Cardiovascular Characteristics and Outcomes of Young Patients with COVID-19

Although 18–45-year-old (y-o) patients represent a significant proportion of patients hospitalized for COVID-19, data concerning the young population remain scarce. The Critical COVID France (CCF) study was an observational study including consecutive patients hospitalized for COVID-19 in 24 centers between 26 February and 20 April 2020. The primary composite outcome included transfer to the intensive care unit (ICU) or in-hospital death. Secondary outcomes were cardiovascular (CV) complications. Among 2868 patients, 321 (11.2%) patients were in the 18–45-y-o range. In comparison with older patients, young patients were more likely to have class 2 obesity and less likely to have hypertension, diabetes and dyslipidemia. The primary outcome occurred less frequently in 18–45-y-o patients in comparison with patients > 45 years old (y/o) (16.8% vs. 30.7%, p < 0.001). The 18–45-y-o patients presented with pericarditis (2.2% vs. 0.5%, p = 0.003) and myocarditis (2.5% vs. 0.6%, p = 0.002) more frequently than patients >45 y/o. Acute heart failure occurred less frequently in 18–45-y-o patients (0.9% vs. 7.2%, p < 0.001), while thrombotic complications were similar in young and older patients. Whereas both transfer to the ICU and in-hospital death occurred less frequently in young patients, COVID-19 seemed to have a particular CV impact in this population.

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490 Right ventricular free wall longitudinal strain negatively impacts prognosis of patients with functional mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair

European Heart Journal Supplements ◽

10.1093/eurheartj/suab132.012 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Giuseppe Iuliano ◽

Angelo Silverio ◽

Cesare Baldi ◽

Michele Bellino ◽

Luca Esposito ◽

...

Keyword(s):

Mitral Valve ◽

Cardiac Death ◽

Longitudinal Strain ◽

Primary Outcome ◽

P Value ◽

Free Wall ◽

Composite Outcome ◽

Valve Repair ◽

Secondary Outcomes

Abstract Aims Although right ventricular (RV) systolic dysfunction seems to be associated with adverse outcome after transcatheter edge-to-edge mitral valve repair (TEER) with the MitraClip system, the prognostic value of RV free wall longitudinal strain (RVFWLS) in this setting has not been yet investigated. The aim of this study is to evaluate RVFWLS as predictor of outcome in patients with severe or moderate-to-severe functional MR undergoing TEER and its prognostic role compared with tricuspid annular plane systolic excursion (TAPSE). Methods and results 102 patients [73 (IQR: 66.8–77.0) years, 73 males (71.6%)] were retrospectively selected from March 2012 to February 2021. Echocardiograms were performed by using General Electric machines. RVFWLS was assessed through RV modified apical 4-chamber view, setting the region of interest to minimum size. Values of RVFWLS > −20% were recognized as abnormal. We considered a composite endpoint including rehospitalization for heart failure (HF) and overall death as primary outcome. Secondary outcomes were overall death, cardiac death and rehospitalization for HF. All patients were assessed at the longest available follow-up [median 22.1 (IQR: 9.7–49.3) months]. Baseline clinical and echocardiographic characteristics are listed in Table 1. Primary outcome was found in 60 (58.8%) patients, while secondary outcomes, i.e. overall death, cardiac death and rehospitalization for HF, were found respectively in 50 (50.0%), 31 (30.4%), and 36 (35.3%) patients. Mean TAPSE was 16.7 ± 4.0 mm and mean RVFWLS was −16.9 ± 6.0%. At univariable analysis both TAPSE (HR: 0.907, CI: 0.848–0.970, P-value: 0.004) and RVFWLS (HR: 0.937, CI: 0.897–0.979, P-value: 0.004) were significantly associated with the primary outcome. Kaplan–Meier survival curves showed that patients with TAPSE <17 mm had a lower survival free from the composite outcome compared with those with TAPSE ≥17 mm (Log-Rank = 0.030); patients with RVFWLS value > −20% also showed a lower survival free from the composite outcome compared with patients with RVFWLS ≤ −20% (Log Rank 0.004). Among patients with preserved RV systolic longitudinal function as indicated by TAPSE ≥ 17 mm, subjects with RVFWLS > −20% had a significantly higher incidence of the composite outcome compare with those with RVFWLS ≤ −20% (Log-Rank = 0.008). Conversely, no difference was found among patients with TAPSE <17 mm. Conclusions RV dysfunction assessed either by TAPSE and RVFWLS is associated with poorer outcome in patients with severe or moderate-to-severe functional MR undergoing TEER. Compared with TAPSE, RVFWLS seems to be superior in identifying patients at higher risk of adverse events during follow-up. Our data encourage the use of this speckle tracking-derived echocardiographic parameter in routinely evaluation of patients with functional MR candidate for TEER.

