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Objective:We aimed to compare the characteristics between elderly and non-elderly corona virus disease 2019(COVID-19)patients, especially patients with different severity, in order to achieve a good understanding of elderly patients' clinical presentations.Methods:Records of patients diagnosed with COVID-19 and hospitalized at Tongji Hospital from February 9, 2020 to February 29, 2020 were retrospectively reviewed.They were divided into the elderly(≥65 years old)and non-elderly(<65 years old)groups according to age.Data on morbidity, underlying diseases, clinical symptoms, laboratory test results, imaging characteristics and hospitalization outcomes were collected retrospectively and analyzed statistically.Results:A total of 51 patients were enrolled with 21 in the elderly group(41.2%), with an average age of(71.9±6.4)years, and 30 non-elderly patients(58.8%). There were 13 elderly patients(61.9%)exhibiting fever, representing a lower rate than in the non-elderly patients(27 or 90%)( χ2=5.764, P=0.016). Bilateral pneumonia was present on chest CT scans in all of the elderly patients, while it was seen in 83.3% of the non-elderly patients( χ2=3.880, P=0.049). The proportion of elderly patients with coronary heart disease(61.9%)or hypertension(26.8%)was higher than that of non-elderly patients.The usage rates of antiviral drugs, systemic hormones and antibiotics were all higher and the causes of death were all due to multiple organ failure in elderly patients. Conclusions:Elderly patients with COVID-19 possess special characteristics, showing atypical symptoms, and multiple concomitant diseases may be the reason for their poor clinical prognosis.More rigorous monitoring and careful treatment should be conducted for elderly COVID-19 patients.
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Objective:To compare death causes and the survival time in elderly patients undergoing hemodialysis versus peritoneal dialysis in the nephrology department of Beijing Hospital in the last 10 years.Methods:This was a retrospective study.Patients aged more than 60 years who had undergone dialysis and died in the dialysis center of Beijing Hospital between January 2010 and January 2019 were enrolled.A detailed medical history including gender, age, primary diseases, diabetes mellitus, time of dialysis initiation, time of death and direct cause of death were recorded.Results:A total of 153 elderly dialysis patients were enrolled, with a mean age of 76.6±7.7 years, a median dialysis vintage of 54.1(26.9, 86.4)months, including 83(54.2%)cases with diabetes.Patients were divided into the hemodialysis group(HD, n=114)and the peritoneal dialysis group(PD, n=39)according to the dialysis method.The mean ages of patients in the HD and PD groups were 77.1±7.9 and 75.0±7.0 years, and the median dialysis vintages were 56.5(27.4, 104.2)and 48.3(26.3, 66.6)months, respectively.The primary diseases of patients undergoing HD and PD were diabetic nephropathy(DN, 32.5% vs.48.7%), chronic glomerulonephritis(29.8% vs.17.9%)and hypertensive renal damage(21.1% vs.10.3%). The top three causes of mortality in patients undergoing HD and PD were cardiovascular diseases(32.4% vs.43.6%), infections(29.8% vs.28.2%)and cerebrovascular diseases(11.4% vs.15.4%). The compositions of primary diseases and death causes were similar between the two groups, with no significant difference.Kaplan-Meier curves indicated that the survival time of dialysis patients with diabetes mellitus was shorter than that of patients without diabetes mellitus(chi-square value was 12.829, P<0.001), and the survival time of HD patients was longer than that of PD patients(chi-square value was 8.161, P=0.004). In patients without diabetes mellitus, the survival time of HD patients was longer than that of PD patients( Z=-2.716, P=0.007). In patients with diabetes mellitus, HD and PD had similar survival outcomes( Z=-0.581, P=0.561). Conclusions:The proportion of patients with diabetic nephropathy is high in elderly dialysis patients.Cardiovascular and cerebrovascular diseases and infections are the main causes of death in elderly dialysis patients.The survival time is longer in HD patients than in PD patients.
