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Background: The diverse and complex presentations of COVID-19 continue to impact the world. Factors related to prognosis and mortality are still not fully illuminated. Objectives: We aimed to asses the relationship of N-terminal pro B-type natriuretic peptide (NT-proBNP) and main pulmonary artery diameter (MPAD) with COVID-19 prognosis and mortality. Methods: 152 COVID-19 patients over the age of 18, were included in the study. Thoracic CT, NT-proBNP values, laboratory and demographic data of these patients were obtained by retrospectively examining the patient files and scanning the results through the patient registry. Results: According to multivariate logistic regression (LR) analysis, high NT-proBNP level (OR=3.542; 95% CI=1.745-9.463; p=0.021) and MPAD/ascending aortic diameter (AAD) ratio>0.75 (OR=2.692; 95% CI=1.264-9.312; p=0.036) were determined as independent risk factors predicting mortality in COVID-19 patients. A significant positive correlation was observed between NT-proBNP level and MPA diameter (r=0.296, p<0.001). The cut-off value was measured as 27.5 mm for MPA diameter and 742 pg/ml for NT-proBNP. Conclusions: Accurate and effective interpretation of available radiological and laboratory data is essential to reveal the factors predicting prognosis and mortality in COVID-19. In this study,we evaluated that the thorax CTs and determined that the MPAD/AAD and NT-proBNP level were independent risk factors in predicting mortality.
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COVID-19 , Péptido Natriurético Encefálico , Humanos , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Arteria Pulmonar/diagnóstico por imagen , Pronóstico , Fragmentos de Péptidos , BiomarcadoresRESUMEN
Background/aim: Physical frailty is thought to be related with a decline in cognitive function, mood, and social activities, especially in patients with depression and dementia. It is not clear whether or not physical frailty is associated with an impairment in cognitive function and mood in patients without dementia and depression. In this study, we evaluated the association of physical frailty with cognitive function and mood in geriatric patients without dementia and depression. Material and methods: In this study, 612 patients aged 65 years and over were evaluated. Physical frailty was assessed by using Fried criteria. Furthermore, comprehensive geriatric assessment was performed to each patient. Results: Median age of the patients was 72 years (min-max: 6593), 58% were female, and 6.5% were frail. Clock drawing (p < 0.001), MMSE (p < 0.001), and Yesevage geriatric depression scale (p: 0.010) test results were worse in frail patients compared to pre-frail and robust ones. Age (p: 0.009), being university graduate (p: 0.031), three words recall test (p: 0.014), activities of daily living (ADL) (p: 0.006), instrumental activities of daily living (IADL) (p < 0.001), and MNA-SF (p: 0.001) scores were determined to be independent related factors of frailty. Conclusion: We have demonstrated that cognitive function and mood might be associated with physical frailty in patients without dementia and depression.
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Afecto , Cognición/fisiología , Depresión , Fragilidad , Evaluación Geriátrica/métodos , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Estudios Transversales , Depresión/epidemiología , Femenino , Fragilidad/epidemiología , Fragilidad/psicología , Humanos , Vida Independiente , MasculinoRESUMEN
Background: This study aims to compare the predictive value of all comprehensive geriatric assessment (CGA) parameters with the predictive value of frailty assessment (with Edmonton Frailty Scale (EFS) and Fried Frailty Index (FFI)) for long-term mortality, in older adults.Methods: A total of 967 patients were included, consecutively. At the first admission, age, gender, comorbidities, number of drugs, and laboratory values of the patients were recorded. Each patient underwent CGA which consisted of anthropometric measurements, functional, cognitive, mood, nutritional, gait, fall, sleep duration, and frailty assessment. Fifty-seven months after the first admission, CGA parameters were analyzed to determine their predictive abilities on long-term mortality due to all causes, comparatively.Results: The median age was 73 years (range 65-94 years). The median follow-up time was 39.9 months (range 0.5-57.3 months). Serum albumin level, FFI, EFS, instrumental activity of daily living (IADL) score, and walking time were the best predictors of mortality. There was no significant difference between these parameters in predicting mortality.Conclusion: FFI and EFS have similar predictive value for mortality. In busy clinical practice, a new index based on IADL, walking time, and serum albumin level may be an alternative of frailty assessment for predicting mortality.
