Search

Objectives To determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors’ influence on survival. Methods Prospective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, haemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up. Results The study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1 year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95% CI: 1.270-2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95% CI: 0.307-0.560) was associated with lower mortality. Conclusions Sarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.

International audience; Aims/hypothesis: Diabetes has been recognised as a pejorative prognostic factor in coronavirus disease 2019 (COVID-19). Since diabetes is typically a disease of advanced age, it remains unclear whether diabetes remains a COVID-19 risk factor beyond advanced age and associated comorbidities. We designed a cohort study that considered age and comorbidities to address this question.Methods: The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) initiative is a French, multicentric, cohort study of individuals with (exposed) and without diabetes (non-exposed) admitted to hospital with COVID-19, with a 1:1 matching on sex, age (±5 years), centre and admission date (10 March 2020 to 10 April 2020). Comorbidity burden was assessed by calculating the updated Charlson comorbidity index (uCCi). A predefined composite primary endpoint combining death and/or invasive mechanical ventilation (IMV), as well as these two components separately, was assessed within 7 and 28 days following hospital admission. We performed multivariable analyses to compare clinical outcomes between patients with and without diabetes.Results: A total of 2210 pairs of participants (diabetes/no-diabetes) were matched on age (mean±SD 69.4±13.2/69.5±13.2 years) and sex (36.3% women). The uCCi was higher in individuals with diabetes. In unadjusted analysis, the primary composite endpoint occurred more frequently in the diabetes group by day 7 (29.0% vs 21.6% in the no-diabetes group; HR 1.43 [95% CI 1.19, 1.72], p

Introducción: La prevalencia de multimorbilidad oscila entre el 20% y 30% a nivel mundial y en Colombia es del 19,5%, su aumento progresivo genera un impacto en los sistemas de salud, por el aumento en el uso de los servicios de salud y por tanto los gastos en salud son considerablemente más altos de lo que se esperaría por los efectos de estas afecciones por separado. Objetivo: Determinar si el Índice de Charlson, calculado a partir de registros administrativos del Sistema General de Seguridad Social en Salud SGSSS, puede ser usado como predictor del costo en paciente pluripatológico, con el fin de aportar herramientas de gestión que favorezcan la política pública sobre esta población. Diseño metodológico: Se realizó un estudio retrospectivo, longitudinal con un horizonte de tiempo de 2 años, el periodo de estudio fue de 2016-2017, con la perspectiva de análisis de los costos del Sistema General de Seguridad social en Salud, basado en la revisión de registros administrativos (base de suficiencia de UPC) para el cálculo del índice de Charlson, costos en salud y selección de las demás variables explicativas. Se seleccionaron los individuos con Charlson ≥1 que sumaron en total 2.765.900 Resultados: Los individuos con Charlson mayor o igual a 1 representaban el 23,8% de los afiliados. Mediante una regresión de mínimos cuadrados generalizados – GLS se encontró que la semielasticidad del costo de atención por el cambio en el Charlson en el año siguiente fue que un punto en el índice de Charlson aumenta en promedio el 41.9% el costo del año siguiente, Conclusiones: Se logró determinar que desde fuentes administrativas la mejor opción para medir la multimorbilidad era el Índice de Charlson. Además se encontró que el Índice de Charlson puede utilizarse como predictor de costo para el año siguiente. Introduction: The prevalence of multimorbidity ranges between 20% and 30% worldwide and in Colombia it is 19.5%. Its increase generates an impact on health systems, due to the increase in health services use and health expenditures, which are considerably higher compared to the expected from the separate effects of the conditions. Objective: Determine if the Charlson Index, calculated from administrative records of the General System of Social Security in Health SGSSS, can be used as a predictor of cost in multimorbidity patients, to provide management tools that favor public policy on this population. Methods design: A retrospective longitudinal study was conducted with a time frame of 2 years for the study period of the years 2016 and 2017. The costs analysis perspective of the General Health Social Security System of Colombia was used. The data was aquied by the review of administrative records (UPC sufficiency base) and the Charlson index was calculated, similarly health costs and other independent variables were selected were selected. Individuals with Charlson index ≥1 were included (N=2,765,900) Results: Individuals with Charlson index ≥1 were 23.8% out of the total of the population in the scheme. From the generalized least squares regression (GLS), it was found that the semi-elasticity of the cost of care due to the Charlson index change in the following year was that a point in the Charlson index increases the cost of the following year by an average of 41.9%. Conclusions: It was determined that, from management sources, the Charlson Index is best option for measuring multimorbidity. In addition, it was found that the Charlson Index is effective the cost of health care for the following year. Magíster en Economía de la Salud Maestría https://orcid.org/0000-0002-0840-5438 https://scholar.google.com/citations?user=AwpvT1IAAAAJ&hl=es https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001714574

Background Age-related comorbidities accumulate faster in people with HIV (PWH) than in those without HIV. We evaluated whether a validated multimorbidity scale, the Charlson index, predicted neurocognitive trajectories in PWH. Methods Scaled scores of a comprehensive neuropsychological battery were averaged across all visits. Multilevel modeling examined between- and within-person predictors of global neurocognition. At the between-person level, averaged Charlson scores were examined as a predictor of neurocognitive change rate, covarying for HIV disease characteristics. Within-persons, visit-specific Charlson index was used to predict fluctuations in global neurocognition at the same and next visit, covarying for disease measures. Results Participants were 1195 PWH (mean baseline age: 43.0; SD: 9.7 years) followed for a mean of 7.1 years (range: 0.5–20.5). At the between-person level, more rapid neurocognitive worsening correlated with higher (worse) average Charlson scores (standardized β: −0.062; SE: 0.015; P = .001) and lower CD4 nadir (standardized β: 0.055; SE: 0.021; P = .011), but not viral suppression or average CD4+ lymphocytes (P > .05). At the within-person level, poorer visit-specific neurocognition was related to worse concurrent, but not preceding, Charlson scores (standardized β: −0.046; SE: 0.015; P = .003), detectable HIV viral load (standardized β: 0.018; SE: 0.006; P = .001), and higher CD4+ (standardized β: 0.043; SE: 0.009; P < .001). Conclusions The impact of comorbidities on neurocognitive decline exceeded that of HIV disease factors. Although correlative, the temporal relationships suggested that treatment of comorbidities might improve neurocognitive prognosis for PWH.

Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)., [Introduction] Mural infective endocarditis (MIE) is a rare type of endovascular infection. We present a comprehensive series of patients with mural endocarditis., [Methods] Patients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series., [Results] Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p, [Conclusion] MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs.

The better understanding of the safety of biologic DMARDs (bDMARDs), as well as the emergence of new bDMARDs against different therapeutic targets and biosimilars have likely influenced the use patterns of these compounds over time. The aim of this study is to assess changes in demographic characteristics, disease activity and treatment patterns in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who started a first- or second-line biologic between 2007 and mid-2020. Patients diagnosed with RA, PsA or AS included in the BIOBADASER registry from January 2007 to July 2020 were included. According to the start date of a first- or second-line biologic therapy, patients were stratified into four time periods: 2007–2009; 2010–2013; 2014–2017; 2018–2020 and analyzed cross-sectionally in each period. Demographic and clinical variables, as well as the type of biologic used, were assessed. Generalized linear models were applied to study the evolution of the variables of interest over time periods, the diagnosis, and the interactions between them. A total of 4543 patients initiated a first biologic during the entire time frame of the study. Over the four time periods, disease evolution at the time of biologic initiation (p p p p p p p p p = 0.004), and incremental changes to the therapeutic target between the first and second biologic (p

