scholarly journals Comparison of hematological and inflammatory mortality predictors between older and younger COVID-19 patients

2021 ◽  
Keyword(s):  
Elderly Patients ◽  
Mortality Risk ◽  
Troponin T ◽  
Mortality Data ◽  
Monocyte Count ◽  
Geriatric Population ◽  
Younger Patients ◽  
Predictors Of Mortality ◽  
Inflammatory Parameters ◽  
Increased Risk

Background/objective: Several hematological and inflammatory parameters so far have been associated with COVID-19 disease severity; however, such evidence for particularly vulnerable elderly patients is lacking. This study aimed to investigate potential and practical biomarkers that could assist in predicting mortality at the presentation in a group of elderly and non-elderly patients. Methods: This retrospective cohort study included 1820 COVID-19 patients hospi-talized for treatment. Clinical and mortality data as well as certain hematological and inflammatory parameters were retrieved from records. For analysis, patients were divided into two groups as geriatric (age ≥65 years) and non-geriatric subjects. The associated factors of the parameters on mortality were examined separately for elderly and younger patients. Results: Following multivariate analysis, high neutrophil count and high troponin T levels emerged as significant independent predictors of mortality in both geriatric patients and younger patients. Low and high monocyte count was associated with increased mortality risk for geriatric and younger patients, respectively. In the geriatric population, high ferritin levels and high RBC count was associated with increased risk, but increased eosinophil count was associated with decreased risk. Low lymphocyte count emerged as a predictor of mortality among younger patients. Conclusion: Several hematological and inflammatory parameters and indices may assist in predicting the mortality risk in patients with COVID-19; however, there appears to be some differences in terms of these predictors of mortality between elderly and younger patients. Larger prospective studies are warranted to support these findings.

P1560Prognostic predictors of mortality in very elderly patients presenting with NSTEMI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Cacho ◽  
A Cordero Fort ◽  
T Gonzalez Ferrero ◽  
M Perez Dominguez ◽  
A Torrelles Fortuny ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Elderly Patients ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Beta Blockers ◽  
Coronary Revascularization ◽  
Very Elderly ◽  
Younger Patients ◽  
Predictors Of Mortality

Abstract Background Elderly patients are usually under-represented in randomized controlled trials, therefore there is less data providing prognostic information for this particular group. NSTEMI clinical practice guidelines indicate that older patients should receive the same therapeutic strategy than younger patients. Methods Observational retrospective study including 8771 patients admitted for acute coronary syndrome in two tertiary referral hospitals between 2003 and 2017: 5673 NSTEMI (64.3%) and 3098 STEMI (35.7%). 999 patients presenting with NSTEMI and aged over 75 years were selected and divided into 3 groups: aged 75–80, aged 80–89 and aged over 90. Cox proportional hazard regression analysis was performed in order to determine independent predictors of mortality. Mortality and survival were represented by Kaplan-Meier curves and log rank test was conducted to assess significant differences in survival between groups. Median follow-up period was 48 months. Results A significant association between female sex and elder age was observed, also a higher prevalence of hyperlipemia and diabetes. In acute phase, no significant differences were found in between congestive heart failure onset, myocardial re-infarction, acute renal failure, stroke or in-hospital mortality amongst the 3 groups. However, at follow-up period, higher mortality in elder groups was documented. After performing a multivariate analysis, age was identified as an independent predictor of mortality at follow-up (<90 years: HR 1.50 CI 95% 1.23–1.83, p=0.0001, >90 years: HR 1.93 CI 95% 1.27–2.93, p=0.002) as well as GRACE score (HR 1.06, CI 95% 1.02–1.09, p=0.002), CRUSADE score (HR 1.01 CI 95% 1.01–1.02, p=0.0001) and treatment with digoxine (HR 1.38 CI 95% 0.95–2.0, p=0.08). On the other side, beta-blockers (HR 0.71 CI 95% 0.59–0.86, p=0.0001) and complete coronary revascularization (HR 0.48 CI 95% 0.37–0.64, p=0.0001) were found to be protective factors. Conclusions In very elderly patients presenting with NSTEMI, prognostic predictors of mild-term mortality are similar to those present in younger patients. Recommendations of clinical practice guidelines, such as beta-blockers' treatment and coronary revascularization, should also be applied in elderly patients.

