Valor pronóstico de la PCT y proteína C reactiva como marcadores de gravedad en neumonía adquirida en la comunidad en adultos mayores / Prognostic value of PCT and CRP as markers of severity in community acquired pneumonia in older adults

Introducción: La neumonía adquirida en la comunidad (NAC) es una de las principales causas de mortalidad en el mundo. La proteína C reactiva puede identificar a pacientes críticamente enfermos. La procalcitonina (PCT) ha sido referida como un marcador sensible de gravedad de la infección bacteriana y sepsis. Metodología: Se realizó un estudio cohorte prospectivo en el servicio de geriatría del Centro Médico ISSEMYM, Metepec, Estado de México, con todos los pacientes que ingresaron a hospitalización con diagnóstico de NAC entre mayo 2012 a marzo 2013. Se midieron PCR, PCT y laboratorios de rutina. Para la comparación de variables continuas se utilizó la T de Student ó U de Mann Whitney según su distribución. Para la comparación de variables cate-góricas se utilizo la prueba de X2. Para el análisis de supervivencia se utilizó el estimador de Kaplan-Meier. Para establecer el riesgo de mortalidad se empleó el modelo de regresión de COX obteniendo el Hazard Ratio. Para la correlación entre los niveles séricos de PCT y PCR se utilizó el coeficiente de correlación de Spearman. Resultados: Se registraron los datos de un total de 82 pacientes. La supervivencia media cuando PCT > de 0.5 ng/dl fue de 17 días (IC 95%, 11 a 23 días) versus 26 días (IC 95%, 17 a 35 días) para PCT < de 0.5 ng/dl (p < 0.01). Conclusiones: El nivel sérico de PCT mayor a 0.5 ng/dl mostró ser un marcador pronóstico en pacientes geriátricos con neumonía...(AU)

Handgrip strength predicts functional decline at discharge in hospitalized male elderly: a hospital cohort study.

Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79-0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and intervene consequently.

Hypertension as a risk factor for developing depressive symptoms among community-dwelling elders.

OBJECTIVE: To determine whether hypertension (HTA) is an independent predictor of depressive symptoms (DS) in a sample of elderly Mexican community-dwelling persons. MATERIAL AND METHODS: Two-year longitudinal study of 3,276 community-dwelling persons aged 60 years and older, participating in the Mexican Health and Aging Study. Subjects that self-reported both having or not having HTA while denying DS at baseline were included. Two-year follow-up data were analyzed, and multiple regression analyses were used to test whether HTA is an independent predictor of incident DS after adjusting for many potential confounders. RESULTS: Mean age of participants was 68.4 +/- 6.9 years. Prevalence of HTA was 36.6%. At follow-up, 28.7% developed DS. After adjusting for multiple covariates (age, sex, education level, relationship status, self-reported health and economic status, diabetes, arthritis, stroke, ischemic cardiopathy, falls, pain, hearing impairment, visual impairment, urinary incontinence, cognitive impairment, smoking, alcohol use, and baseline disability), HTA was an independent predictor of DS at two years followup (Adjusted Odds Ratio = 1.18; 95% confidence interval = 1.01-1.40). CONCLUSIONS: Hypertension is an independent risk factor for the development of depressive symptoms. Programs to support early treatment of cardiovascular disease and hypertension should be implemented in order to prevent late-onset of depressive symptoms.