA, DNMT3A, IDH1 and FLT3-ITD). There was a strong interaction between IDH2 mutation and NPM1 mutational status. Concurrent presence of IDH2 R140 and NPM1 mutations was independently associated with longer overall survival (OS; P=0.038, HR=0.42) and event free survival (EFS; P=0.034, HR=0.46) compared to the wild type counterpart in multivariable analyses. In contrast, IDH1 mutations were independently associated with shorter OS (P=0.004, HR=1.98) and EFS (P=0.014, HR=1.72) in multivariable analyses. Notably, IDH1 R132 mutations harbored higher levels of total 2-hydroxyglutarate compared to IDH2 R140Q mutations. Patients with IDH1 mutations or IDH2 R140 and NPM1 mutations harbored also distinct miRNA-expression signatures. Future studies will establish whether these difference between IDH1 and IDH2 mutations will be relevant with respect to response of the respective subsets of patients to the emerging therapies with IDH1 and IDH2 inhibitors. Disclosures No relevant conflicts of interest to declare.

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Sublingual microcirculation detects impaired perfusion in dehydrated older patients

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-200859 ◽

2020 ◽

Vol 75 (4) ◽

pp. 475-487 ◽

Cited By ~ 1

Author(s):

Raphael Romano Bruno ◽

Maryna Masyuk ◽

Johanna M. Muessig ◽

Stephan Binneboessel ◽

Michael Bernhard ◽

...

Keyword(s):

Older Patients ◽

Video Quality ◽

Clinical Problem ◽

Dark Field ◽

Lower Percentage ◽

Sidestream Dark Field ◽

Clinical Frailty Scale ◽

Old Patients ◽

Small Vessels ◽

Sublingual Microcirculation

BACKGROUND: Dehydration occurs frequently in older patients and constitutes a significant clinical problem. OBJECTIVE: This proof-of-concept study examines whether 1) sublingual measurement in dehydrated old patients is feasible, 2) frailty and incompliance in old, awake patients affects video-quality, 3) dehydration impacts microcirculation METHODS: This prospective observational study included clinically dehydrated patients aged ≥65 years immediately after admission. Dehydration was assessed clinically. A sidestream dark field camera (SDF) was used for measurement. Video-quality was evaluated with MIQS (microcirculation image quality score). Both AVA 4.3C- and AVA POEM-software analyzed the videos. Seventeen patients ≥65 years not showing dehydration served as control. RESULTS: Thirteen patients (8 female) were included. The average age was 83±8 years. The mini-mental test was 17±15 points, the Clinical Frailty Scale 4±3, the Barthel-Index 59±39. None of these parameters correlated with MIQS (3.4±4.2 SD (“acceptable”)). Dehydrated patients had a slightly impaired microcirculation, with a significantly lower percentage of perfused small vessels compared to control (83.1±7.7% versus 88.0±6.0%, P < 0.05). After rehydration, there was acute improvement in the microcirculation. CONCLUSIONS: Sublingual microcirculatory SDF-measurement is both, safe and valid for dehydrated old patients - regardless of frailty, age or cognitive performance. Dehydration leads to an impaired microcirculation.

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Peripheral Blood Stem Cell Collection in Elderly Patients

Blood ◽

10.1182/blood.v112.11.4139.4139 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4139-4139

Author(s):

Adrian Tempescul ◽

Jean-Christophe Ianotto ◽

Jean-Richard Eveillard ◽

Elisabeth Hardy ◽

Gaelle Guillerm ◽

...

Keyword(s):

Stem Cells ◽

Stem Cell ◽

Young People ◽

Elderly Patients ◽

Older Patients ◽

Autologous Transplantation ◽

Old Patients ◽

Peripheral Stem Cell ◽

Peripheral Stem Cells ◽

The Impact

Abstract Introduction Intensive treatments like autologous stem cells transplantations are final standard treatment in lymphoma and myeloma for young people (1,2). In the context of population’s ageing, those treatments should be eligible for older patients. One of the major causes which did not allowed these procedures in elderly patients is the reports of the impact of the age on the process of mobilisation of peripheral stem cell (3). We proceed a retrospective study to explore the feasibility of stem cells collection in patients older than 65 years, compared to younger people. Material and patients During the period of 1999–2006, we identified all the patients older than 65 years, with myeloma and lymphoma, who performed peripheral stem cells collection in Brest’s blood collection centre. We excluded patients for bone marrow collection. Patients were eligible if they achieved more than 2.106 CD34/kg. Then we compared the results obtained in older patients with the results obtained in younger people. Results We identified 100 patients older than 65 years between the 359 patients who underwent peripheral stem cell harvest in Brest’s harvest centre. We excluded 37 others patients for non-conformity. The elderly patients were significantly older (age 68.9 vs. 49.3 y, p<10−6). No differences were seen for the number of collection between the older and the younger patients (1.59 vs. 1.50, p>0.05). The number of CD34/kg per patient was sufficient to realise more than one autologous transplantation in both groups of patients (5.3 vs. 6.67, p=0.004). Samples were sufficiently rich for CD34/kg (4.36 vs. 5.54, p=0.02). Patients were harvested in one (60), two (25) or more than 2 collections (15). Among the older patients, 71% achieved a sufficient collection of more than 2.106 CD34/kg in one sample only. Conclusion We identified one hundred patients older than 65 years, during a period of 8 years, who performed peripheral stem cells collection, with sufficient wealth (>2.106 CD34/kg). The majority of patients, 60%, need only one stem cells harvesting. The study confirmed that old patients could be harvested like young people, and eligible for stem cells autologous transplantation.

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Zinc Depletion Increases Readmission in Older Patients: An Example of Interactions Between Nutrition and Disease

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000275 ◽

2017 ◽

Vol 87 (1-2) ◽

pp. 10-16 ◽

Cited By ~ 1

Author(s):

Salah Gariballa ◽

Awad Alessa

Keyword(s):

Nutritional Status ◽

Inductively Coupled Plasma ◽

Older Patients ◽

Controlled Trial ◽

Prognostic Indicators ◽

Hospitalised Patients ◽

Increased Risk ◽

Co Morbidity ◽

The Impact ◽

Poor Nutrition

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

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