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Fragilidad , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Envejecimiento , Comorbilidad , Anciano Frágil , Fragilidad/diagnóstico , Fragilidad/epidemiología , Evaluación Geriátrica , HumanosRESUMEN
BACKGROUND: The Global Leadership Initiative on Malnutrition (GLIM) has developed new criteria for diagnosing patients with malnutrition. The aims of this study were to investigate the prevalence of malnutrition according to the GLIM criteria, Subjective Global Assessment (SGA), and Nutrition Risk Screening 2002 (NRS-2002) and their association with long-term mortality in patients hospitalized for acute illnesses. METHODS: A retrospective analysis was performed in a sample of 231 patients with different comorbidities hospitalized for acute illnesses in medical or surgical wards. Nutrition status was retrospectively assessed with GLIM criteria using patients' records at admission in addition to SGA and NRS-2002. The agreement between the tools was calculated using κ statistics, and the association of malnutrition according to each tool and mortality were analyzed using Cox regression analysis. RESULTS: The mean age of the patients was 62.2 ± 18.2 years, and 56.7% were women. The prevalence of malnutrition was 35.9% with GLIM criteria, 37.2% with SGA, and 38% with NRS-2002. The agreement between tools was good (GLIM-SGA, κ = 0.804; GLIM-NRS-2002, κ = 0.784). During a median follow-up period of 63.2 months, 79 deaths occurred. The sensitivity in predicting 5-year mortality was 59.49%, 58.23%, and 58.23%, and specificity was 76.32%, 73.68%, and 72.37% for GLIM criteria, SGA, and NRS-2002, respectively. After adjusting for confounders, GLIM criteria best predicted 5-year mortality (hazard ratio, 3.09; 95% CI, 1.96-4.86; P < .001). CONCLUSIONS: Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting all-cause mortality among patients hospitalized for acute illnesses.
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Desnutrición , Estado Nutricional , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Liderazgo , Desnutrición/diagnóstico , Desnutrición/epidemiología , Persona de Mediana Edad , Evaluación Nutricional , Estudios RetrospectivosRESUMEN
BACKGROUND: The influence of preoperative comprehensive geriatric assessment and frailty on postoperative morbidity, mortality, delirium were examined. METHODS: A total of 108 patients were evaluated. The Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Brody Instrumental Activities of Daily Living Scale (IADL), the Mini-Nutrition Assessment test (MNA), the Mini-Mental State Examination (MMSE), Yesavage Geriatric Depression Scale (GDS) were performed. Fried Criteria were used to assess physical frailty. We used the Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity score (POSSUM), the American Society of Anesthesiologists Score (ASA), and the Charlson Comorbidity Index (CCI) to determine the risk of postoperative morbidity and mortality. Assessment Test for Delirium (4AT) was applied for detection of delirium. RESULTS: The median age was 71 years (min-max: 65-84). IADL (p = 0.032), MNA (p = 0.01), MMSE scores (p = 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p = 0.005), operative score (p = 0.015) and CCI (p = 0.029) were significantly higher in the patients with morbidity. Patients developed morbidity were found to be more frail (p < 0.001). The patients with delirium were found to have lower IADL (p = 0.049) and MMSE scores (p = 0.004), higher POSSUM physiology score (p = 0.005) and all of them were frail. It was found that frailty (OR = 23.695 95% CI: 6.912-81.231 p < 0.001), POSSUM operative score (OR:1.118 95% CI: 1.021-1.224 p = 0.016) and preoperative systolic blood pressure (OR:0.937%95 CI: 0.879-0.999 p = 0.048) were independently related factors for postoperative morbidity. CONCLUSION: In our study, CGA and frailty in preoperative period were found to be indicators for postoperative morbidity and delirium.