BackgroundComorbidity burden has been identified as a relevant predictor of critical illness in patients hospitalized with coronavirus disease 2019 (COVID-19). However, comorbidity burden is often represented by a simple count of few conditions that may not fully capture patients’ complexity.PurposeTo evaluate the performance of a comprehensive index of the comorbidity burden (Queralt DxS), which includes all chronic conditions present on admission, as an adjustment variable in models for predicting critical illness in hospitalized COVID-19 patients and compare it with two broadly used measures of comorbidity.Patients and methodsWe analyzed data from all COVID-19 hospitalizations reported in eight public hospitals of Catalonia (North-East Spain) between June 15 and December 8 2020. The primary outcome was a composite of critical illness that included the need for invasive mechanical ventilation, transfer to ICU, or in-hospital death. Predictors included age, sex, and comorbidities present on admission measured using three indices: the Charlson index, the Elixhauser index, and the Queralt DxS index for comorbidities on admission. The performance of different fitted models was compared using various indicators, including the area under the receiving operating characteristics curve (AUC).ResultsOur analysis included 4,607 hospitalized COVID-19 patients. Of them, 1,315 experienced critical illness. Comorbidities significantly contributed to predicting the outcome in all summary indices used. The AUC for prediction of critical illness was 0.641 (95% CI 0.624-0.660) for the Charlson index, 0.665 (0.645-0.681) for the Elixhauser index, and 0.787 (0.773-0.801) for Queralt DxS. Other metrics of model performance also showed Queralt DxS being consistently superior to the other indices.ConclusionIn our analysis, the ability of comorbidity indices to predict hospital outcomes in hospitalized COVID-19 patients increased with their exhaustivity. The comprehensive Queralt DxS index may improve the accuracy of predictive models for resource allocation and clinical decision-making in the hospital setting.

Background and Aims Changes on body composition have an impact on the survival of haemodialysis (HD) patients. The aim of the study was to determine the impact of the reduction of physical activity due to COVID19 lockdown on body composition in HD patients. Method Retrospective and observational study including 149 HD patients. Nutritional and Bioimpedance spectroscopy (BIS) data were recorded before and after COVID19 lockdown (mean of 148 ± 20 days between determinations). Results Over the 49 days of COVID19 lockdown, we observed a decrease in normohydrated weight (NHW) of 1.01 ± 3.59 kg mainly secondary to a reduction on total body water (TBW) 0.95 ± 3.78 L (extracellular water 0.45 ± 1.58 L and intracellular water 0.41 ± 2.36 L). There was also a small loss on lean tissue index (LTI) of 0.28 ± 2.42 kg/m2, with an increase of fat tissue index (FTI) 0f 0.02 ± 2.82 kg/m2. Twenty-three patients presented COVID19 infection, of which 21 required admission (median of 10 [4-16] days). Patients who presented COVID19 were older (70.7 ± 12.0 vs 64.9 ± 16.6 years, NS) with higher Charlson index (7.48 ± 2.77 vs 6.33 ± 2.65, p = 0.07). Patients with COVID19 infection presented a greater loss on LTI (-1.18 ± 3.15 bs -0.16 ± 2.30 kg/m2; p = 0.22), FTI (-0.41 ± 3.38 vs 0.06 ± 2.74 kg/m2; p = 0.54); BMI (-1.49 ± 2.14 vs -0.25 ± 0.96 kg/m2; p = < 0.01) and NHW (-4.00 ± 6.33 vs -0.62 ± 2.90 kg; p = < 0.01) compared to patients without COVID19 infection. The length of hospitalization was associated with greater loss of BMI and NHW, resulting, therefore, in overhydration. There also had lower serum phosphorus (3.6 ± 0.8 vs 5.2 ± 0.8 mg/dl; p = 0.01) and serum albumin (3.5 ± 0.4 vs 4.0 ± 0.1 g/dl; p = 0.01). Seven patients died during hospitalization. Deceased patients were older (78.4 ± 6.6 vs 67.4 ± 12.4 years; p = 0.01), presented higher comorbidity (estimated by Charlson index 10.0 [8.0-11.0] vs 6.5 [4.3-8.0]; p = 0.02) and were more overhydrated (3.4 ± 3.6 vs 1.9 ± 1.9; p = 0.34). Although not statistically different, they had lower LTI (10.4 ± 2.1 vs 12.0 ± 3.4 kg/m2; p = 0.18) and lower serum albumin (3.4 ± 0.6 vs 3.9 ± 0.4 g/dl; p = 0.08) compared to survivors. Patients who survived COVID19 infection had longer hospitalization (57% were discharged between twelfth and forty third day; mean hospitalization 14.6 ± 11.5 days). Deceased patients died within the first 12 days of hospitalization (6.8 ± 4.1 days). Conclusion COVID19 lockdown induced a weight reduction on HD patients due to decrease in total body water. COVID19 infection increased this reduction, inducing greater loss on lean and fat tissue composition. Moreover, COVID19 impact on body composition was magnified with the length of hospitalization.

Aims Transcatheter aortic valve replacement (TAVR) as an alternative to surgical aortic valve replacement (SAVR) has profoundly changed the management of patients with aortic valve stenosis (AS). Large unbiased nationwide data regarding TAVR implementation, impact on SAVR and their respective outcomes are scarce. Methods and results Based on a French administrative hospital-discharge database, we collected data on all consecutive aortic valve replacements (AVRs) performed in France for AS between 2007 and 2019 [106 253 isolated SAVR (49%), 46 514 combined SAVR (21%), and 65 651 TAVR (30%)]. The number of AVR linearly increased between 2007 and 2019 (from 10 892 to 23 109, P for trend < 0.0001) due to a marked increase in TAVR (from 253 to 13 030, P for trend < 0.0001), while SAVR increased up to 2013 and then declined (10 892 in 2007, 12 699 in 2013, and 10 079 in 2019). The Charlson index decreased linearly for TAVR, but in two steps for SAVR (2011 and 2017). In-hospital mortality rates of both SAVR and TAVR declined (both P for trend < 0.0001) and were similar or lower for TAVR than for isolated SAVR in patients 75 years or above in the last 3 years (2017–19). Complication rates of TAVR also declined but permanent pacemaker rates remained high and length of stay substantial (16.7% and median 6 days, respectively, in 2017–19). Conclusion The number of AVR has doubled in a decade and TAVR has become the dominant form of AVR in 2018. The improvement in patient profiles seems to have anticipated the demonstrated benefit of TAVR in intermediate and low-risk patients. In patients 75 years or older, TAVR should be considered as the first option. We also highlight two important areas for improvement, the high permanent pacemaker rates, and the long length of stay even in the contemporary era. Our results may have major implications for clinical practice and policymakers.

Simple Summary Selecting older patients for adjuvant breast cancer treatments is challenging as its benefits can be diminished by shorter life expectancies. In addition to age, comorbidity increases the risk of dying from other causes than breast cancer. Available prediction tools have either not adjusted for individual comorbidities or have shown inaccurate predictions when a higher number of comorbidities are present. Up to now, an optimal comorbidity score to be used in prediction tools has not been established. Therefore, this study aimed to assess the predictive value of the Charlson comorbidity index for other-cause mortality and to compare these predictions with using a simple comorbidity count. We found that the Charlson index performed similarly as comorbidity count. The use of comorbidity count in the development of new prediction tools for older patients with breast cancer is recommended as its simplicity enhances the tool’s applicability in clinical practice. Abstract Background: Individualized treatment in older patients with breast cancer can be improved by including comorbidity and other-cause mortality in prediction tools, as the other-cause mortality risk strongly increases with age. However, no optimal comorbidity score is established for this purpose. Therefore, this study aimed to compare the predictive value of the Charlson comorbidity index for other-cause mortality with the use of a simple comorbidity count and to assess the impact of frequently occurring comorbidities. Methods: Surgically treated patients with stages I-III breast cancer aged ≥70 years diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. Competing risk analysis was performed to associate 5-year other-cause mortality with the Charlson index, comorbidity count, and specific comorbidities. Discrimination and calibration were assessed. Results: Overall, 7511 patients were included. Twenty-nine percent had no comorbidities, and 59% had a Charlson score of 0. After five years, in 1974, patients had died (26%), of which 1450 patients without a distant recurrence (19%). Besides comorbidities included in the Charlson index, the psychiatric disease was strongly associated with other-cause mortality (sHR 2.44 (95%-CI 1.70–3.50)). The c-statistics of the Charlson index and comorbidity count were similar (0.65 (95%-CI 0.64–0.65) and 0.64 (95%-CI 0.64–0.65)). Conclusions: The predictive value of the Charlson index for 5-year other-cause mortality was similar to using comorbidity count. As it is easier to use in clinical practice, our findings indicate that comorbidity count can aid in improving individualizing treatment in older patients with breast cancer. Future studies should elicit whether geriatric parameters could improve prediction.