scholarly journals Utility of hospitalization for elderly individuals affected by COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250730
Author(s):  
Giorgio Costantino ◽  
Monica Solbiati ◽  
Silvia Elli ◽  
Marco Paganuzzi ◽  
Didi Massabò ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Health Care Organizations ◽  
The Elderly ◽  
Mortality Data ◽  
Standardized Mortality Ratio ◽  
Older Individuals ◽  
Younger Patients ◽  
Mortality Ratio ◽  
Two Phases ◽  
Peak Phase

Background During the COVID-19 pandemic, the number of individuals needing hospital admission has sometimes exceeded the availability of hospital beds. Since hospitalization can have detrimental effects on older individuals, preference has been given to younger patients. The aim of this study was to assess the utility of hospitalization for elderly affected by COVID-19. We hypothesized that their mortality decreases when there is greater access to hospitals. Methods This study examined 1902 COVID-19 patients consecutively admitted to three large hospitals in Milan, Italy. Overall mortality data for Milan from the same period was retrieved. Based on emergency department (ED) data, both peak and off-peak phases were identified. The percentage of elderly patients admitted to EDs during these two phases were compared by calculating the standardized mortality ratio (SMR) of the individuals younger than, versus older than, 80 years. Results The median age of the patients hospitalized during the peak phase was lower than the median age during the off-peak phase (64 vs. 75 years, respectively; p <0.001). However, while the SMR for the younger patients was lower during the off-peak phase (1.98, 95% CI: 1.72–2.29 versus 1.40, 95% CI: 1.25–1.58, respectively), the SMR was similar between both phases for the elderly patients (2.28, 95% CI: 2.07–2.52 versus 2.48, 95% CI: 2.32–2.65, respectively). Conclusions Greater access to hospitals during an off-peak phase did not affect the mortality rate of COVID-19-positive elderly patients in Milan. This finding, if confirmed in other settings, should influence future decisions regarding resource management of health care organizations.

scholarly journals Male survival advantage on the Baja California peninsula

2020 ◽  
Vol 16 (11) ◽  
pp. 20200600
Author(s):  
Ryan Schacht ◽  
Shane J. Macfarlan ◽  
Huong Meeks ◽  
Paola Linette Cervantes ◽  
Fernando Morales
Keyword(s):  
Risk Factors ◽  
Mortality Risk ◽  
Baja California ◽  
Cox Regression ◽  
Survival Advantage ◽  
Baja California Peninsula ◽  
Mortality Data ◽  
Consistent Finding ◽  
Increased Risk ◽  
Extrinsic Risk

A consistent finding from contemporary Western societies is that women outlive men. However, what is unclear is whether sex differences in survival are constant across varying socio-ecological conditions. We test the universality of the female survival advantage with mortality data from a nineteenth century population in the Baja California peninsula of Mexico. When examined simply, we find evidence for a male-biased survival advantage. However, results from Cox regression clearly show the importance of age intervals for variable survival patterns by sex. Our key findings are that males: (i) experience significantly lower mortality risk than females during the ages 15–30 (RR = 0.69), (ii) are at a significantly increased risk of dying in the 61+ category (RR = 1.30) and (iii) do not experience significantly different mortality risk at any other age interval (0–14, 31–45, 46–60). We interpret our results to stem from differing intrinsic and extrinsic risk factors for sex-biased mortality across age intervals, highlighting the relevance of a lifecourse approach to the study of survival advantage. Ultimately, our results make clear the need to more broadly consider variability in mortality risk factors across time and place to allow for a clearer understanding of human survival differences.

Abstract MP96: Dysglycemia and Mortality in Older Adults With and Without Diabetes

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Priya Palta ◽  
Elbert S Huang ◽  
Rita R Kalyani ◽  
Sherita H Golden ◽  
Frederick L Brancati ◽  
...  
Keyword(s):  
Older Adults ◽  
Mortality Risk ◽  
Survey Design ◽  
Smoking Status ◽  
Hdl Cholesterol ◽  
Mortality Data ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Nationally Representative ◽  
Diagnosed Diabetes