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Anciano Frágil , Fragilidad , Evaluación Geriátrica , Complicaciones Posoperatorias/diagnóstico , Anciano , Delirio , Fragilidad/diagnóstico , Humanos , Morbilidad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Malnutrition in hospitalized patients is a serious problem and is associated with a number of adverse outcomes. The Nutritional Risk Screening-2002 (NRS-2002) tool was designed to identify patients at nutrition risk. The validation of NRS-2002 compared with detailed clinical assessment of nutrition status was not studied before in hospitalized Turkish adults. The aim of this study is to determine validity, sensitivity, and specificity of the Turkish version of NRS-2002 in a hospitalized adult population. METHODS: A total of 271 consecutive hospitalized patients aged >18 years admitted to surgical and medical wards of a university hospital in Turkey were included in this single-center non interventional validity study. Assessment by geriatricians was used as the reference method. Two geriatricians experienced in the field of malnutrition interpreted the patients' nutrition status after the evaluation of several parameters. Patients were divided into "at nutrition risk" and "not at nutrition risk" groups by geriatricians. Concordance between the 2 geriatricians' clinical assessments was analyzed by κ statistics. Excellent concordance was found; therefore, the first geriatrician's decisions were accepted as the gold standard. The correlation of nutrition status of the patients, determined with NRS-2002 and experienced geriatrician's decisions, was evaluated for the validity. RESULTS: NRS-2002 has a sensitivity of 88% and specificity of 92% when compared with professional assessment. The positive and negative predictive values were 87% and 92%, respectively. Testretest agreement was excellent as represented by a κ coefficient of 0.956. CONCLUSIONS: NRS-2002 is a valid tool to assess malnutrition risk in Turkish hospitalized patients.
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Desnutrición , Evaluación Nutricional , Medición de Riesgo , Adulto , Anciano , Hospitalización , Humanos , Desnutrición/diagnóstico , Desnutrición/prevención & control , Desnutrición/terapia , Persona de Mediana Edad , Estado Nutricional , Valor Predictivo de las Pruebas , Medición de Riesgo/métodos , Medición de Riesgo/normas , Factores de Riesgo , TurquíaRESUMEN
BACKGROUND: Determining predictors of mortality among older adults might help identify high-risk patients and enable timely intervention. AIMS: The aim of the study was to identify which variables predict geriatric outpatient mortality, using routine geriatric assessment tools. METHODS: We analyzed the data of 1141 patients who were admitted to the geriatric medicine outpatient clinic between 2001 and 2004. Comprehensive geriatric assessment was performed by an interdisciplinary geriatric team. Mortality rate was determined in 2015. The parameters predicting survival were examined. RESULTS: Median age of the patients (415 male, 726 female) was 71.7 years (53-95 years). Mean survival time was 12.2 years (95 % CI; 12-12.4 years). In multivariate analysis, age (OR: 1.16, 95 % CI: 1.09-1.23, p < 0.001), smoking (OR: 2.51, 95 % CI: 1.18-5.35, p = 0.017) and metabolic syndrome (OR: 2.20, 95 % CI: 1.05-4.64, p = 0.038) were found to be independent risk factors for mortality. MNA-SF scores (OR: 0.84, 95 % CI: 0.71-1.00, p = 0.050) and free T3 levels (OR: 0.70, 95 % CI: 0.49-1.00, p = 0.052) had borderline significance. DISCUSSION: The present study showed that the risk conferred by metabolic syndrome is beyond its individual components. Our findings confirm previous studies on the prognostic role of nutritional status, as reflected by MNA-SF. Serum fT3, a simple laboratory test, may also be used in geriatric outpatient clinics to identify individuals at risk. CONCLUSIONS: The results of the study demonstrated the need for addressing modifiable risk factors such as smoking, metabolic syndrome, and undernutrition in older adults.