A retrospective review of prospectively collected data.The purpose of this study is to compare and validate several preoperative scores for predicting outcomes following spine tumor resection.Preoperative risk assessment for patients undergoing spinal tumor resection remains challenging. At present, few risk assessment tools have been validated in this high-risk population.The 2008 to 2014 National Surgical Quality Improvement database was used to identify all patients undergoing surgical resection of spinal tumors, stratified as extradural, intradural extramedullary, and intramedullary based on CPT codes. American Society of Anesthesiologists (ASA) score, modified Charlson Comorbidity Index (CCI), and modified Frailty Index (mFI) were computed. A binary logistic regression model was used to explore the relationship between these variables and postoperative outcomes, including mortality, major and minor adverse events, and hospital length of stay (LOS). Other significant variables such as demographics, operative time, and tumor location were controlled for in each model.Two thousand one hundred seventy patients met the inclusion criteria. Higher CCI scores were independent predictors of mortality (OR = 1.24, 95% CI: 1.14-1.36, P 0.001), major adverse events (OR = 1.07, 95% CI: 1.01-1.31, P = 0.018), minor adverse events (OR = 1.15, 95% CI: 1.10-1.20, P 0.001), and prolonged LOS (OR = 1.14, 95% CI: 1.09-1.19, P 0.001). Patients' mFI scores were significantly associated with mortality and LOS, but not major or minor adverse events. ASA scores were not associated with any outcome metric when controlling for other variables.The CCI demonstrated superior predictive capacity compared with mFI and ASA scores and may be valuable as a preoperative risk assessment tool for patients undergoing surgical resection of spinal tumors. The validation of assessment scores is important for preoperative risk stratification and improving outcomes in this high-risk group.3.

INTRODUÇÃO: Episódios de quedas estão associados com redução da mobilidade e mortalidade e são mais comuns em idosos. O Timed up and Go (TUG) é um dos principais instrumentos para rastrear o risco de cair em idosos. OBJETIVO: Avaliar a associação do teste TUG para autorrelato de quedas no último ano em idosos hospitalizados. MATERIAIS E MÉTODOS: Estudo transversal realizado em um hospital privado da cidade de Salvador/BA, no período de Agosto de 2013 a Janeiro de 2014. Foram incluídos indivíduos de ambos os sexos, a partir do 1º ao 5º dia de internação. A acurácia do teste foi calculada pela curva ROC (Receiver Operator Characteristic) e análise dos valores de sensibilidade e especificidade. Os resultados foram dispostos em média e desvio padrão ou valor absoluto e percentual. Foi considerado significativo um valor de p

There is a paucity of literature defining the minimal clinically important difference (MCID) for the Knee Society Scores (KSS) after total knee arthroplasty (TKA), and no data on the substantial clinical benefit (SCB) for KSS have been reported. The purpose of this study was to determine MCID and SCB for the KSS in patients with primary TKA. The median age of patients was 71.6 (range 50–88) years, and 60.3% were females 507 patients with TKA were prospectively enrolled. Patients completed the KSS before surgery and at second postoperative year. The MCID values of the KSS were estimated using anchor-based method, distribution-based method and receiver operating characteristic (ROC) curve analysis with calculation of the area under curve (AUC). SCB was estimated using ROC. The MCID for KSS-knee score was 7.2 points by the anchor-based method, 7.2 by the distribution-based method, and using a ROC analysis the cutoff point was 8.9 points with an AUC of 0.75. For KSS-function score, the MCID values were 9.7, 6.3, and 10.3 (AUC 0.71), respectively. SCB values were 39.7 points (AUC 0.74) for the KSS-knee score, and 38.6 (AUC 0.76) for the KSS-function score. Logistic regression showed age and Charlson index to negatively affect the changes in KSS. Different methods for MCID calculation lead to different results. With the use of ROC curve analysis, patients with an improvement of at least 9 points for KSS-knee and 10 points for KSS-function scores experience a clinically important change, whereas those who have at least an improvement of 40 points for KSS-knee and 39 points for KSS-function scores experience a substantial clinical benefit. These findings can ensure clinical improvement from the patient’s perspective and also aid in interpreting results from clinical studies. III.

Background The Charlson Comorbidity Index (CCI) is frequently used to control for confounding by comorbidities in observational studies, but its performance as such has not been studied. We evaluated the performance of CCI and an alternative summary method, logistic principal component analysis (LPCA), to adjust for comorbidities, using as an example the association between insurance and mortality. Materials and methods Using all admissions in the National Trauma Data Bank 2010-2015, we extracted mortality, payment method, and 36 International Classification of Disease, Ninth Revision–derived comorbidities. We estimated odds ratios (ORs) for the association between uninsured status and mortality before and after adjusting for CCI, LPCA, and separate covariates. We also calculated standardized mean differences (SMDs) of comorbidity variables before and after weighting the sample using inverse probability of treatment weights for CCI, LPCA, and separate covariates. Results In 4,936,880 admissions, most (68.3%) had at least one comorbidity. Considerable imbalance was observed in the unweighted sample (mean SMD = 0.086, OR = 1.17), which was almost entirely eliminated by inverse probability of treatment weights on separate covariates (mean SMD = 0.012, OR = 1.36). The CCI performed similarly to the unweighted sample (mean SMD = 0.080, OR = 1.25), whereas two LPCA axes were better able to control for confounding (mean SMD = 0.04, OR = 1.31). Using covariate adjustment, the CCI accounted for 56.1% of observed confounding, whereas two LPCA axes accounted for 91.3%. Conclusions The use of the CCI to adjust for confounding may result in residual confounding, and alternative strategies should be considered. LPCA may be a viable alternative to adjusting for each comorbidity when samples are small or positivity assumptions are violated.

Introduction Given the high prevalence of erectile dysfunction in male population between 40 and 70 years old and the effect of radical prostatectomy on this domain, it is important to perform a baseline study. Material and methods Prior radical prostatectomy, erectile function has been assessed prospectively in 112 prostate cancer patients using the erectile function (EF) domain of the International Index of Erectile Function (EF-IIEF), Erectile Hardness Score (EHS) and a penile doppler ultrasound (PDUS). Comorbidities and Charlson index were collected. The EORTC QLQ C-30 and PR-25 tests were administered. Results According to EF-IIEF questionnaire, 50.9% of patients showed normal EF and EHS grade 3–4 erection was achieved in the 75.9%. PDUS was normal only in 28.6% of patients and 51.8% showed arterial insufficiency. We found a significant association (p Conclusions In order to predict EF recovery after surgery, global assessment is required. Solely self-administered tests are not enough. In this baseline study, PDUS can play an important role.

[Objectives] To develop and validate baseline, perioperative and at-discharge risk-scoring systems for postsurgical prosthetic joint infection (PJI) in patients undergoing arthroplasty., [Methods] A multicentre prospective cohort study of patients undergoing hip and knee arthroplasty was performed. Patients were randomly assigned (2:1) to a derivation cohort (DC) or a validation cohort (VC). Multivariable predictive models of PJI were constructed at baseline (preoperative period), perioperative (adding perioperative variables) and at-discharge (adding wound state at discharge). The predictive ability of the models and scores was evaluated by area under the receiving operating characteristic curves (AUROC)., [Results] The DC and VC included 2324 and 1245 patients, respectively. Baseline model included total hip arthroplasty (THA), revision arthroplasty (RA), Charlson index and obesity. The AUROC for the score was 0.75 and 0.78 in the DC and VC, respectively. Perioperative model included THA, RA, obesity, National Nosocomial Infections Surveillance (NNIS) index ≥2, significant wound bleeding and superficial surgical site infection; the AUROC was 0.81 and 0.77 in the DC and VC, respectively. The at-discharge model included THA, RA, obesity, NNIS index ≥2, superficial surgical site infection and high-risk wound; the AUROC was 0.82 and 0.84 in the DC and VC, respectively. A score ≥8 points provided 99% negative predictive values for all models., [Conclusions] Simple scores for predicting PJI at three different moments of care in patients undergoing arthroplasty were developed and validated. The scores allow early and accurate identification of high-risk individuals in whom enhanced preventive measures and follow-up may be needed. Further external validation is needed.