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The effect of dapagliflozin across the spectrum of baseline risk: a post-hoc analysis of DAPA-HF

European Heart Journal ◽

10.1093/ehjci/ehaa946.0931 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K.F Docherty ◽

P.S Jhund ◽

O Bengtsson ◽

D.L Demets ◽

S.E Inzucchi ◽

...

Keyword(s):

Heart Failure ◽

Risk Score ◽

Primary Outcome ◽

Cardiovascular Death ◽

Baseline Risk ◽

P Value ◽

Funding Source ◽

Composite Outcome ◽

Primary Composite Outcome ◽

Outcome Event

Abstract Background In DAPA-HF, compared to placebo, the sodium-glucose cotransporter 2 (SGLT-2) inhibitor, dapagliflozin, reduced the risk of cardiovascular death or worsening heart failure in patients with heart failure with reduced ejection fraction (HFrEF). The majority of patients in DAPA-HF reported mild functional limitation, however there is significant heterogeneity in prognosis among these patients. Purpose To examine the effect of dapagliflozin compared with placebo across the spectrum of baseline risk in DAPA-HF. Methods The primary composite outcome of DAPA-HF was time-to-first cardiovascular death or worsening heart failure event (hospitalization for heart failure or outpatient visit requiring intravenous therapy). We examined whether the effect of dapagliflozin was modified by baseline risk, as determined by the MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) risk score based upon 13 predictive variables giving a potential maximum score of 57. The number needed to treat (NNT) to over a median follow-up of 18.2 months was calculated by applying the overall relative risk reduction in DAPA-HF (26%, 95% CI 15–35) to the proportion of patients with a primary outcome event in the placebo group of each MAGGIC risk score category (defined by quintiles of score). Results The MAGGIC risk score was calculable for 4740 of 4744 patients in DAPA-HF. The median score was 22 (range 3–43). The event rate for the primary outcome was 7.2 per 100 patient-years in the lowest risk score quintile and 25.7 in the highest. A 1-point increase in score was associated with an 8% increase in the risk of a primary outcome event (p<0.001). Dapagliflozin, compared to placebo, reduced the risk of the primary outcome across quintiles of the MAGGIC risk score (Figure - Interaction p value=0.69) and when the score was analysed as a continuous variable (Interaction p value=0.56). The NNT to prevent one primary event was 39 (95% CI 29–68) in the lowest quintile of risk scores, compared with 14 (11–25) in the highest quintile (Figure). Similar results were found for the individual components of the primary composite outcome and for all-cause mortality. Conclusions DAPA-HF included patients with a wide spectrum of risk. Treatment with dapagliflozin, compared to placebo, reduced the risk of cardiovascular death or worsening heart failure, irrespective of baseline risk as measured by the MAGGIC risk score. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): DAPA-HF was funded by AstraZeneca

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Prognostic Impact of Serum Albumin for Developing Heart Failure Remotely after Acute Myocardial Infarction

Nutrients ◽

10.3390/nu12092637 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2637

Author(s):

Goro Yoshioka ◽

Atsushi Tanaka ◽

Kensaku Nishihira ◽

Yoshisato Shibata ◽

Koichi Node

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Serum Albumin ◽

Primary Outcome ◽

Independent Predictor ◽

Cardiovascular Death ◽

Prognostic Impact ◽

Composite Outcome ◽

The Relationship ◽

Primary Composite Outcome

Low serum albumin (LSA) on admission for acute myocardial infarction (AMI) is related to adverse in-hospital outcomes. However, the relationship between LSA and long-term post-AMI cardiovascular outcomes is unknown. A single-center, non-randomized, retrospective study was performed to investigate the prognostic impact of LSA at admission for AMI on cardiovascular death or newly developed HF in the remote phase after AMI. Admission serum albumin tertiles (<3.8, 3.8–4.2, ≥4.2 g/dL) were used to divide 2253 consecutive AMI from February 2008 to January 2016 patients into three groups. Primary outcome was a composite of hospitalization for HF and cardiovascular death remotely after AMI. Cox proportional hazard models were used to explore the relationship between admission LSA and primary outcome. During follow-up (median: 3.2 years), primary composite outcome occurred in 305 patients (13.5%). Primary composite outcome occurred individually for hospitalization for HF in 146 patients (6.5%) and cardiovascular death in 192 patients (8.5%). The cumulative incidence of primary composite outcome was higher in the LSA group than the other groups (log-rank test, p < 0.001). Even after adjustments for relevant clinical variables, LSA (<3.8 mg/dL) was an independent predictor of remote-phase primary composite outcome, irrespective of the clinical severity and subtype of AMI. Thus, LSA on admission for AMI was an independent predictor of newly developed HF or cardiovascular death and has a useful prognostic impact even remotely after AMI.