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Causas de Muerte , Evaluación Geriátrica/métodos , Anciano , Anciano de 80 o más Años , Comorbilidad , Estudios Transversales , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Síndrome Metabólico/mortalidad , Persona de Mediana Edad , Estado Nutricional , Factores de Riesgo , Fumar/mortalidadRESUMEN
BACKGROUND: Sarcopenia is an important problem for older adults, leading to morbidity and mortality; therefore, early detection with a precise method is essential. We aimed to investigate the role of bioelectrical impedance analysis-derived phase angle as a determinant of sarcopenia. MATERIALS AND METHODS: A cross section of 263 community-dwelling and hospitalized older adults (>65 years) were assessed in terms of sarcopenia with bioelectrical indices and anthropometric measurements. Sarcopenic and nonsarcopenic groups were compared, and significant determinants of sarcopenia were further analyzed with multivariate logistic regression analysis. RESULTS: Forty patients were diagnosed with sarcopenia. The following were significant correlates of sarcopenia: female sex, low weight/height, low body mass index, decreased muscle strength, low calf circumference, low skeletal muscle mass/index, high impedance at 50 kHz, a history of hypertension, worse nutrition status, and low phase angle. Diagnostic parameters with well-known association were omitted, and sex, height, weight, body mass index, creatinine, nutrition status, phase angle, impedance at 50 kHz, and hypertension category were included in regression analysis. The following were independent associated factors with sarcopenia: phase angle (odds ratio [OR]: 0.59, 95% confidence interval [95% CI]: 0.40-0.87, P = .008), body mass index (OR: 0.84, 95% CI: 0.77-0.93, P = .001) impedance at 50 kHz (OR: 1.010, 95% CI: 1.006-1.015, P < .001), and height (OR: 0.93, 95% CI: 0.88-0.97, P = .001). Receiver operating characteristic analysis revealed that the optimal phase angle cutoff value to detect sarcopenia was ≤4.55º. CONCLUSIONS: Bioelectrical phase angle can be useful for diagnosis of sarcopenia.
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Envejecimiento , Fenómenos Fisiológicos Nutricionales del Anciano , Desnutrición/diagnóstico , Estado Nutricional , Sarcopenia/diagnóstico , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Comorbilidad , Estudios Transversales , Impedancia Eléctrica , Femenino , Evaluación Geriátrica , Humanos , Masculino , Desnutrición/epidemiología , Desnutrición/fisiopatología , Evaluación Nutricional , Servicio Ambulatorio en Hospital , Prevalencia , Sarcopenia/epidemiología , Sarcopenia/fisiopatología , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Factores Sexuales , Centros de Atención Terciaria , Turquía/epidemiologíaRESUMEN
BACKGROUND: Sarcopenia is a geriatric syndrome characterized by the presence of low muscle mass and function. Possible mechanisms underlying sarcopenia include oxidative stress and elevation of inflammatory cytokines. AIMS: The aim of the study was to evaluate the relationship between sarcopenia and biomarkers that may be involved in its pathogenesis and hence early detection. METHODS: A total of 72 patients (36 sarcopenic and 36 non-sarcopenic) were included in the study. An experienced geriatric team applied comprehensive geriatric assessment to all patients. Anthropometric measures, gait speed and handgrip strength were recorded. Bioelectrical impedance analysis was used to assess skeletal muscle mass. In addition to routine clinical laboratory tests, serum adiponectin, thioredoxin-1 and pentraxin-3 levels were measured. Sarcopenia was defined according to the European Working Group on Sarcopenia in older Adults as the presence of low muscle mass and low muscle function or muscle performance. RESULTS: Sarcopenic patients were more likely to be functionally dependent and had lower scores on comprehensive geriatric assessment tools. Erythrocyte sedimentation rate (ESR) and C-reactive protein levels were significantly higher in the sarcopenic group. There was no significant difference in serum levels of thioredoxin-1 and pentraxin-3. Sarcopenic patients had lower levels of hemoglobin, albumin, total protein, calcium, triglycerides, uric acid and adiponectin (p < 0.05). Hypertension and body mass index were inversely correlated with sarcopenia whereas ESR was positively correlated. DISCUSSION AND CONCLUSION: The present study demonstrated an association of sarcopenia with inflammatory markers CRP, ESR and adiponectin. Long-term prospective studies are warranted to confirm the relationship between markers oxidative stress and age related muscle decline.