Background: There is a lack of detailed population-based data for renal cell carcinoma (RCC). Objectives: The study aimed to examine the contemporary changes in the clinical picture and treatment of RCC. Methods: A total of 1,719 consecutive patients living in the Helsinki metropolitan area with a solid or cystic renal mass (Bosniak 3–4) ≥10 mm were identified. Data from medical records was evaluated for clinical characteristics and treatments in the periods I (2006–2008), II (2009–2011), III (2012–2014), and IV (2015–2016). Results: The proportions of patients with comorbidities (Charlson index ≥2) and frailty (Eastern Co-operative Oncology Group classification ≥2) increased significantly during the study period. The percentage of clinical stage I patients, cystic tumors and use of needle biopsies increased significantly. Use of observation increased from 9% (I) to 32% (IV; p < 0.001). First-line oncological treatments within 6 months were given to 47% of 262 patients with metastases and ­cytoreductive nephrectomy (CN) was delivered to 54% of those patients. Conclusions: The size of renal tumors continued to decrease, while the percentage of patients with significant comorbidity or frailty increased. Active surveillance emerged as the initial strategy. Tyrosine kinase inhibitors with CN remained the primary option in patients with metastatic RCC.

INTRODUCCIÓN: la neumonía adquirida en la comunidad (NAC) es una de las principales enfermedades infecciosas que afecta principalmente a la población geriátrica y que puede ser potencialmente una causa de mortalidad asociada con el desarrollo de sepsis pulmonar. Por tanto, el presente estudio tiene como objetivo evaluar los índices predictivos CURB-65, Quick-SOFA y el índice de Charlson en la asociación de mortalidad y estancia hospitalaria en pacientes con NAC.MATERIALES Y MÉTODOS: se realizó un estudio observacional, analítico y retrospectivo en el Hospital Regional de Duitama, de junio a diciembre de 2016. Se incluyeron los pacientes con diagnóstico clínico, paraclínico y radiológico de NAC. Se tuvo en cuenta la asociación de variables demográficas, comorbilidades, condiciones clínicas y resultados clínicos frente a la mortalidad y estancia hospitalaria según los índices CURB-65, q-SOFA e índice de Charlson.RESULTADOS: se obtuvo una muestra de 116 pacientes. El 77,5 % eran mayores de 75 años. Los puntajes de CURB-65 y q-SOFA se asociaron con mortalidad (CURB-65 AUC: 0,75 [0,61 %-0,88 %]; q-SOFA AUC: 0,73 [0,59-0,88 %]). El puntaje de CURB-65 ≥ 3 tiene una S: 64 % E: 79 %, y el q-SOFA ≥ 2 tiene una S: 64 % E: 85 %. El índice de Charlson no tiene un buen poder de predicción de la mortalidad en el manejo agudo. Los tres índices no se asociaron con una buena predicción de la estancia hospitalaria o del uso de antibiótico de amplio espectro.CONCLUSIONES: los índices q-SOFA y CURB-65 son escalas que pueden ser utilizadas en el manejo agudo de la NAC para estimar la mortalidad del paciente.

Background: There is scarce information on the prognostic role of frailty and Atrial Fibrillation (AF) in elderly patients Acute Coronary Syndrome (ACS). Methods: The aim was to analyse the management of elderly patients with frailty and AF who suffered an ACS using data of the prospective multicentre LONGEVO-SCA registry. We evaluated the predictive performance of FRAIL, Charlson scores and AF status for adverse events at 6 months follow-up. Results: A total of 531 unselected patients with ACS and above 80 years old [mean age 84.4 (SD=3.6) years; 322 (60.6%) male] were enrolled, of whom 128 (24.1%) with AF and 145 (27.3%) with frailty. Mutually exclusive number of patients were as follows: non-Frail and sinus rhythm (SR) 304 (57.2%); Frail and SR 99 (18.6%); non-Frail and AF 82 (15.4%); Frail and AF 46 (8.7%). Frail and AF patients compared with non-frail and SR patients had higher risk of all-cause mortality [HR 2.61, (95%CI 1.28-5.31; p=0.008)], readmissions [HR 2.28, (95%CI 1.37-3.80); p=0.002)] and its composite [HR 2.28, (95%CI 1.44-3.60); p

Management for HCV has undergone a notable change using direct-acting antiviral drugs (DAAs), which are safe and effective even in elderly. Here, we define impact of comorbidities, concomitant medication and drug–drug interactions in elder patients with HCV related disease before starting DAAs regimen. We analyzed data of 814 patients prospectively enrolled at our Unit within the web based model HCV Sicily Network. Out of 814, 590 were treated with DAAs and 414 of them were older than 65 years. We divided those 414 in two groups, one including 215 patients, aged between 65 and 74 years, and another with 199 patients, aged of 75 years and over. Charlson Comorbidity Index (CCI) was assessed for each patient; drug–drug interactions (DDI) and de-prescribing process were carried out appropriately. Within 414 patients included, percentage rates of women treated was higher than males, BMI was lower and cirrhosis was frequently reported in patients older than 75 years. Hypertension, diabetes mellitus, dyslipidemia (p p p p

Background: Survival after hospital admission has been evaluated as a possible risk factor for long-term mortality in selected classes of diseases. The aim of this study was to evaluate survival after hospital admission in all patients admitted as in-patients in a general hospital of Milano, Italy. Methods: 2,580 consecutive patients admitted at Ospedale San Paolo, July1-December 31, 2012, for several classes of diseases (internal medicine, cancer, infectious diseases, trauma and surgery, pneumonia, and heart diseases) were studied; age, total diseases, type of admission, length of admission, age-adjusted Charlson index, prognostic nutritional index (PNI), and full blood count were evaluated. Results: At univariate analysis, all investigated variables, except sex and lymphocytes, were associated with death of patients. At stepwise regression analysis, Charlson index or age plus total diseases, type of admission, number of admissions, and PNI were significant risk factors in the whole sample and in the majority of classes of diseases. Conclusion: Pre-existing conditions and nutritional state represent the major risk factor for mortality in most classes of disease, and possibly influence other predictors, such as type of admission, length of stay. This suggests that the current model of hospital admission might be improved, for instance through comprehensive care at home, instead of hospital admission, or before admission. Funding Information: This study received only institutional funds from Universita degli Studi di Milano and from IRCCS Multimedica; a grant by the Italian Ministry of Health (Ministero della Salute), was issued to IRCCS Multimedica (Ricerca Corrente). Declaration of Interests: LL, FG, ASZ, MF, AV, AEP, and ET declare no conflict of interest with the content of this paper. Ethics Approval Statement: The protocol of the study was approved by the local Ethics in 2013 (original study) and in 2020 (follow-up study).

