Malnutrition status in patients of very advanced age with nonvalvular atrial fibrillation and its impact on clinical outcomes

Background and aimsMalnutrition is associated with adverse outcomes in patients with chronic disease. We screened malnutrition among patients of very advanced age with nonvalvular atrial fibrillation (AF) by malnutrition scores and investigated the associations between malnutrition and clinical outcomes.Methods and resultsThis retrospective observational study included 461 patients aged ≥80 years with nonvalvular AF. Malnutrition was screened using the Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI) scores. The primary endpoints were composite events, including thromboembolic events and all-cause death. Malnutrition was present in 62.9%, 5.0%, and 21.9% of patients according to the CONUT, PNI, and GNRI scores, respectively. During a median 27-month follow-up, 130 (28.2%) patients had composite events. Kaplan−Meier curves revealed that patients with moderate to severe malnutrition had the worst clinical outcomes (log-rank P < 0.05 for all scores). Multivariate Cox proportional hazards analysis showed that moderate to severe malnutrition was an independent predictor of composite events [hazard ratio (HR): 2.051, 95% confidence interval (95%CI): 1.143–3.679, P = 0.016 for CONUT score; HR: 3.374, 95%CI: 1.898–5.998, P < 0.001 for PNI score; HR: 2.254, 95%CI: 1.381–3.679, P = 0.001 for GNRI score]. Addition of the CONUT or GNRI score to a baseline prediction model for composite events significantly improved the net reclassification improvement and integrated discrimination improvement (all P < 0.05).ConclusionModerate to severe malnutrition was an independent predictor of adverse outcomes among patients of very advanced age with nonvalvular AF. Screening for malnutrition might provide useful information regarding prognosis and risk stratification.     

Impact of Controlling nutritional status (CONUT) in patients with unresectable advanced pancreatic cancer receiving multi-agent chemotherapy: A single center,retrospective cohort study

Controlling nutritional status (CONUT) calculated using the serum albumin concentration, total lymphocyte count, and total cholesterol, was developed as a screening tool for the early detection of undernutrition. In addition, CONUT has been reported to be a prognostic predictor of various malignancies.AimTo investigate the impact of CONUT in patients with advanced pancreatic cancer (APC).MethodsBetween June 2014 and October 2020, 110 consecutive patients with APC who received multi-agent chemotherapy were retrospectively reviewed. Patients were classified into four categories (normal, 1; light, 2; moderate, 3; severe, 4) based on CONUT. Progression-free survival (PFS) and overall survival (OS) were evaluated.ResultsThirty-nine (35.4%), 63 (57.2%), and 8 (7.2%) patients had CONUT 1, 2, and 3, respectively, but no patients for CONUT 4. The baseline characteristics did not differ significantly between CONUT classifications. In the multivariate analyses, the presence of metastasis (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.22–3.52), CONUT 2 (HR, 2.15; 95% CI, 1.32–3.54), and CONUT 3 (HR, 9.18; 95% CI, 2.67–23.50) were independent risk factors for PFS. The presence of metastasis (HR, 1.76; 95% CI, 1.04–3.07), CONUT 2 (HR, 1.92; 95% CI, 1.16–3.24), and CONUT 3 (HR, 10.71; 95% CI, 3.87–27.63) were also independent risk factors for OS. A median OS in CONUT 1, 2, and 3 were 20, 14.5, and 3.5 months (CONUT 1 vs. CONUT 2, p = 0.02; CONUT 1 vs. CONUT 3, p < 0.01; CONUT 2 vs. CONUT 3, p < 0.01), respectively.ConclusionCONUT could be a predictor of prognosis for survival in patients with APC.     