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Abstract 123: Replicating the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial in Real-World Claims Data

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a123 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Bijan J Borah ◽

Nilah D Shah ◽

Victor M Montori

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Risk Reduction ◽

Composite Outcome ◽

Cardiovascular Risk Reduction ◽

All Cause Mortality ◽

Secondary Outcomes ◽

Primary Composite Outcome

Background: The ACCORD-Lipid Trial’s finding that statin-fibrate combination therapy (CT) provides no incremental cardiovascular risk reduction in type 2 diabetese over statin monotherapy (MT) prompted FDA to issue a public communication on 11/9/2011 stating that fenofibrate may not reduce risk of heart attack or stroke. Yet, fibrate use continues unabated with over $1 billion in sales in the US that raises concern regarding the inconsistency in diffusion of scientific evidence into clinical practice. Critics of ACCORD findings maintain that ACCORD trial adopted flexible thresholds for qualifying HDL and triglyceride levels and that it left unanswered whether the effects of non-ACCORD statins or fibrates or combinations thereof will be different. By replicating the ACCORD-Lipid trial as closely as possible using 16-year longitudinal claims database from a large national health plan, our study seeks to compare the following ACCORD outcomes between CT and MT cohorts: (i) primary composite outcome of nonfatal MI, nonfatal stroke and cardiovascular death; (ii) secondary outcomes of all-cause mortality, expanded macrovascular outcome, major CAD events and CHF. Methods (Research Design, Data Source and Data Analysis Methods) : Retrospective claims analysis that included patients enrolled between 1995 and 2010 using ACCORD inclusion/exclusion criteria including type 2 diabetes patients aged 40 to 79 with baseline A1C≥7.5 and on statin. Patients in the two study cohorts, CT and MT, were required to have minimum of 1-year baseline and 90-day follow-up periods. Propensity score (PS) matching was used to adjust for patient baseline characteristics. T- and Chi-squared tests were used to assess differences in continuous and categorical covariates and Cox proportional hazard model was used to assess the hazard of study events. Results: The study included 6765 patients (CT=954; MT=5811) with a mean follow-up of 2.4 years. An average patient in the sample was a White male aged 57 years from the South. The two study cohorts differed in demographics (age, female, ethnicity, income categories), baseline lipids (HDL, LDL, triglyceride and HbA1c), and in numerous comorbid conditions. After 1-to-1 PS matching, baseline LDL, triglycerides and total cholesterol were similar but HDL (HbA1c) was higher (lower) in CT than in MT cohort (n=943 in each cohort). Most other baseline covariates were balanced. Unadjusted results showed that compared to MT, CT cohort had higher primary composite outcomes (62 vs 45), all-cause deaths (113 vs 105), macrovascular events (16 vs 9), major CAD (84 vs 59), nonfatal stroke (35 vs 33) and CHF (60 vs 51). Adjusted results show no difference in the rate of primary composite outcome (hazard rate or HR=1.44, p=0.09) and in secondary outcomes of macrovascular events (HR=1.61), all-cause mortality (HR=1.22), major CAD (HR=1.45), CHF (HR=1.24) and non-fatal stroke (HR=0.98) [all p>.05] Conclusion: The study results appear to confirm the non-significance of CT over MT in cardiovascular risk reduction among type 2 diabetes patients in a large US commercial health plan.

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Association between NSAIDs use and adverse clinical outcomes among adults hospitalised with COVID-19 in South Korea: A nationwide study

10.1101/2020.06.01.20119768 ◽

2020 ◽

Author(s):

Han Eol Jeong ◽

Hyesung Lee ◽

Hyun Joon Shin ◽

Young June Choe ◽

Kristian B. Filion ◽

...