[Background] The incidence of nosocomial and health care-related infective endocarditis (IE) is increasing. Heart transplantation (HT) implies immunosuppression and frequent health care contact. Our aim was to describe the current profile and prognosis of IE in HT recipients., [Methods] Multicenter retrospective registry-based study in Spain and France that included cases between 2008 and 2019., [Results] During the study period, 8305 HT were performed in Spain and France. We identified 18 IE cases (rate 0.2%). Median age was 57 years; 12 were men (67%). Valve involvement did not have a predominant location and three patients (16.7%) had atrial or ventricular vegetations without valve involvement. The median age-adjusted Charlson index was 4 (interquartile range 3–5). Eleven IE cases (61%) were nosocomial/health care-related. Median time (range) between HT and development of IE was 43 months (interquartile range 6–104). The major pathogens were Staphylococcus sp. (n = 8, 44%), Enterococcus sp. (n = 4, 22%), and Aspergillus sp. (n = 3, 17%). Although eight patients (44%) had a surgical indication, it was only performed in three cases (17%). Three patients (17%) died during the first IE hospital admission., [Conclusions] IE in HT recipients has specific characteristics. Valve involvement does not have a predominant location and non-valvular involvement is common. Three fifths have a nosocomial/health care-related origin. The major pathogens were staphylococci (44%), enterococci (22%), and Aspergillus (17%). In-hospital mortality was 17%.

Old patients receiving anticoagulant therapy for venous thromboembolism (VTE) are at an increased risk for bleeding. We used data from the RIETE registry to assess the prognostic ability of the Comorbidity Charlson Index (CCI) to predict the risk for major bleeding in patients aged > 75 years receiving anticoagulation for VTE beyond the third month. We calculated the area under the receiver-operating characteristic curve (AUC), the category-based net reclassification index (NRI) and the net benefit (NB). We included 4303 patients with a median follow-up of 706 days (interquartile range [IQR] 462-1101). Of these, 147 (3%) developed major bleeding (27 died of bleeding). The AUC was 0.569 (95% CI 0.524-0.614). Patients with CCI = 4 points were at a lower risk for adverse outcomes than those with CCI > 10 (major bleeding 0.81 (95% CI 0.53-1.19) vs. 2.21 (95% CI 1.18-3.79) per 100 patient-years; p < 0.05; all-cause death 1.9 (95% CI 1.45-2.44) vs. 15.67 (95% CI 12.63-19.22) per 100 patient-years; p < 0.05). A cut-off point of 4 points (CCI4) had a sensitivity of 82% (95% CI 75-89) and a specificity of 30% (95% CI 29-31) to predict major bleeding beyond the third month. CCI4 reclassification improved the NB of the RIETE bleeding score to predict bleeding beyond the third month (CCI4 NB 1.78% vs. RIETE NB 0.44%). Although the AUC of the CCI to predict major bleeding was modest, it could become an additional help to select patients aged > 75 years that obtain more benefit of extended anticoagulation, due to a lower risk for bleeding and better survival.

Nasal bleeding (NB) is a pathological condition that threatens the patient's life. This is a common condition in emergency otorhinolaryngology, occurring in 60% of the population. The simultaneous presence of several diseases in one patient (multimorbidity) becomes crucial to consider in the era of personalized approach in medicine. NB can be addressed not only as an independent condition, but also in combination with concomitant pathology. The study of the NB epidemiology does not lose its relevance, since the revealed patterns allow us to develop measures for effective management of hospitals that provide emergency assistance. Purpose of the study: to establish the long-term epidemiological features of NB in the structure of otorhinolaryngological departments of general hospitals. Material and methods. We studied the annual reports of the heads of ENT departments from 15 hospitals of the Moscow Healthcare Department, which provide assistance to the adult population, for the period from 2003 to 2019 (17 years). We analyzed admissions with NB and their annual dynamics. The following indicators were assessed in the reports: the number of patients treated in the otorhinolaryngology departments; the number of patients treated with a diagnosis of NB; the number of patients with NB who died; ratio and dynamics of these indicators. We performed the cumulative technical analysis of the data obtained with the determination of tendencies from the average values of the indicators, the graphical display of which is the trend line (TL), using Microsoft Office Excel software. The use of TL allowed to predict the future dynamics of the indicators. Each NB-related death was investigated from the deceased patient's brief “information note”. The information on concomitant pathology (clinical diagnosis) in patients who died from NB in a hospital was studied, the multimorbidity index (the number of nosologies in the diagnosis in one patient) and the Charlson comorbidity index were calculated with and without relation to the age of the patients. Results. During the observation period, 563189 patients were treated in the ENT departments of Moscow, 20623 (3.7%) patients were treated with NB. The average length of hospital stay was 1.04 bed-days. The trend values of prevalence and mortality are practically at the same level with the minimum multidirectional linear dynamics – 0.24% and + 0.04%, respectively. We observed an increase in the number of patients treated per year in otorhinolaryngological departments over the past 17 years by 58.5%. The increase in the absolute number of hospitalized patients with NB annually over the same period of time was 51.1%. We have identified 3 periods. From 2003 to 2010, the average growth rate of patients number per year was 3.3% (min 1.3% in 2004 and max 4.5% in 2007). From 2011 to 2015 - 0.5% (min 0.04% – 2013 and max 1.2% – 2011). From 2016 to 2019 - 6.4% (min 2.2% - 2016 and max 11.2% - 2019). The proportion of patients with NB during from the total number of treated patients was practically at the same level during the entire observation period, and on average was 3.7% (min 3.1% in 2016 and max 4% - 2008 and 2012). The mortality rate in the cohort of patients with NB was 0.25% (n = 52, of which 33 were men and 19 were women). The average age of the deceased was 64.7 years. Along with NB and post-hemorrhagic anemia, 17 other diseases / conditions appeared in clinical diagnoses (from 2 to 5 in each patient). The risk of death with NB remained at approximately the same level, with an average annual increase of 0.002% (according to approximation analysis). In patients who died from NB, the multimorbidity coefficient averaged 2.9±0.6 diseases / conditions, the comorbidity index – 5.74±1.12 points on the Charlson scale with considering patients age and 3.27±0.74 points without considering patients age (from 0 to 9 points). Diseases / conditions such as radiation and chemotherapy, pulmonary and cerebral edema, cachexia, coagulopathy, and pulmonary embolism were reported in 40 clinical diagnoses, but were not included in the Charlson score. Conclusion. When studying the prevalence of NB in the structure of ENT hospitals in Moscow, due to a large volume of statistical data, we managed to analyze not only absolute values and relative values, but also to determine trends characteristic of a given epidemiological process, the frequency of deaths, dynamics of death rates and indicators of multi- and comorbidity in this cohort of patients over a 17-year observation period. With the increasing number of patients treated with NB, the mortality rate in hospitals remained stable for 17 years, which is possible due to well-coordinated work and constant improvement of the provision of specialized medical care to these patients. Based on the trend analysis, it is possible to predict a further increase in the absolute number of patients with NB in ENT hospitals in Moscow. The deceased patients with NB belonged to the older age group with severe concomitant pathology and a high level of comorbidity. Perhaps, upon admission to the hospital, patients of the older age group with NB require a more thorough examination. The results of the study are of clinical significance and should be correlated with pathological data and data on the comorbidity of other groups of patients with NB in the future, to assess NB as a risk factor for long-term mortality., Носовое кровотечение (НК) – патологическое состояние, угрожающее жизни больного. НК может рассматриваться не только как самостоятельное заболевание, но и в совокупности с сопутствующей патологией. Изучение эпидемиологии НК не теряет своей актуальности, т.к. выявляемые закономерности позволяет разрабатывать меры эффективного управления стационарами, оказывающими экстренную помощь населению. Цель исследования: установить эпидемиологические особенности НК в структуре оториноларингологических отделений многопрофильных больниц за длительный период времени. Материал и методы. Проведен анализ ежегодных отчетов заведующих ЛОР-отделениями 15 стационаров ДЗМ, оказывающих помощь взрослому населению, за период с 2003 по 2019 г. (17 лет). Были проанализированы госпитализации пациентов с НК и их годовая динамика. По данным отчетов были исследованы следующие показатели: число пациентов, пролеченных в оториноларингологическом отделении; число больных, которые находились на лечении с диагнозом НК; число умерших больных НК; соотношения и динамика указанных показателей. Совокупный технический анализ полученных данных с определением тенденциозных закономерностей средних значений анализируемых показателей, графическим отображением которых является линия тренда (ЛТ), был проведен с помощью программного обеспечения Microsoft Office Excel®. Результаты. За период наблюдения в ЛОР-отделениях г. Москвы были пролечены 563 189 больных, 20 623 (3,7%) пациента находились на лечении с НК. Средняя продолжительность госпитализации составила 1,04 койко-дня. Был отмечен прирост числа пролеченных за год больных в оториноларингологических отделениях за прошедшие 17 лет на 58,5%. Увеличение абсолютного числа ежегодно госпитализируемых пациентов с НК за тот же период времени составило 51,1%. Наряду с НК и постгеморрагической анемией в клинических диагнозах фигурировали еще 17 заболеваний/состояний (от 2 до 5 у каждого пациента). Риск смерти при НК сохранялся приблизительно на одном уровне. У пациентов, погибших от НК, коэффициент полиморбидности составил в среднем 2,9±0,6 заболевания/состояния, индекс коморбидности – 5,74±1,12 баллов по шкале Чарлсон с учетом возраста и 3,27±0,74 балла без учета возраста. Заключение. При изучении распространенности НК в структуре ЛОР-стационаров Москвы, благодаря большому объему статистических данных, удалось провести анализ не только абсолютных значений и относительных величин, но и определить тенденции, характерные для данного эпидемиологического процесса, определить частоту летальных исходов, охарактеризовать ее динамику и установить показатели поли- и коморбидности у данного контингента больных за 17-летний период наблюдения., Head and neck. Russian Journal, Выпуск 2 2021