Prognostic significance of preoperative PNI and CA19-9 for pancreatic ductal adenocarcinoma: A multi-institutional retrospective study

BackgroundThe aim of this study was to investigate the clinical value of nutritional and immunological prognostic scores as predictors of outcomes and to identify the most promising scoring system for patients with pancreatic ductal adenocarcinoma (PDAC) in a multi-institutional study.MethodsData were retrospectively collected for 589 patients who underwent surgical resection for PDAC. Prognostic analyses were performed for overall (OS) and recurrence-free survival (RFS) using tumor and patient-related factors, namely neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, Prognostic Nutritional Index (PNI), Glasgow Prognostic Score (GPS), modified GPS, C-reactive protein-to-albumin ratio, Controlling Nutritional Status score, and the Geriatric Nutritional Risk Index.ResultsCompared with PDAC patients with high PNI values (≥46), low PNI (<46) patients showed significantly worse overall survival (OS) (multivariate hazard ratio (HR), 1.432; 95% CI, 1.069–1.918; p = 0.0161) and RFS (multivariate HR, 1.339; 95% CI, 1.032–1.736; p = 0.0277). High carbohydrate antigen 19–9 (CA19-9) values (≥450) were significantly correlated with shorter OS (multivariate HR, 1.520; 95% CI, 1.261–2.080; p = 0.0002) and RFS (multivariate HR, 1.533; 95% CI, 1.199–1.961; p = 0.0007). Stratification according to PNI and CA19-9 was also significantly associated with OS and RFS (log rank, P < 0.0001).ConclusionsOur large cohort study showed that PNI and CA19-9 were associated with poor clinical outcomes in PDAC patients following surgical resection. Additionally, combining PNI with CA19-9 enabled further classification of patients according to their clinical outcomes.     

Prediction of all-cause mortality with malnutrition assessed by nutritional screening and assessment tools in patients with heart failure：a systematic review

Background and aimsIn the absence of a gold standard or scientific consensus regarding the nutritional evaluation of heart failure (HF) patients, this study aimed to summarize and systematically evaluate the prognostic value of nutritional screening and assessment tools used for all-cause mortality in HF patients.Methods and resultsRelevant studies were retrieved from major databases (PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Data, and China Biology Medicine disc (CMB)) and searched from the earliest available date until July 2021. If three or more studies used the same tool, meta-analysis using RevMan 5.3 was performed. This systematic review was registered at PROSPERO (number CRD42021275575). A total of 36 articles involving 25,141 HF patients were included for qualitative analysis and 31 studies for quantitative analysis. Meta-analysis of these studies indicated, poor nutritional status evaluated by using 5 nutritional screening tools (Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status Score (CONUT), Nutritional Risk Index (NRI), and Short Form Mini Nutritional Assessment (MNA-SF)) or 2 nutritional assessment tools (the Mini Nutritional Assessment (MNA) and Generated Subjective Global Assessment (SGA)) predicted all-cause mortality in HF patients. Of all tools analyzed, MNA had the maximum HR for mortality [HR = 2.62, 95%CI 1.11–6.20, P = 0.03] and MNA-SF [HR = 1.94, 95%CI 1.40–2.70, P＜0.001] was the best nutritional screening tools.ConclusionPoor nutritional status predicted all-cause mortality in HF patients. MNA may be the best nutritional assessment tool, and MNA-SF is most recommended for HF patient nutritional screening. The application value of MNA, especially in patients with reduced left ventricular ejection fraction (LVEF), needs to be further confirmed. The clinical application value of Mini-Nutrition Assessment Special for Heart Failure (MNA-HF) and Global Leadership Initiative on Malnutrition (GLIM) in HF patients needs to be confirmed.     