Studies in middle-aged adults report higher levels of glycated hemoglobin are associated with increased risk of mortality in non-diabetic individuals. Few studies have sufficient data to assess this association in older adults. We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994), Continuous NHANES (1999-2004), and their linked mortality data (through December 2006) to determine the risk of mortality by levels of HbA1c in older adults with and without diabetes. All analyses are weighted to represent the US population and to account for the complex survey design. Cox proportional hazard models examining the relationship between HbA1c and mortality were adjusted for age, sex, race, education, body mass index, smoking status, HDL cholesterol and hypertension. At baseline, in 7,405 adults, age ≥65 with HbA1c data (42.9% men; 7.5% black; 2.4% Mexican; mean age 73.5 (0.13)), 22.8% had clinically diagnosed diabetes (defined as self-reported physician diagnosis of diabetes and/or use of insulin or hypoglycemic medications). Over a median follow-up of 7.8 years, 4,625 participants (41.9%; 68.1 per 1000 person-years) died due to cardiovascular disease (CVD; n=1520) or non-CVD (n=3105). Non-diabetic older adults with a HbA1c between 5.7-6.4% (defined as “at risk for diabetes” by the American Diabetes Association) had a significantly greater risk of all-cause (HR: 1.39; 95% CI: 1.03-1.89) and non-CVD (HR: 1.55; 95% CI: 1.13-2.13) mortality compared to those with HbA1c<5.0% (referent). In older diabetic adults, there was a graded increase in mortality risk with significant associations found between HbA1c and all-cause (HR: 1.90; 95% CI: 1.13-3.28) and CVD (HR: 2.67; 95% CI: 1.17-6.09) mortality, in analyses comparing participants with a HbA1c between 8.0-8.9% to those with HbA1c <6.5% (referent). These data from a large, nationally representative sample of older adults indicate that dysglycemia is associated with increased mortality risk in older adults with and without diabetes.

P6363Achieved blood pressure and cardiovascular outcomes in hypertensives

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H.-Y Park ◽  
N.-K Lim ◽  
W.-H Kim ◽  
J.-W Lee ◽  
M.-C Cho
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Events ◽  
Health Examination ◽  
Composite Outcome ◽  
Younger Patients ◽  
Hypertensive Patients ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk

Abstract Background/Introduction Lowering blood pressure is very beneficial in reducing the risk of cardiovascular morbidity and mortality. But, the extent of optimal target blood pressure in hypertensive patients is still controversial. Purpose The objectives of this study were to assess the level of proper systolic and diastolic blood pressure to prevent cardiovascular events in older and younger patients. Methods We used the National Sample Cohort from the National Health Insurance Service of 2007 to 2013 in Korea and analyzed data from 44,462 hypertensive patients aged from 20 to 84, treated with one or more antihypertensive agents and participated at least one general health examination. Achieved systolic and diastolic blood pressure (SBP/DBP) were categorized by exclusive average achieved SBP (<120, <130, <140, <150, and ≥150 mmHg) and DBP (<70, <80, <90, <100, and ≥100 mmHg) categories using the blood pressure measurements of one or more available health examinations. The primary outcome was defined as composite, which was the first occurred event among admissions of myocardial infarction, stroke, and heart failure or cardiovascular death. Secondary outcomes were individual components of composite outcome and all-cause death. Results Of 44,462 patients, 5,478 (12.3%), 13,410 (30.2%), 15,021 (33.8%), 7,051 (15.9%), and 3,502 (7.9%) patients achieved SBP <120 mm Hg, 120–129 mm Hg, 130–139 mm Hg, 140–149 mm Hg, and ≥150 mm Hg, respectively. During the median follow-up of 6.8 years, 2,151 (4.8%) died by all-cause of death, and 2,463 (5.5%) met the criteria of composite outcome. In elderly patients, compared with achieved SBP 120–129 (reference), there was no significant increase in risk at SBP 130–139 mm Hg and 140–149 mm Hg, but SBP 150 mm Hg or more was positively associated with significant risk of composite outcome and all-cause death, with HR of 1.29 (95% CI, 1.11–1.51) and 1.66 (95% CI, 1.43–1.92), respectively (Figure). On the other hand, in younger patients, the risk for incidence of composite outcome was significantly increased both at SBP 140–149 mm Hg (HR, 1.39; 95% CI, 1.11–1.73) and 150 mm Hg or more (HR, 2.00; 95% CI, 1.53–2.62) In addition, an achieved SBP 130 mm Hg and more was also significantly associated with all-cause death with HR of 1.27 (95% CI, 1.00–1.62). Compared with 120–129 mm Hg, elderly patients who had achieved SBP less than 120 mm Hg were more likely to have increased risk for composite outcome (HR, 1.29; 95% CI, 1.10–1.52), but not in younger patients (HR, 1.01; 95% CI, 0.78–1.30). Conclusion In conclusion, an intensive lowering of blood pressure is more likely to increase the risk rather than to prevent major cardiovascular events and all-cause death, particularly in older than younger. Therefore, an intensive blood pressure lowering of SBP/DBP below 120/70 mm Hg in the elderly should be avoided. Acknowledgement/Funding The Korea National Institute of Health research grant 2017-NI63001-00