Background/Objective: Since January 2020, there have been over 3 million individuals infected with the coronavirus in the United States, quickly spreading across at least 171 countries. The severity and morbidity of patients with COVID-19 are significantly increased when comorbidities, such as Chronic Kidney Disease (CKD), are present. Because the main target of SARS-CoV-2 is ACE2, patients with CKD may be a more vulnerable population. The goal of this study was to determine if COVID-19 positive patients with CKD had increased mortality, inpatient admission, and ED visitation rates compared to those without CKD. Methods: This retrospective chart review includes patients from over 100 separate healthcare entities who were diagnosed with COVID-19 between January 1, 2020 and July 13, 2020 and are over the age of 18. The subjects were first separated into those diagnosed with CKD and those without, basic descriptive calculations were computed, and a Chi Square test was used to analyze outcomes. Results: The CKD COVID-19 positive population was compromised of 47.5% men and 52.5% women while the non-CKD control group was made up of 45.4 % men, 54.1% women, and 0.5% other. The median Charlson index for the CKD and non-CKD population was 4 and 1, respectively. The interest and control groups were further divided into subpopulations by age and race and analyzed accordingly. Chi square tests demonstrated that there is a statistically significant difference (p

Objectives: Appetite loss is common in hospitalised older individuals but not routinely assessed. Poor appetite in hospital has previously been identified as predictive of greater mortality in the six months following discharge in a single study of female patients. The present study aimed to assess this association in a larger sample including both hospitalised men and women. Design: Longitudinal observational study with six month follow up. Setting: Acute hospital wards in a single large hospital in England. Participants: Older inpatients aged over 70 years. Measurements: Appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ) during hospital stay. Deaths during six month follow-up period were recorded. Association between SNAQ score during hospital admission and death 6 months post-discharge was assessed using binary logistic regression in unadjusted and adjusted analysis. Results: 296 participants (43% female, mean age 83 years (SD 6.9)) were included in this study. Prevalence of poor appetite (SNAQ score

Introduction A prospective evaluation of outcomes in a series of patients with post-prostatectomy incontinence (PPI) treated with two different devices is presented. Methods Consecutive patients with PPI underwent interventions with an adjustable transobturator male system (ATOMS) or artificial urinary sphincter (AUS). Decisions were based on patient preference after physician counselling. Patient characteristics and operative and postoperative parameters including dryness, satisfaction, complications, revision and device durability were evaluated. Results One hundred twenty-nine patients were included: 102 (79.1%) received ATOMS and 27 (20.9%) AUS. Mean follow-up was 34.9 ± 15.9 months. No difference was observed between patient age (p = 0.56), ASA score (p = 0.13), Charlson index (p = 0.57) and radiation (p = 0.3). BMI was higher for AUS (27.1 vs. 29.7; p = 0.003) and also baseline incontinence severity (7.9% mild, 44.1% moderate and 48% severe for ATOMS vs. 11.1% moderate and 88.9% severe for AUS; p = 0.0007). Differential pad test was higher for AUS (− 470 vs. − 1000 ml; p

Background Bariatric surgery results in rapid weight loss and resolution of comorbidities such as type 2 diabetes mellitus (T2DM). We aimed to determine whether the type of surgical procedure—vertical sleeve gastrectomy (VSG) versus Roux-en-Y gastric bypass (RYGB)—was associated with sustained remission from T2DM, and to identify other independent predictors of sustained remission. Methods Using the IBM MarketScan database of privately insured patients in the United States, we performed a retrospective cohort study on individuals aged 18-65 y with T2DM on hypoglycemic medication, who underwent either VSG or RYGB from 2010 to 2016. Remission was defined as no refill of antidiabetic medication 180 d after a patient's medication was expected to run out and recurrence as medication refill after at least 180 d of remission. Results Of 5119 patients in our cohort, 4127 (81%) experienced remission of T2DM, and 816 (19.8%) of the 4127 patients experienced recurrence. Patients who underwent RYGB had a 24% (HR = 1.24, 95% CI: 1.16, 1.32) increased probability of achieving remission compared with VSG. RYGB had a 36% (HR = 0.64, 95% CI: 0.55, 0.74) decreased risk of recurrence compared with VSG. A higher number of diabetic medications at the time of surgery and a higher Charlson index score were associated with decreased probability of remission and an increased risk of recurrence of T2DM. Conclusions While both procedures are initially effective, RYGB may be better than VSG at providing lasting remission of T2DM.

Background:. The purpose of this study was to determine the perioperative mortality rate, reintervention rate, and total healthcare costs for head and neck cancer patients who underwent free tissue transfer (FTT) in Colombia. The prognostic factors associated with those results were estimated. Methods:. A retrospective cohort study was performed using administrative data from patients of all ages diagnosed with head and neck cancer who underwent FTT between 2013 and 2016 in Colombia’s contributory health system. Postoperative mortality rates were estimated at 30, 90, and 180 days, as well as reintervention rates at 30 and 90 days. Total healthcare costs were calculated. Generalized linear models were generated to determine prognostic factors associated with outcomes. Results:. A total of 485 patients were included, 215 (44.33%) of which were women. Mean age was 61.4 years. Mortality rate was 3.09 at 30 days, 9.28 at 90 days, and 15.26 at 180 days, per 100 surgeries. Reintervention rate was 5.77 at 30 days and 8.25 at 90 days, per 100 surgeries. The 30-day reintervention rate was lower for 40- to 59-year-old group and for a Charlson Index ≤ 3. The median total healthcare cost of an episode was USD 12,403.68 (interquartile range, 5754–16,736). The bivariate and multivariate models determined that age, the Charlson Index, and geographic region were associated with outcomes. Conclusion:. For patients undergoing FTT in Colombia, differences in reintervention and total costs incurred by the national health system exist, and these differences are associated with age, the Charlson Index, and the geographic region.