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Objective To analyze the causes of death of maintenance hemodialysis (MHD) patients,and to compare the long term survival rate between elderly patients and non-elderly patients and between diabetic nephropathy (DN) patients and non-DN patients at our hemodialysis center during last 20 years.Methods A total of 317 MHD patients were collected,and divided into elderly (≥60 years) and non-elderly (＜60 years) groups based on the age at starting hemodialysis.Besides,data of gender,primary diseases,and the direct cause of death in maintenance hemodialysis patients from 1996 to 2016 were collected.Results Cardiogenic diseases,infections,and cerebrovascular accidents were the three leading causes of death.The mean dialysis age was shorter in elderly MHD patients than in non-elderly MHD patients[(51.8 ± 45.7) months vs.(81.6 ± 66.5) months,t =4.271,P=0.000]with a lower survival rate (x2 =32.422,P =0.000).The mean dialysis age was significantly lower in DN patients than in non-DN patients[(44.1±33.8) months vs.(69.4±60.6) months,t=3.632,P =0.000)] with a lower survival rate (x2 =13.361,P =0.000).The overall survival rate was 59.8％ after the fifth year of MHD,was 33.3％ after the 10th year,was 8.4％ after the 20th year,in our dialysis center.Conclusions The long-term survival rate of patients receiving maintenance hemodialysis in our center is as high as that in the developed countries and in other hospitals in Beijing.The top three death causes are cardiac diseases,infections,and cerebrovascular accidents.For old or DN patients,the overall prognosis is poor.
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Objective To investigate the clinical characteristics and laboratory examinations in incident dialysis effect on the prognosis of elderly patients undergoing hemodialysis.Methods Ninety-three patients aged 65 years or older initiating hemodialysis were enrolled from Hemadialysis Center of Beijing Hospital from January lst,2007 to June 30th,2016.The duration time of HD of all patients was more than three months.Patients were divided into death group and non-death group.The clinical characteristics and laboratory examinations were compared between the two groups.Cox proportional hazards regression was used for the multivariate analysis to determine independent prognosis factors.Results The average year of patients was 74.2±6.5 years old with 43 months of median time of follow-up.The first two causes of death were infection (n =25,49.0％) and cardiovascular and cerebrovascular diseases (n =16,31.4％).Cox single factor regression analysis showed that the older ages,diabetic nephropathy being the cause of end-stage renal disease (ESRD),complicating with diabetes mellitus or congestive heart failure,the higher Charlson cardiovascular diseases score,ALB being under 35 g/L were correlated with poor outcome respectively(P＜0.05).Cox multivariate regression analysis indicated that older ages (HR =1.056,P =0.021),diabetic nephropathy being the cause of ESRD (HR =2.661,P =0.001),the higher Charlson cardiovascular diseases score (HR =1.675,P =0.010),central venous catheters being vascular access(HR=1.167,P=0.048) on incident dialysis were the main risk factors for mortality in elderly patients.Conclusion The older ages,diabetic nephropathy being the cause of ESRD,the higher Charlson cardiovascular diseases score,central venous catheters being vascular access on incident dialysis are independent risk factors influencing survival of elderly patients.