Unrecognized benign paroxysmal positional vertigo in elderly patients

2000 ◽  
Vol 122 (5) ◽  
pp. 630-634 ◽  
Author(s):  
John S. Oghalai ◽  
Spiros Manolidis ◽  
Justine L. Barth ◽  
Michael G. Stewart ◽  
Herman A. Jenkins
Keyword(s):  
Elderly Patients ◽  
Benign Paroxysmal Positional Vertigo ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Geriatric Population ◽  
Cross Sectional ◽  
Balance Disorders ◽  
Positional Vertigo ◽  
Increased Risk ◽  
Paroxysmal Positional Vertigo

Balance disorders in elderly patients are associated with an increased risk of falls but are often difficult to diagnose because of comorbid chronic medical problems. We performed a cross-sectional study to determine the prevalence of unrecognized benign paroxysmal positional vertigo (BPPV) and associated lifestyle sequelae in a public, inner-city geriatric population. Dizziness was found in 61% of patients, whereas balance disorders were found in 77% of patients. Nine percent were found to have unrecognized BPPV. Multivariate analysis demonstrated that the presence of a spinning sensation and the absence of a lightheadedness sensation predicted the presence of unrecognized BPPV. Patients with unrecognized BPPV were more likely to have reduced activities of daily living scores, to have sustained a fall in the previous 3 months, and to have depression. These data indicate that unrecognized BPPV is common within the elderly population and has associated morbidity. Further prospective studies are warranted.

scholarly journals Predictors of Mortality in Elder Patients With Proximal Humeral Fracture

2017 ◽  
Vol 9 ◽  
pp. 215145851772815 ◽  
Author(s):  
Chad M. Myeroff ◽  
Jeffrey P. Anderson ◽  
Daniel S. Sveom ◽  
Julie A. Switzer
Keyword(s):  
Elderly Patients ◽  
Proximal Humerus ◽  
Humeral Fracture ◽  
Patient Characteristics ◽  
Treatment Method ◽  
Shoulder Function ◽  
Predictors Of Mortality ◽  
Inpatient Ward ◽  
Increased Risk ◽  
American Society

Background: Known possible consequences of proximal humerus fractures include impaired shoulder function, decreased independence, and increased risk for mortality. The purpose of this report is to describe the survival and independence of elderly patients with fractures of the proximal humerus, treated in our institution, relative to patient characteristics and treatment method. Methods: Retrospective cohort study from 2006 to 2012. Setting: Community-based hospital with level 1 designation. Patients/Participants: Three hundred nineteen patients ≥60 years who presented to the emergency department with an isolated fracture of the proximal humerus were either admitted to the inpatient ward for the organization and provision of immediate definitive care or discharged with the expectation of coordination of their care as an outpatient. Treatment was nonoperative or operative. Outcome Measures: One- and 2-year mortality. Results: Significant predictors of mortality at 1 year included Charlson Comorbidity Index (CCI; continuous, hazard ratio [HR] = 1.40; 95% confidence interval [CI]: 1.06-1.86), body mass index (BMI; <25 vs ≥25; HR = 3.43; 95% CI: 1.45-8.14), and American Society of Anesthesiologists (ASA) disease severity score (3-4 vs 1-2; HR = 4.48; 95% CI: 1.21-16.55). In addition to CCI and BMI, reliance on a cane/walker/wheelchair at the time of fracture predicted mortality at 2 years (vs unassisted ambulation; HR = 3.13; 95% CI: 1.59-5.88). Although the Neer classification of fracture severity significantly correlated with inpatient admission ( P < .001), it was not significantly associated with mortality or with loss of living or ambulatory independence. Among admitted patients, 64% were discharged to a facility with a higher level of care than their prefracture living facility. Twenty percent of study patients experienced a loss in ambulatory status by at least 1 level at 1 year postfracture. Conclusion: In a cohort of elderly patients with fractures of the proximal humerus, patient characteristics including comorbidities, ASA classification, and lower BMI were associated with increased mortality. Specifically, those admitted at the time of fracture and treated nonoperatively had the highest mortality rate and, likely, represent the frailest cohort. Those initially treated as outpatients and later treated operatively had the lowest mortality and, likely, represent the healthiest cohort. These data are inherently biased by prefracture comorbidities but help stratify our patients’ mortality risk at the time of injury.