Introduction: Chronic obstructive pulmonary disease (COPD) and bronchiectasis, chronic inflammation disorders of the bronchial tree through the mechanism of 'spill-over' of inflammatory mediators, may lead to systemic manifestations of illness of the respiratory system and comorbidities. The aim of the study was to evaluate the frequency of coexisting chronic obstructive pulmonary disease and bronchiectasis and influence of bronchiectasis on COPD comorbid diseases. Material and methods: A post-hoc cross-sectional analysis of cohort study of 288 consecutive patients hospitalized due to acute exacerbation of COPD was performed. Results: 177 males (61.5%) and 111 females (38.5%) with mean age = 71.0 8 ± 8.9 yrs, FEV1 % pred. = 34.6 ± 16.8 with COPD diagnosis were studied. In this group, 29 (10.1%) patients presented with bronchiectasis confirmed by HRCT scan. COPD patients with and without bronchiectasis had similar Charlson index results (2.5 vs. 2.1, p = 0.05). COPD patients with bronchiectasis required longer hospitalization during exacerbation. COPD patients with bronchiectasis significantly more often than patients without this comorbidity revealed the features of colonization with P. aeruginosa (OR = 4.17, p = 0.02). Conclusions: Bronchiectasis is a relatively common comorbidity in COPD patients. COPD patients with bronchiectasis are more frequently colonized with P. aruginosa comparing to non-bronchiectasis COPD patients. We did not confirm the influence of bronchiectasis on COPD comorbidities.

RESUMEN : Introducción: La EPOC es una enfermedad heterogénea que se asocia con frecuencia a exacerbaciones y comorbilidades. Estas exacerbaciones pueden influir en curso clínico de la enfermedad. Las comorbilidades también constituyen un factor pronóstico de mortalidad. Además, suponen una mayor utilización de recursos sanitarios, carga económica e impacto negativo en la calidad de vida. Objetivo: Los objetivos del estudio son describir las comorbilidades en los pacientes con EPOC, valorar el impacto de las comorbilidades en el pronóstico de la EPOC mediante los índices de comorbilidad, así como evaluar la correlación entre los diferentes índices de comorbilidad (Índice de Charlson, Índice de Charlson Ajustado por edad, Índice COTE) con las principales variables clínicas en los pacientes con EPOC. Metodología: Estudio de Cohortes retrospectivo realizado a través de la revisión de historias clínicas de pacientes con EPOC del Hospital Universitario Marqués de Valdecilla de Santander (España). Se recogieron las siguientes variables clínicas: edad, género, variables espirométricas post-broncodilatación (FEV1, FVC, FEV1/FVC), grado de disnea según la mMRC, cumplidor o no de criterios de bronquitis crónica, Global Initiative for Chronic Obstructive Lung Disease (GOLD), agudizaciones e ingresos por EPOC en el año previo a la consulta, índice Charlson, índice de Charlson ajustado por edad, Índice de COTE, COPD Assessment Test (CAT), agudizaciones, ingresos y éxitus en el año posterior a la a la fecha de consulta. Resultados: Se incluyeron 218 pacientes en el estudio. 157 varones (70,2%) y edad media de 69 años. Las comorbilidades más frecuentemente asociadas fueron la hipertensión (53,7%), dislipemia (52,9%), depresión (15,4%) y Diabetes Mellitus (13,2%). Se encontraron diferencias estadísticamente significativas en COTE para el grupo ABCD de GOLD (p= 0,025) y para el grado de disnea mMRC (p= 0,025); y en el índice Charlson para el grado de disnea mMRC (p= 0,040). El índice de Charlson es predictor de ingresos por agudización de EPOC (p= 0,030; RR= 6,953) pero no de agudizaciones (p= 0,097). Conclusión: Las enfermedades cardiovasculares, la diabetes y la depresión prevalecieron en nuestros pacientes con EPOC. En nuestro estudio el índice de Charlson es un factor predictor independiente de ingresos, pero no de agudizaciones. Aquellos pacientes con altas puntuaciones en el índice de Charlson tienen un riesgo de ingreso hospitalario 6,9 veces mayor que el resto. ABSTRACT : Introduction: COPD is a heterogeneous disease that is frequently associated with exacerbations and comorbidities. These exacerbations, especially if they are frequent, can influence the clinical course of the disease. Comorbidities are also a mortality prognostic factor. In addition, they represent a greater healthcare resource utilisation, economic burden and negative impact on quality of life. Objetive: The study’s objectives are are to describe comorbidities in patients with COPD, to assess the impact of comorbidities on the prognosis of COPD using comorbidity index, in addition to evaluate the correlation between different comorbidity index (Charlson Comorbidity Index, age-adjusted Charlson Index, COTE Index) with the main clinical characteristics in COPD patients. Methodology: Retrospective cohort study. Patients clinical records were reviewed in Pneumology service at the Marqués de Valdecilla University Hospital in Santander (Spain). The following clinical variables were collected: age, gender, postbronchodilation spirometric variables (FEV1, FVC, FEV1/FVC), mMRC dyspnea score, criteria of chronic bronchitis, Global Initiative for Chronic Obstructive Lung Disease (GOLD), COPD exacerbations and admissions in the previous year, Charlson index, ageadjusted Charlson Index, COTE index, COPD Assessment Test (CAT), exacerbations, admissions and deaths in the year after the consultation date. Results: 218 patients were included in the study. 157 (70.2%) males and mean age of 69 years. The most frequent comorbidities were hypertension (53.7%), dyslipidemia (52.9%), depression (15.4%) and Diabetes Mellitus (13.2%). Statistically significant differences were found in COTE for the ABCD of GOLD (p = 0.025) and for the score of mMRC dyspnea (p = 0.025); also in Charlson index for the score of mMRC dyspnea (p = 0.040). Charlson index is a predictor of admissions for exacerbation of COPD (p = 0.030; RR = 6.953) but not of exacerbations (p = 0.097). Conclusion: Cardiovascular diseases, diabetes and depression were predominant in our patients with COPD. In our study, the Charlson index is an independent predictor of admissions, but not of exacerbations. Those patients with high scores on the Charlson index have a hospital admission risk 6,9 times greater than the rest. Grado en Medicina

Introduction: the objective was to assess the utility of the Eating Assessment Tool (EAT-10) in hospitalisation units with patients at high risk of dysphagia. Patients and methods: a cross-sectional study was conducted in the Neurology and Internal Medicine wards; patients with admission24 hours and in a terminal stage of disease were excluded. In the first 24-48 hours of admission the presence of dysphagia as assessed with the EAT-10, the risk of malnutrition as assessed with the Malnutrition Universal Screening Tools (MUST), and comorbidities using the Charlson index were screened. Results: a total of 169 patients were recruited (76.0 years, 52 % women); 19.5 % were at risk of malnutrition. The EAT-10 instrument could be administered in 80.6 % of the patients, and was positive in 26.6 % (women 34.1 % vs. men 18.4 %; p = 0.025). When comparing patients with higher comorbidity with those with a lower Charlson index, a lower response rate to EAT-10 was observed (78.4 % vs. 93.9 %; p = 0.038), without differences in screening positivity (28.3 % vs. 19.4 %; p = 0.310). The prevalence of dysphagia risk was higher in the Internal Medicine unit than in the Neurology unit (30.4 % vs. 19.6 %; p = 0.133), as was the percentage of cases in which screening could not be performed (21.1 % vs. 11.1 %; p = 0.011). There were no significant differences in risk of malnutrition, mortality, hospital stay, or readmission according to the EAT-10. Conclusions: The EAT-10 has limited utility in the studied hospitalisation units due to a high rate of unfeasible tests, especially among patients at higher risk of dysphagia.Introducción: el objetivo del estudio fue evaluar la utilidad del Eating Assessment Tool (EAT-10) en unidades de hospitalización con pacientes de alto riesgo de disfagia. Pacientes y métodos: estudio transversal de pacientes hospitalizados en Medicina Interna y Neurología; los pacientes con ingreso24 horas y en fase terminal de la enfermedad fueron excluidos. En las primeras 24-48 horas de ingreso se cribó la disfagia con el EAT-10, el riesgo de desnutrición con el Malnutrition Universal Screening Tool (MUST) y la comorbilidad con el índice de Charlson. Resultados: se reclutaron 196 pacientes (76,0 años, 52 % mujeres). El 19,5 % estaban en riesgo de desnutrición. El EAT-10 se pudo realizar en el 80,6 % de la muestra y fue positivo en el 26,6 % (mujeres 34,1 % vs. hombres 18,4 %; p = 0,025). Al comparar a los pacientes con mayor comorbilidad con aquellos que tenían un índice de Charlson más bajo, se observó una tasa de respuesta más baja al EAT-10 (78,4 % vs. 93,9 %; p = 0,038), sin diferencias en la positividad del cribado (28,3 % vs. 19,4 %; p = 0,310). La prevalencia del riesgo de disfagia fue mayor en la unidad de Medicina Interna que en la de Neurología (30,4 % vs. 19,6 %; p = 0,133), así como el número de casos en que no se pudo realizar el cribado (21,1 % vs. 11,1 %; p = 0,011). No hubo diferencias significativas en el riesgo de desnutrición, mortalidad, estancia hospitalaria o reingreso según el EAT-10. Conclusiones: el EAT-10 tiene una utilidad limitada en las unidades de hospitalización estudiadas debido a una alta tasa de pruebas no realizables, especialmente entre los pacientes con mayor riesgo de disfagia.

