Factors associated with normal physical function in patients with rheumatoid arthritis of different ages

Abstract Background To investigate factors associated with normal physical function of middle-aged (55-64), old (65-74) or very old (75-84) patients with rheumatoid arthritis (RA). Methods Data from RA patients in the National Database of Rheumatic Diseases in Japan (NinJa) were extracted from April 2017 to March 2018. Factors associated with impaired physical function (Health Assessment Questionnaire Disability Index [HAQ-DI] >0.5) were analyzed by multivariable logistic regression. Association of glucocorticoids (GCs) and age with impaired physical function were presented as adjusted odds ratio (OR) for the 5 groups relative to middle-aged patients without GCs as the reference group. Results Low disease activity (3.3< simplified disease activity index [SDAI] ≤11) or remission (SDAI ≤3.3) was achieved in 3,466 (31.4%) or 3,021(27.4%) of 11,036 patients aged 55-84, respectively. To reduce the influence of joint destruction on HAQ-DI, we assessed the 3,708 patients in both SDAI ≤11 and Steinbrocker stage I/II. About half of the very old patients were receiving methotrexate, which was the lowest proportion amongst the three age groups. GCs were continued in 32.6% of very old patients, and the proportion was higher than in old and middle-aged patients. On the other hand, 16.2% of the very old patients received biological disease-modifying anti-rheumatic drugs (bDMARDs), and the proportions were similar among the three groups. SDAI was higher in patients with HAQ-DI >0.5 at all ages, and GCs was used more frequently in the old and very old patients with HAQ-DI >0.5, compared to those with HAQ-DI ≤0.5. To minimize the influence of disease activity on HAQ-DI, we selected the 2078 patients in both remission and stage I/II. Multivariable analysis revealed the use of GCs further increased the adjusted OR from 4.01 (95% confidence interval [CI] 2.30-6.99) to 6.81 (95%CI 3.65-12.7) in the very old patients, while the adjusted OR was 2.03 (95%CI 1.17-1.13) in the old patients without GCs, 2.22 (95%CI 1.13-4.36) in the old patients with GCs, and 0.73 (95%CI 0.21-2.56) in the middle-aged patients with GCs. Conclusions The negative impact of GCs was likely to most strongly influence physical function of very old patients than middle-aged or old patients.

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Effects of Inappropriate Empirical Antimicrobial Therapy on the Outcomes of Patients with Community-Onset Bacteremia: Age Matters

10.21203/rs.3.rs-225115/v1 ◽

2021 ◽

Author(s):

Chih-Hao Lin ◽

Po-Lin Chen ◽

Ching-Yu Ho ◽

Chung-Hsun Lee ◽

Chih-Chia Hsieh ◽

...

Keyword(s):

Average Increase ◽

Middle Aged ◽

Multicenter Cohort Study ◽

Aged Patients ◽

Old Patients ◽

Very Old ◽

Age Related ◽

Crude Mortality ◽

Community Onset ◽

Very Old Patients

Abstract Background: Studies have reported the effects of delayed administration of appropriate empirical antimicrobial (AEA) on the prognosis of patients with bloodstream infections; however, whether there is an age-related difference in these effects remains debated. Methods: In this 4-year multicenter cohort study, patients with community-onset bacteremia were retrospectively included and categorized into “middle aged” (45–64 years), “old” (65–74 years), and “very old” (≥75 years) groups. To determine the timing of AEA administration for each patient, all causative microorganisms were prospectively obtained. For each age group, the effects of delayed AEA administration on 30-day mortality were investigated after adjustment for the independent predictors of 30-day mortality determined using a logistic regression model.Results: Significant differences were observed in the distribution of comorbidity types, comorbidity severity, bacteremia sources, bacteremia severity, and causative microorganisms among 968 (33.2%) middle-aged, 683 (23.4%) old, and 1,265 (43.4%) very old patients. Although significant effects (adjusted odds ratio [AOR], 1.002; P = 0.07) of delayed AEA administration on prognosis were not observed in middle-aged patients, each hour of AEA delay resulted in an average increase in the 30-day crude mortality of 0.036% (AOR, 1.0036; P < 0.001) and 0.38% (AOR, 1.0038; P < 0.001) in old and very old patients, respectively. Practically in critically ill patients, each hour of delayed AEA administration resulted in an average increase of 0.03% (AOR, 1.003; P = 0.04), 0.4% (AOR, 1.004; P < 0.001), and 0.5% (AOR, 1.005; P = 0.001) in 30-day crude mortality in middle-aged, old, and very old patients, respectively. Conclusions: Regardless of bacteremia severity, the adverse effects of delayed AEA administration on the survival of patients with community-onset bacteremia increased with patients’ age. To achieve favorable outcomes, rapid AEA administration is recommended in older patients.

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