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Objective To investigate the long-term prognostic factors and the significance of serum cardiac troponin T (cTnT) and C-reactive protein (CRP) in maintenance hemodialysis (MHD) patients.Methods Clinical data of 76 MHD patients in our hospital from January 2002 to January 2003 were retrospectively analyzed.Time and cause of death in the next 10 years were recorded.Survival rate was calculated by Kaplan-Meier and impact factors of long-term prognosis were explored.Significance of cTnT and CRP was elucidated by COX regression analysis.Results CRP was positive in 28 cases (36.8％) and cTnT was positive in 22 cases (28.9％) among 76 patients.The median survival time was 37.9 months,2-year survival rate was 65.9％ and 10-year survival rate was 24.2％.Univariate analysis found positive CRP,positive cTnT,old age,diabetes,cardiocerebrovascular disease,anemia,low serum albumin,Kt/V decline were associated with long-term prognosis.Multivariate analysis showed that increased age (P =0.010),cardiocerebrovascular disease (P =0.048),positive cTnT (P =0.036),positive CRP (P =0.009) were independent risk factors of the 10-year survival of MHD patients.Ten-year mortality of cardiocerebrovascular diseases in positive cTnT group was not significantly different as compared with negative cTnT group (50.0％ vs 35.4％,P =0.248).But the positive cTnT group had higher 2-year mortality than negative cTnT group (40.9％ vs 14.6％,P =0.015).Mortality of cardiocerebrovascular disease was higher in positive CRP group as compared to negative CRP group at both 2-year and 10-year time (48.1％ vs 7.0％,P =0.000; 66.7％ vs 23.3％,P =0.000).Compared with both negative cTnT and CRP group,both positive cTnT and CRP group had much higher all-cause mortality (92.9％ vs 55.6％,P =0.030),higher mortality of cardiocerebrovascular disease at 10-year (64.3％ vs 25.0％,P =0.009),and higher mortality of cardiocerebrovascular disease at 2-year (57.1％ vs 5.6％,P =0.000).Conclusions Aging,cardiocerebrovascular disease,positive cTnT and positive CRP are independent risk factors of long-term prognosis for MHD patients.Positive cTnT can predict cardiocerebrovascular mortality of MHD patients in 2 years,while positive CRP can predict short-and long-term cardiocerebrovascular mortality.Positive cTnT combined with positive CRP may be more valuable in predicting the poor prognosis of MHD patients.
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Objective To investigate the change of renal tubular function in elderly patients after use of β lactam antibiotic. Methods The elderly patients with pulmonary infection were treated with β lactam antibiotic,the dosage was 50%-70% of normal use. The renal tubular function indicated by urine α1-MG, β2-MG, pro/Cre, NAG/Cre and glomerulus function marked by eGFR, serum creatinine (Cre)), cystatin C were detected during drugs treatment and 7 days after stopping medications. Results The infection was controlled well in 3-7 days after treatment. Urine α1-MG, β2-MG, pro/Cre and NAG/Cre were abnormal before treatment, were elevated in 3, 14 days after using antibiotic, and came down to the level before treatment on 7 days after stopping treatment. The level of Cre and eGFR was (89.0±25.97) μmol/L and (26.39±8.17) ml/min before treatment, then elevated and decreased in 14 days after treatment, respectively, and down to the level before treatment on 7 days after stopping of antibiotic. Cystatin c was abnormal before treatment and did not change significantly after treatment and after stopping antibiotic. Conclusions It is important to protect renal tubular function and to adjust antibiotic dosage according to eGFR during using antibiotic in elderly patients to control infection.
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Objective To investigate serum cardiac troponin T(cTnT) and C-reactive protein (CRP) levels and assess the prognostic values of cTnT and CRP of mortality and cardiovascular events in maintenance hemodialysis (MHD) patients. Methods One hundred and six MHD patients were enrolled in this study. Serum cTnT, CRP, creatinine, albumin were measured in pre-hemodialysis at the beginning of the study. The mortality and cardiovascular events were recorded during the period of follow up. Results At the initiation of the study,28 patients (26.42%) were recorded with positive cTnT level, 32(30.19%) with positive CRP and 16 (15.09%) with positive cTnT and CRP. Logistic regression analysis showed a significant correlation between serum cTnT and serum CRP and Scr. Patients with positive cTnT and CRP levels had higher mortality and more cardiovascular events than those with negative levels. Kaplan-Meier survival analysis showed a significant difference between patients with normal and abnormal cTnT and CRP levels. Conclusions Some MHD patients have elevated serum cTnT level. Serum cTnT level is correlated with serum CRP and creatinine level. Patients with positive cTnT and CRP levels have higher mortality and more cardiovascular events than those with negative levels.