Background & Aims: Patients with advanced liver fibrosis remain at risk of cirrhosis-related outcomes and those with severe comorbidities may not benefit from hepatitis C (HCV) eradication. We aimed to collect data on all-cause mortality and relevant clinical events within the first two years of directacting antiviral therapy, whilst determining the prognostic capability of a comorbidity-based model. Methods: This was a prospective non-interventional study, from the beginning of direct-acting antiviral therapy to the event of interest (mortality) or up to two years of follow-up, including 14 Spanish University Hospitals. Patients with HCV infection, irrespective of liver fibrosis stage, who received direct-acting antiviral therapy were used to build an estimation and a validation cohort. Comorbidity was assessed according to Charlson comorbidity and CirCom indexes. Results: A total of 3.4% (65/1,891) of individuals died within the first year, while 5.4% (102/1,891) died during the study. After adjusting for cirrhosis, platelet count, alanine aminotransferase and sex, the following factors were independently associated with one-year mortality: Charlson index (hazard ratio [HR] 1.55; 95% CI 1.29-1.86; p = 0.0001), bilirubin (HR 1.39; 95% CI 1.11-1.75; p = 0.004), age (HR 1.06 95% CI 1.02-1.11; p = 0.005), international normalized ratio (HR 3.49; 95% CI 1.36-8.97; p = 0.010), and albumin (HR 0.18; 95% CI 0.09-0.37; p = 0.0001). HepCom score showed a good calibration and discrimination (C-statistics 0.90), and was superior to the other prognostic scores (model for end-stage liver disease 0.81, ChildPugh 0.72, CirCom 0.68) regarding one-and two-year mortality. HepCom score identified low- (= 25 points: 56%-59%) mortality groups, both in the estimation and validation cohorts. The distribution of clinical events was similar between groups. Conclusions: The HepCom score, a combination of Charlson comorbidity index, age, and liver function (international normalized ratio, albumin, and bilirubin) enables detection of a group at high risk of one-and two-year mortality, and relevant clinical events, after starting direct-acting antiviral therapy. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Diabetes is often poorly managed in hospitals. This study assessed the level of adherence to current Canadian practice guidelines for inpatient pharmacologic management of type 2 diabetes and whether it affected the frequency of hyperglycemia or hypoglycemia.Retrospectively, we assessed the first 3 days of routine inpatient capillary blood glucose measurement (CBGM) records for hyperglycemia (8 mmol/L fasting,10 mmol/L nonfasting) and hypoglycemia (4 mmol/L) in adults with drug-treated type 2 diabetes admitted to internal medicine without metabolic decompensation or nil per os (NPO) status at 2 hospitals during October through December 2014. Patients, divided according to their admission orders into guideline-adherent versus guideline-nonadherent groups were compared for frequency of hyperglycemia and hypoglycemia. Factors predicting guideline adherence were assessed.Of 150 patients with diabetes who were admitted, 108 met entry criteria. A total of 89 patients received guideline-based care (82%), whereas 19 patients did not (18%). Charlson index and preadmission medications did not predict guideline-based care, but admitting physicians' seniority did (junior, senior resident, attending physician; p=0.05). In the adherent group, 43% of CBGMs were hyperglycemic, versus 64% in the nonadherent group (p=0.01). For hypoglycemia, proportions were 2% versus 1%, respectively (p=0.21).Adherence to guidelines for inpatient type 2 diabetes management is good and may be greater with more training. Hyperglycemia was more common in patients who did not receive guideline-based care. Hypoglycemia was uncommon and did not appear to be more common in the guideline-adherent group, although numbers were small. These results may alleviate physicians' fear that providing adequate insulin to hospitalized patients may cause hypoglycemia.

OBJECTIVE To apply 3advanced chronic disease evaluation tools in elderly patients admitted to an intermediate and long-term care centre, and evaluate its relationship with mortality. METHODS The NECPAL tool, PROFUND prognostic index, and Charlson comorbidity index were applied to 87 patients. RESULTS The NECPAL tool identified 31 patients (35.6%) in need of palliative care, and according to the PROFUND index, 45 (54.7%) had high/very high risk of mortality (≥7 points), and according to Charlson index, 31 (35.6%) had high comorbidity (≥4 points). Of the NECPAL positive patients, 80.5% had a PROFUND index score ≥7, and 48.3% a Charlson index ≥ 4. These percentages were 34.4% and 28.5% in negative NECPAL patients (P

Background: Lung cancer (LC) and chronic obstructive pulmonary disease (COPD) are associated with increased morbidity and mortality. The differential clinical and functional features among LC patients with or without COPD have not been defined. Objectives: The aims of this study were to examine the prevalence and underdiagnosis rate of COPD in LC patients and to compare the clinical and functional features of LC patients with and without COPD. Methods: We designed a multicenter hospital-based study including all LC cases diagnosed from January 2014 to August 2016. We assessed epidemiological, clinical, radiological, functional, and histological variables in all cases. Results: We recruited 602 patients with LC, most of them men (77.9%), with a median age of 67 ± 15 years. The COPD prevalence among LC patients was 51.5%, with a underdiagnosis rate of 71.6%. The LC+COPD patients were older and the proportion of men was higher compared with the LC-only patients. The LC+COPD patients had more pack-years, more squamous LC, a lower monoxide transfer coefficient (KCO), and higher Charlson index scores than patients with LC only. The median survival of LC-only patients was 37% longer than that of LC+COPD patients (22 vs. 16 months), but this difference was not statistically significant. Conclusions: Among LC patients, COPD is prevalent and underdiagnosed. Patients with LC+COPD more often have squamous LC, have greater comorbidities, and have a lower KCO. More effort should be made for an early diagnosis of COPD to select patients at higher risk of developing LC.

Fecal microbiota transplantation (FMT) is a new technique recently introduced to treat recurrent Clostridium difficile infection (CDI). Little is known about the efficacy and risks of FMT in elderly and ill patients. To investigate FMT efficacy in ill and elderly patients compared to conventional treatment. The study comprised two groups of patients between 2012 and 2016 with recurrent CDI at two medical centers in Israel. The study group received FMT and the controls conventional therapy. The primary end points were CDI recurrence, length of hospitalization, and short-term survival. Thirty-four patients altogether, (21 females, mean age 82 years) participated, 11 received FMT and 23 controls. Demographics and clinical characteristics were similar between the two groups. Comorbidity indexes, i.e., Charlson index was high in both groups. In the FMT group, 10/11 (90%) patients showed clinical improvement 3 days after initiating treatment compared to 9/23 (39%) in the control group, p = 0.02. Survival at 2 months did not differ between the groups (FMT 54%, Control 50%, p = 0.816), but mean survival in the FMT group was higher than in the control (12 vs. 4 months, respectively, p = 0.015). Two significant adverse events from the FMT group included suspected aspirations, both occurring during gastroscopy route of administration. FMT is effective for elderly and very ill patients. Safety is a concern, but is rare even in patients with much comorbidity. Colonoscopy may be the preferred route of FMT infusion.

Objectives To analyze the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014. Material and methods We analyzed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity. Results Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2 ± 17.1 vs. 74 ± 16.2; p Conclusions During the analyzed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management.