Keyword(s):

Primary Outcome ◽

Population Based ◽

Secondary Outcome ◽

Hospital Death ◽

Cohort Entry ◽

Healthcare Database ◽

Renal Complications ◽

Hospitalised Patients ◽

Inflammatory Drugs ◽

Primary Composite Outcome

SUMMARYBACKGROUNDNon-steroidal anti-inflammatory drugs (NSAIDs) may exacerbate COVID-19 and worsen associated outcomes by upregulating the enzyme that SARS-CoV-2 binds to enter cells. However, to our knowledge, no study has examined the association between NSAID use and the risk of COVID-19-related outcomes among hospitalised patients.METHODSWe conducted a population-based cohort study using South Korea’s nationwide healthcare database, which contains data of all subjects who received a test for COVID-19 (n=69,793) as of April 8, 2020. We identified a cohort of adults hospitalised with COVID-19, where cohort entry was the date of hospitalisation. NSAIDs users were those prescribed NSAIDs in the 7 days before and including the date of cohort entry and non-users were those not prescribed NSAIDs during this period. Our primary outcome was a composite of in-hospital death, intensive care unit admission, mechanical ventilation use, and sepsis; our secondary outcome was cardiovascular or renal complications. We conducted logistic regression analysis to estimate odds ratio (OR) with 95% confidence intervals (CI) using inverse probability of treatment weighting to minimize potential confounding.FINDINGSOf 1,824 adults hospitalised with COVID-19 (mean age 490 years, standard deviation 19 0 years; female 59%), 354 were NSAIDs users and 1,470 were non-users. Compared with non-use, NSAIDs use was associated with increased risks of the primary composite outcome (OR 1 65, 95% CI 1-21-2-24) and of cardiovascular or renal complications (OR 187, 95% CI 1-25-2-80). Our main findings remained consistent when we extended the exposure ascertainment window to include the first three days of hospitalisation (OR 187, 95% CI 1 06-3 29).INTERPRETATIONUse of NSAIDs, compared with non-use, is associated with worse outcomes among hospitalised COVID-19 patients. While awaiting the results of confirmatory studies, we suggest NSAIDs be used with caution among patients with COVID-19 as the harms associated with their use may outweigh their benefits in this population.FUNDINGGovernment-wide R&D Fund for Infectious Disease Research (HG18C0068).

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The study of transcarotid artery revascularization under local versus general anesthesia with results from the Society for Vascular Surgery Vascular Quality Initiative

Vascular ◽

10.1177/1708538120924158 ◽

2020 ◽

Vol 28 (6) ◽

pp. 784-793 ◽

Cited By ~ 2

Author(s):

Dipankar Mukherjee ◽

Devon T Collins ◽

Chang Liu ◽

Neul Ha ◽

Jeffrey Jim

Keyword(s):

Myocardial Infarction ◽

Length Of Stay ◽

General Anesthesia ◽

Local Anesthesia ◽

Transient Ischemic Attack ◽

Primary Outcome ◽

Composite Outcome ◽

Reversal Time ◽

Secondary Outcomes ◽

Ischemic Attack

Objective The primary purpose of this study was to examine any potential difference in clinical outcomes between transcarotid artery revascularization performed under local anesthesia compared with general anesthesia by utilizing a large national database. Methods The primary outcome of the study was a composite endpoint of postoperative in-hospital stroke, myocardial infarction and mortality following transcarotid artery revascularization for the index procedure. Secondary outcomes included a composite outcome of postoperative in-hospital stroke, transient ischemic attack, myocardial infarction and mortality along with several subsets of its components and each individual component, flow reversal time (min), radiation dose (GY/cm2), contrast volume utilized (mL), total procedure time (min), extended total length of stay (>1 day) and extended postoperative length of stay (>1 day). Statistical analyses employed both descriptive measures to characterize the study population and analytic measures such as multivariable mixed-effect linear and logistic regressions using both unmatched and propensity-score matched cohorts. Results A total of 2609 patients undergoing transcarotid artery revascularization between the years 2016 and 2018 in the US were identified, with 82.3% performed under general anesthesia and 17.7% under local anesthesia. The primary composite outcome was observed in 2.3% of general anesthesia patients versus 2.6% of local anesthesia patients ( p = 0.808). The rate of postoperative transient ischemic attack and/or myocardial infarction was 1.6% with general anesthesia versus 1.1% with local anesthesia ( p = 0.511). For adjusted regression analysis, general anesthesia and local anesthesia were comparable in terms of primary outcome (OR: 0.72; 95% CI: 0.27–1.93, p = 0.515). As for the secondary outcomes, no significant differences were found except for contrast, where the results demonstrated significantly less need for contrast with procedures performed under general anesthesia (coefficient: 4.94; 95% CI: 1.34–8.54, p = 0.007). A trend towards significance was observed for lower rate of postoperative transient ischemic attack and/or myocardial infarction (OR: 0.33; 95% CI: 0.09–1.18, p = 0.088) and lower flow reversal time under local anesthesia (coefficient: –0.94: 95% CI: –2.1–0.22, p = 0.111). Conclusions Excellent outcomes from transcarotid artery revascularization for carotid stenosis were observed in the VQI database between the years 2016 and 2018, under both local anesthesia and general anesthesia. The data demonstrate the choice of anesthesia for transcarotid artery revascularization does not appear to have any effect on clinical outcomes. Surgical teams should perform transcarotid artery revascularization under the anesthesia type they are most comfortable with.

