Total blood lymphocyte count as a prognostic factor among unselected inpatients.

PURPOSE: The aim of this study was to determine the relationships between total lymphocyte count (TLC) and prognosis among inpatients. PATIENTS AND METHODS: We retrospectively analyzed data from electronic medical documentation of 54 976 inpatients hospitalized in an urban university hospital during 3 consecutive years (2014-2017). RESULTS: TLC was available for 12 651 (23.01%) of the inpatients. Patients with TLC <0.8 G/L constituted about 15% of the inpatients studied and had the highest risk of death, hospital readmission within 14 days, hospital readmission within 30 days and hospital readmission within 1 year, the lowest values for biochemical parameters of nutritional status assessment, and the highest C-reactive protein levels. An increase in TLC was associated with reduced risk of in-hospital death (odds ratio [OR]; 95% confidence interval [CI]): 0.31; 0.27-0.36 and 14-day readmission: 0.78; 0.72-0.86. The risk of in-hospital death associated with the Nutritional Risk Screening 2002 (NRS-2002) score, blood albumin concentration, and the score for the combined values of hemoglobin, TLC, albumin and neutrophils (HLAN) was (OR; 95% CI): 2.44; 2.35-2.53; 0.32; 0.28-0.36; and 0.96; 0.94-0.97; respectively. CONCLUSIONS: TLC < 0.8 G/L is associated with the highest risk of in-hospital death, 14-day and 30-day readmission, and longer in-hospital stay. An increase in TLC predicted in-hospital survival and freedom from early readmission with a power similar to or greater than a number of prognostic formulas based on questionnaires (e.g. NRS-2002), biochemical parameters (e.g. albumin) and formulas composed of multiple parameters (e.g. HLAN).

Blood albumin as a prognostic factor among unselected medically treated inpatients.

Aim: The aim of this study is to determine the prognostic value of blood albumin (BA) in an unselected population of inpatients. Materials & methods: We performed prospective analysis of the medical documentation of 7279 patients hospitalized between July 2014 and September 2017. Results: Individuals with BA ≥3.35 mg/dl had significantly lower risk of in-hospital death (odds ratio [OR]: 0.22; 95% CI: 0.19-0.27; p < 0.001) and 14-day readmission (OR: 0.64; 95% CI: 0.55-0.77; p < 0.0001). BA concentration was the strongest favorable factor predicting inpatient survival in a Cox hazard regression model (OR: 0.43; 95% CI: 0.36-0.50; p < 0.001), did not correlate with body mass index and actual-to-ideal bodyweight ratio and was strongly affected by numerous non-nutrient factors. Conclusion: BA concentration showed similar or better predictive and diagnostic power in relation to all-cause in-hospital mortality and 14-day readmission among inpatients than selected multifactorial scores.

Body mass index as a biomarker for the evaluation of the "Obesity Paradox" among inpatients.

BACKGROUND: Overweight and obesity are, on the one hand, recognized as risk factors for many health-related disorders, and, on the other, as favorable prognostic factors in various patients treated for several different conditions; what is called the "obesity paradox". Until now, the existence of this phenomenon among a general population of consecutive inpatients has not been evaluated. We decided, therefore, to perform an evaluation. PATIENTS AND METHODS: Historical prospective analysis of the medical documentation of 23 603 hospitalizations during two consecutive years in one center was performed. The outcomes measured were as follows: length of stay, in-hospital all-cause mortality, and non-scheduled readmission in the 14-day, 30-day and one-year periods following discharge. RESULTS: Overweight and obese patients had a lower or similar prevalence of the measured outcomes than malnourished patients and those of normal weight. Adjustment of the standard WHO BMI ranges for patients aged ≥65 y (normal weight BMI range 23-33 kg/m2) made these differences more apparent. In logistic regression, the ratio of fat to fat-free body mass was a stronger and unfavorable risk factor compared with BMI for the measured outcomes. CONCLUSIONS: The greatest risk of all-cause in-hospital death and readmission concerned malnourished inpatients. Compared to patients with a normal BMI range, overweight and obesity had a lower or similar (but not greater) risk of the outcomes measured. However, due to several BMI limitations, our observations should be interpreted as suggesting a "BMI paradox", rather than an "obesity paradox".

The "cholesterol paradox" among inpatients - retrospective analysis of medical documentation.

INTRODUCTION: There is evidence of positive relationships between cholesterol concentration and risk of cardiovascular diseases. However, higher mortality in patients with a low cholesterol level has been reported (the "cholesterol paradox"). MATERIAL AND METHODS: Medical records of 34 191 inpatients between 2014 and 2016 were reviewed and the relationships between total (TC), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) cholesterol and triglyceride blood concentrations and all-cause in-hospital death and readmission within 14 and 30 days and 1 year were determined in univariate and multivariate analyses. RESULTS: Patients with TC in the lower quartile and LDL-C < 70 mg/dl had greater risk of the outcomes measured than individuals with a TC level in the remaining quartiles and LDL-C ≥ 70 mg/dl. Moreover, patients with TC in the highest quartile, OR (95% CI): 0.36 (0.13-0.99), p < 0.05, and LDL-C ≥ 115 mg/dl, OR (95% CI): 0.53 (0.37-0.77), p < 0.05, had the lowest all-cause in-hospital mortality. However, multivariate analysis using logistic regression and a Cox proportional hazard model showed no significant influence of blood lipid levels on the occurrence of the outcomes measured. CONCLUSIONS: A significant effect of a "cholesterol paradox" linking better prognosis with higher blood lipid concentration was found only in univariate analysis but, after adjustment for clinical characteristics in multivariate analysis, the plasma lipid level had a neutral influence on the occurrence of the measured outcomes. This suggests that a low cholesterol level should be interpreted as a biomarker of illness severity.

[Score method evaluation of the sanitary condition of the University Hospital in Bydgoszcz and personnel education in 2007 - 2010]. / Punktowa metoda oceny stanu sanitarno-higienicznego i wyszkolenia personelu Szpitala Uniwersyteckiego w Bydgoszczy w latach 2007-2010.

UNLABELLED: The Quality Management System ISO 9001:2008 introduced by the Management Board of the hospital in the year 2007 resulted in change of the methods used by the Hospital Infection Control Team (HICT) to assess the sanitary-and-hygienic condition. The inspection protocol used by HICT was modified as part of the Quality Management System. It was supplemented by the score sheet which made the inspection results more objective. The purpose of the study was to assess the results of the supervision over the sanitary and epidemiologic condition of the hospital as well as personnel training carried out in the years 2007-2010 by the Hospital Infection Control Team (HICT) of Szpital Uniwersytecki nr 2 im. dr. J.Biziela (J.Biziel University Hospital no. 2). 407 inspection protocols issued in the years 2007-2010 were analysed. The sanitary/hygienic condition indicators and personnel education indicators were calculated based on the analysed data. The sanitary/hygienic condition indicator for the entire hospital in the years 2008-2010 amounted to over 91.50% and only in the year 2007 it was 89.33%. While the personnel education indicator for the entire hospital increased from 90.35% in 2007 to 93.75% in 2010. CONCLUSIONS: the assessment of hospital units performed on the basis of the new protocol of the sanitary/hygienic condition has been proven in practice, i.e. insufficient personnel education as regards hospital hygiene is efficiently detected by HICT at individual workstations and the Management Board of the hospital is notified on the ongoing basis on the results of supervision provided by HICT.