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Adiponectina/sangre , Evaluación Geriátrica/métodos , Músculo Esquelético/patología , Sarcopenia/diagnóstico , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Fuerza Muscular/fisiología , Estrés Oxidativo/fisiología , Estudios Prospectivos , Sarcopenia/patología , Componente Amiloide P SéricoRESUMEN
AIM: The study aimed to investigate the effects of frailty on clinical outcomes of patients in an intensive care unit (ICU). METHODS: In this prospective study, 122 patients (59 frail, 37 pre-frail and 26 robust) were included. A frailty index (FI) derived from comprehensive geriatric assessment parameters was used for the evaluation. The FI score of ≤0.25 was considered as robust, 0.25-0.40 as pre-frail and >0.40 as frail. The prognostic effects of FI were investigated and FI and APACHE II and SOFA scores, the prognostic scores using in ICU, were compared. RESULTS: Median age of the patients was 71 years old and 50.8 % were male. ICU mortality rate and median length of stay (LOS) were 51.6 % and 8 days (min-max: 1-148), respectively. ICU mortality was higher (69.2, 56.8 and 40.7 %, respectively, p = 0.040) and median overall survival was lower in frail group compared to pre-frail and robust subjects (23, 31 and 140 days, p = 0.013, respectively). Long term mortality over 3 and 6 months in frail patients were 80.8 and 84.6 %, respectively and significantly higher than others. Multivariate analysis showed that LOS in ICU (HR 1.067, 95 % CI 1.021-1.114), SOFA score (HR 1.272, 95 % CI 1.096-1.476) and FI (HR 39.019, 95 % CI 1.235-1232.537) were the independent correlates for ICU mortality (p = 0.004, p = 0.002 and 0.038, respectively). There was a weak but statistically significant positive correlation between APACHE II and FI scores (r = 0.190, p = 0.036). CONCLUSIONS: FI may be used as a predictor for the evaluation of elderly patients' clinical outcomes in ICUs.
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Enfermedad Crítica/epidemiología , Anciano Frágil/estadística & datos numéricos , APACHE , Anciano , Femenino , Evaluación Geriátrica/métodos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Mortalidad , Pronóstico , Estudios Prospectivos , Proyectos de Investigación , Estadística como Asunto , Turquía/epidemiologíaRESUMEN
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tube placement is a common procedure performed to provide a route for enteral feeding. We aimed to examine the survival after PEG in older adults with neurologic disease and to demonstrate the factors associated with mortality. METHODS: We analyzed the data of 500 patients who underwent PEG placement between 2005 and 2015 at a university hospital. The data included age, sex, follow-up duration, comorbidities, medications, indications for PEG, complications, and laboratory results. Related risk factors and mortality rates were analyzed. RESULTS: Median age was 77 years. Median survival time after PEG placement was 13.9 months. The 30-day, 3-month, 1-year, 2-year, 3-year, and 5-year mortality rates were 11.3%, 28.3%, 46.8%, 56.3 %, 63.0%, and 67.8%, respectively. Stroke was independently correlated with mortality (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.52-3.19; P < .001). Overall survival time after PEG placement was shorter in patients with stroke than without stroke (11.4 vs 27.1 months, P = .014). In multivariate logistic regression analyses, preprocedural neutrophil percentage (OR, 1.10; 95% CI, 1.02-1.17, P = .015) and late complications (OR, 9.2; 95% CI, 1.80-46.90; P = .008) were independent risk factors for mortality in the stroke subgroup. Prophylactic antibiotic usage (OR, 0.07; 95% CI, 0.17-0.29; P < .001) and hyperlipidemia (OR, 0.30; 95% CI, 0.86-1.00; P = .048) were independently and inversely correlated with mortality in stroke patients. CONCLUSIONS: Stroke patients had higher mortality rates than other neurological indications for PEG. In stroke patients with PEG, neutrophil percentage was independently correlated with mortality, while hyperlipidemia and preprocedural antibiotic usage were independently related with survival.