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Screening for Frailty in Older Emergency Patients and Association with Outcome

Geriatrics ◽

10.3390/geriatrics5010020 ◽

2020 ◽

Vol 5 (1) ◽

pp. 20 ◽

Cited By ~ 1

Author(s):

Siobhan Lewis ◽

Louis Evans ◽

Timothy Rainer ◽

Jonathan Hewitt

Keyword(s):

Older Patients ◽

Primary Outcome ◽

Independent Predictor ◽

Care Home ◽

Adverse Outcomes ◽

Urgent Care ◽

High Incidence ◽

Screening Questions ◽

The Mean ◽

Secondary Outcomes

Older people have a high incidence of adverse outcomes after urgent care presentation. Identifying high-risk older patients early is key to targeting interventions at those patients most likely to benefit. This study used the Frailsafe three-point screening questions amongst older Emergency Department (ED) attendees. Consecutive unplanned ED attendances in patients aged ≥75 were assessed for Frailsafe status. The primary outcome was mortality at 180 days. A Frailsafe screen was completed in 356 patients, of whom 194/356 (54.5%) were Frailsafe positive. The mean age was 85.8 for Frailsafe screen positive and 82.2 for Frailsafe screen negative patients (p < 0.001). A positive Frailsafe screen was a predictor of death within 180 days of presentation to the ED and remained so after adjustment (AOR = 3.23, 95% CI 1.45–7.19, p = 0.004). A positive Frailsafe screen was an independent predictor of a new care home admission at 180 days (AOR = 8.95, 95% CI 2.01–39.83, p = 0.004). A positive Frailsafe screen was also predictive of a number of secondary outcomes, such as length of stay of >28 days (AOR 3.42, 95% CI 1.41–8.31, p = 0.007) and re-attendance within 30 days of discharge after admission (OR = 2.73, 95% CI 1.27–5.88, p = 0.01). Frailsafe screen results independently predict a range of outcomes amongst older ED attendees.

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Efficacy of Corticosteroids in Non-Intensive Care Unit Patients with COVID-19 Pneumonia from the New York Metropolitan region

10.1101/2020.07.02.20145565 ◽

2020 ◽

Cited By ~ 1

Author(s):

Monil Majmundar ◽

Tikal Kansara ◽

Joanna Marta Lenik ◽

Hansang Park ◽

Kuldeep Ghosh ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Primary Outcome ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Composite Outcome ◽

Icu Patients ◽

Icu Transfer ◽

Primary Composite Outcome ◽

Over Time

AbstractIntroductionThe role of systemic corticosteroid as a therapeutic agent for patients with COVID-19 pneumonia is controversial.ObjectiveThe purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID-19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF).MethodsThis was a single-center retrospective cohort study, comprising of 205 patients admitted to the general wards with COVID-19 pneumonia. The primary outcome was a composite of ICU transfer, intubation, or in-hospital mortality. Cox-proportional hazard regression was implemented.ResultAmong 205 patients, 60 (29.27%) were treated with corticosteroid. The mean age was ∼57 years, and ∼75% were men. Thirteen patients (22.41%) developed a primary composite outcome in the corticosteroid cohort vs. 54 (37.5%) patients in the non-corticosteroid cohort (P=0.039). The adjusted hazard ratio (HR) for the development of the composite primary outcome was 0.15 (95% CI, 0.07 – 0.33; P <0.001). The adjusted hazard ratio for ICU transfer was 0.16 (95% CI, 0.07 to 0.34; P < 0.001), intubation was 0.31 (95% CI, 0.14 to 0.70; P – 0.005), death was 0.53 (95% CI, 0.22 to 1.31; P – 0.172), and discharge was 3.65 (95% CI, 2.20 to 6.06; P<0.001). The corticosteroid cohort had increasing SpO2/FiO2 over time compared to the non-corticosteroid cohort who experience decreasing SpO2/FiO2 over time.ConclusionAmong non-ICU patients hospitalized with COVID-19 pneumonia complicated by AHRF, treatment with corticosteroid was associated with a significantly lower risk of the primary composite outcome of ICU transfer, intubation, or in-hospital death.