scholarly journals Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2104
Author(s):  
Styliani Mantziari ◽  
Hugo Teixeira Farinha ◽  
Vianney Bouygues ◽  
Jean-Charles Vignal ◽  
Yannick Deswysen ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Esophageal Cancer ◽  
Elderly Patients ◽  
Treatment Plan ◽  
Cell Cancer ◽  
Neoadjuvant Treatment ◽  
Younger Patients ◽  
Definitive Chemoradiation ◽  
Increased Risk ◽  
Treatment Surgery

Esophageal cancer, despite its tendency to increase among younger patients, remains a disease of the elderly, with the peak incidence between 70–79 years. In spite of that, elderly patients are still excluded from major clinical trials and they are frequently offered suboptimal treatment even for curable stages of the disease. In this review, a clear survival benefit is demonstrated for elderly patients treated with neoadjuvant treatment, surgery, and even definitive chemoradiation compared to palliative or no treatment. Surgery in elderly patients is often associated with higher morbidity and mortality compared to younger patients and may put older frail patients at increased risk of autonomy loss. Definitive chemoradiation is the predominant modality offered to elderly patients, with very promising results especially for squamous cell cancer, although higher rates of acute toxicity might be encountered. Based on the all the above, and although the best available evidence comes from retrospective studies, it is not justified to refrain from curative treatment for elderly patients based on their age alone. Thorough assessment and an adapted treatment plan as well as inclusion of elderly patients in ongoing clinical trials will allow better understanding and management of esophageal cancer in this heterogeneous and often frail population.

scholarly journals Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL)

2011 ◽  
Vol 42 (4) ◽  
pp. 843-853 ◽  
Author(s):  
T. J. Holwerda ◽  
A. T. F. Beekman ◽  
D. J. H. Deeg ◽  
M. L. Stek ◽  
T. G. van Tilburg ◽  
...  
Keyword(s):  
Social Isolation ◽  
Mortality Risk ◽  
The Elderly ◽  
Older Men ◽  
Mortality Data ◽  
Physical And Mental Health ◽  
Men And Women ◽  
Risk Of Mortality ◽  
Increased Risk

BackgroundLoneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors.MethodIn our prospective cohort study of 4004 older persons aged 65–84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors.ResultsAt 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04–1.63] in men and 1.04 (95% CI 0.90–1.24) in women. No higher risk of mortality was found for social isolation.ConclusionsFeelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.

551 INCREASED POSTOPERATIVE MORBIDITY AFTER TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER IN ELDERLY PATIENTS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Nikolaj Baranov ◽  
Nikolaj Baranov ◽  
Frans Van Workum ◽  
Camiel Rosman
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Minimally Invasive Esophagectomy ◽  
Age Groups ◽  
The Elderly ◽  
Elderly Group ◽  
Younger Patients ◽  
Invasive Esophagectomy ◽  
Outcome Parameters ◽  
Increased Risk

Abstract   The incidence of elderly patients with esophageal cancer is increasing. The aim of this study is to compare postoperative outcomes after esophagectomy between elderly patients and younger patients and to compare outcomes after totally minimally invasive esophagectomy (TMIE) and open esophagectomy (OE) in these age groups. Methods Data was retrieved from the Dutch Upper Gastrointestinal Cancer Audit (DUCA), a national surgical outcome registry. The primary outcome parameter was severe complications, defined as Clavien Dindo ≥3. Secondary outcome parameters were postoperative complications, reintervention rate, length of hospital stay and mortality. Outcome parameters were compared between patients aged ≥75 years and &lt; 75 years and between TMIE and OE in these age groups. We adjusted for the following casemix parameters: gender, Charlson Co-morbidity Index score ASA score and neoadjuvant therapy. A sensitivity analysis was performed with different age groups: &lt;65, 65–69, 70–74, 75–79 and ≥ 80 years. Results Of all 5539 included patients 14.0% were aged ≥75 years and 86.0% were aged &lt;75 years. Severe complications were observed more frequently in the elderly group compared to the younger group (RR = 1.15 [1.04–1.27], p = 0.007). Interestingly, there was an increased risk of severe complications after TMIE in both the elderly group (RR = 1.50 [1.19–1.90], p = 0.001) and the younger group (RR = 1.41 [1.28–1.56], p &lt; 0.001). No difference in mortality between TMIE and OE was found. Sensitivity analyses of TMIE compared to OE across all age groups showed increased risk of severe complications. Adjustment for casemix for all analysis did not change the results. Conclusion Severe complications after esophagectomy occur more frequently in elderly compared to younger patients. TMIE in elderly patients did not result in less morbidity and was in fact associated with more severe complications compared to OE across all age groups, which may be due to a learning curve effect.

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