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Nutrición Enteral , Gastrostomía , Intubación Gastrointestinal , Enfermedades del Sistema Nervioso , Anciano , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND/OBJECTIVES: To sonographically assess the muscle mass and architecture of sarcopenic elderly subjects, and to explore the utility of ultrasound (US) measurements in predicting sarcopenia. METHODS: One hundred elderly subjects were enrolled in this cross-sectional study. Mean age value of our study population was 73.08±6.18years. The diagnosis of sarcopenia was confirmed by measuring fat-free mass index (using bioelectrical impedance analysis) and handgrip strength. Calf circumference was measured and US evaluations comprised bilateral gastrocnemius muscle (MG) thickness, fascicle length and pennate angles; subcutaneous fat and dermis thicknesses in the calf. RESULTS: Bilateral muscle thickness and fascicle length values were significantly lower in patients with sarcopenia (both p<0.05). Sarcopenic and nonsarcopenic subjects had similar pennate angles, subcutaneous fat and dermis thicknesses. Median thickness ratio (100×t (MG)/[t (subcutaneous tissue)+t (dermis)+t (MG)]) values were 64% (40-88%) in the right and 64% (38-86%) in the left calf. Bilateral MG thickness and fascicle length values showed high sensitivity in predicting sarcopenia (all values>76.92%). CONCLUSIONS: Gastrocnemius muscle thickness and fascicle length values are lower in sarcopenic elderly and these two parameters can serve as alternative measurements for predicting/quantifying sarcopenia. Calf circumference measurements alone may not be appropriate for assessing sarcopenia. Instead, US imaging can conveniently be used to evaluate different compartments of the musculoskelal system in (sarcopenic) elderly.
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Músculo Esquelético/diagnóstico por imagen , Sarcopenia/diagnóstico , Anciano , Estudios Transversales , Dermis/diagnóstico por imagen , Impedancia Eléctrica , Femenino , Fuerza de la Mano , Humanos , Masculino , Grasa Subcutánea/diagnóstico por imagen , UltrasonografíaRESUMEN
AIM OF THE STUDY: Urinary incontinence and vitamin D deficiency are common problems encountered in geriatric population. We aimed to investigate if there is a relationship between these conditions. SUBJECTS AND METHOD: Among 2281 patients who were admitted to our geriatric medicine outpatient clinic spanning the last three years, 705 patients with known vitamin D status, urinary incontinence and subtype, and calcium plus vitamin D therapy data were included in statistical analysis. Patients who are using calcium plus vitamin D therapy were excluded. SPSS (Statistical Package for Social Sciences) version 15.0 for Windows was used for statistical analysis and p<0.05 was considered as statistically significant. RESULTS: Mean age of the study population was 72.3±6.4years and 62.8% were female. Plasma vitamin D level (OR: 0.968, 95%CI: 0.943-0.993, p=0.013), MMSE (Mini Mental State Examination) score (OR: 0.944, 95%CI: 0.902-0.989, p=0.014), and serum ALP (Alkaline Phosphatase) level (OR: 0.995, 95%CI: 0.992-0.998, p=0.001) were found to be inversely correlated factors, and serum calcium level (OR: 1.772, 95%CI: 1.008-2.888, p=0.022) was found to be a positively correlated factor of overactive bladder. Considering the different clinical subtypes of urinary incontinence, only urgency incontinence was associated with lower plasma vitamin D level (p=0.013). CONCLUSIONS: Vitamin D deficiency and insufficiency are independent associated factors for overactive bladder in older adults. This is explicable by effects of vitamin D on muscle growth and function.