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Active management of hyponatraemia and mortality in older hospitalised patients compared with younger patients: results of a prospective cohort study

Age and Ageing ◽

10.1093/ageing/afaa248 ◽

2020 ◽

Author(s):

Owen Thorpe ◽

Martin Cuesta ◽

Ciaran Fitzgerald ◽

Owen Feely ◽

William P Tormey ◽

...

Keyword(s):

Older Patients ◽

Reference Group ◽

Age Groups ◽

Young Patients ◽

Active Management ◽

Hospital Death ◽

Plasma Sodium ◽

Younger Patients ◽

Hospitalised Patients ◽

The Impact

Abstract Introduction Hyponatraemia is associated with increased morbidity and mortality; the aetiology and outcomes of hyponatraemia in older patients have not been defined in prospective studies. Methods A single-centre 9-month prospective observational study in which clinical outcomes in hospitalised patients ≥ 65 years (older patients with hyponatraemia (OP-HN)) and those <65 years (young patients with hyponatraemia (YP-HN)) with hyponatraemia were analysed, and compared with eunatraemic controls (older patients with normonatraemia (OP-NN) and young patients with normonatraemia (YP-NN)). Results In total, 1,321 episodes of hyponatraemia in 1,086 patients were included; 437 YP-HN, median age 54 years (IQR 44,60) and 884 OP-HN, median age 77 years (IQR 71,82). A total of 1,120 consecutive eunatraemic control patients were simultaneously recruited; 690 OP-NN, median age 77 years (IQR 71,83) and 430 YP-NN, median age 52 years (IQR 41,58). Euvolaemic hyponatraemia was the commonest cause of hyponatraemia in both age groups (48% in YP-HN and 46% in OP-HN). Sixty-two percent of OP-HN received hyponatraemia-directed treatment within the initial 48 h, compared with 55% of YP-HN, P = 0.01. Despite the greater treatment rates in OP-HN, younger patients were 24% more likely to be discharged with normal plasma sodium concentration (pNa) compared with older patients, relative risk (RR) 1.24 (95% confidence interval (CI) 1.12–1.37), P < 0.001. Using OP-NN as the reference group, the RR of in-hospital death in OP-HN was 2.15 (95% CI 1.3–3.56), P = 0.002. Using YP-NN as the reference group, the RR of in-hospital death in YP-HN was 4.34 (95% CI 1.98–9.56), P < 0.001. Conclusion Despite greater rates of HN-targeted treatment, the risk of in-hospital death is increased in older hyponatraemic patients compared with older eunatraemic controls. The impact of hyponatraemia on mortality is even greater in younger patients.

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Lymphoma in Older Patients

Journal of Clinical Oncology ◽

10.1200/jco.2006.10.5957 ◽

2007 ◽

Vol 25 (14) ◽

pp. 1916-1923 ◽

Cited By ~ 86

Author(s):

Catherine Thieblemont ◽

Bertrand Coiffier

Keyword(s):

Elderly Patients ◽

Older Patients ◽

Survival Rates ◽

Significant Proportion ◽

Young Patients ◽

Disease Free Survival ◽

B Cell Lymphoma ◽

High Dose ◽

Chop Regimen ◽

Free Survival

One half of patients newly diagnosed with lymphoma are older than 60 years and a significant proportion of them older than 80 years. Older patients treated for lymphoma may not tolerate the high-dose therapies used in younger patients, usually because of the presence of concomitant diseases. Diffuse large B-cell lymphoma represents more than 60% of all lymphomas seen in older patients. Clinical presentation and prognostic parameters are identical to those described in young patients. However, response rate is usually lower in elderly patients compared with young patients, even if the patients are treated with the cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen. Therefore, event-free and overall survival rates are shorter in elderly patients, even if disease-free survival rates are not really shorter than in young patients. Rituximab added to the CHOP regimen has recently been shown to dramatically improve the survival of these older patients without increasing the toxicity of the treatment. Patients older than 80 years may also be treated with rituximab plus CHOP, except for those having severe organ failure secondary to other diseases. Very few of these older patients may benefit from a salvage treatment after relapse.

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