The impact of malnutrition on atrial fibrillation recurrence post ablation

Background and aimsBoth malnutrition and atrial fibrillation (AF) are the major health problems in modern society. Only a few studies focused on the relationship between malnutrition and recurrence of atrial arrhythmias post AF ablation (AF recurrence), which used body mass index (BMI) as nutrition assessment tool. However, BMI can't credibly reflect body composition and has limitation in patients with water-sodium retention. In this study, we used controlling nutritional status score (CONUT score) and geriatric nutritional risk index (GNRI) to identify the malnutrition patients and explored the effect of malnutrition on AF recurrence.Methods and resultsThis retrospective study included 246 patients who underwent AF ablation. During a median 11-month follow-up, 77 patients (31.3%) experienced AF recurrence. The recurrence group had higher CONUT score (2.3 ± 1.5 vs. 0.9 ± 1.0, P < 0.001) and lower GNRI (99.9 ± 7.6 vs. 103.9 ± 5.6, P < 0.001). After balancing the traditional risk factors, both CONUT score (OR: 2.614, 95%CI: 1.831–3.731, P < 0.001) and GNRI (OR: 0.884, 95%CI: 0.828–0.944, P < 0.001) were the independent predictors for AF recurrence. Pre-ablation CONUT score ≥1 and GNRI≥95.66 are indicative of AF recurrence. Adding CONUT score or GNRI to the base prediction model for AF recurrence significantly improved the discrimination and calibration. However, adding BMI to the base prediction model did not improve the model performance.ConclusionsCONUT score and GNRI are ideal tools to evaluate the nutrition status of AF patients. Undernourished patients are more likely to suffer from AF recurrence. Improving nutrition status may be a potential target for reducing the postoperative recurrence rate.     

External validation of the Besançon nomogram in Asian patients with advanced pancreatic cancer receiving second-line chemotherapy: A multi-institute experience in Taiwan

BackgroundDetermining survival outcome in advanced pancreatic ductal adenocarcinoma (aPDAC) patients receiving second-line (L2) chemotherapy is important for clinical decision-making. The Besançon group from France recently proposed a prognostic nomogram to predict overall survival (OS) for aPDAC patients receiving L2 chemotherapy. The present study aimed to externally validate the performance of the Besançon nomogram in predicting OS in an Asian cohort.MethodsWe retrospectively enrolled 349 patients who received L2 chemotherapy for aPDAC between 2010 and 2016 at four institutes in Taiwan. The performance of the Besançon model in this cohort was evaluated with C-index and calibration plots.ResultsThe median OS time in our patient cohort was 4.5 months (95% confidence interval [CI], 3.0–5.0). Using the Besançon nomogram-predicted risk groups, the median OS times in the low, intermediate, and high-risk groups were 6.7 (95% CI, 5.3–8.2), 3.2 (95% CI, 2.4–3.9), and 1.7 months (95% CI, 0.6–2.7), respectively. The C-index of the predicted six- and 12-month survival probabilities for the Besançon nomogram were 0.766 (95% CI, 0.715–0.816) and 0.698 (95% CI, 0.641–0.754), respectively. The calibration plot showed that the observed six-month survival probability was close to the diagonal line, while that for 12-month survival deviated below the diagonal line compared to the survival probability predicted by the Besançon nomogram.ConclusionsAlthough the Besançon nomogram tended to over-estimate the 12-month survival probability, our study demonstrated that the nomogram is a reliable and readily applicable model to estimate survival outcomes of aPDAC patients receiving L2 chemotherapy.     

Controlling Nutritional Status (CONUT) score and the risk of mortality or impaired physical function in stroke patients: A systematic review and meta-analysis

AimsThe Controlling Nutritional Status (CONUT) score is a tool for assessing the risk of malnutrition (undernutrition) that can be calculated from albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration. CONUT score has been proposed as a promising prognostic marker in several clinical settings; however, a consensus on its prognostic value in patients with stroke is lacking. The aim of this systematic review and meta-analysis was to evaluate the relationship between CONUT score and clinical outcomes in patients with stroke based on all current available studies.Data synthesisSystematic research on PubMed, Scopus and Web of Science from inception to February 2023 was performed on the association between CONUT score and clinical outcomes in patients with stroke. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality was evaluated using the Newcastle-Ottawa Scale quality assessment tool. Pooled effect estimation was calculated by a random-effect model.Through the initial literature search, 15 studies (all high-quality) including 16 929 patients were found to be eligible and analysed in the meta-analysis.A significant risk of malnutrition (in most studies defined by a CONUT score ≥5) was directly associated with mortality, higher risk of poor functional outcome according to the modified Rankin Scale and total infection development. Evidence was consistent for acute ischaemic stroke and preliminary for acute haemorrhagic stroke.ConclusionCONUT score is an independent prognostic indicator, and it is associated with major disability and infection development during hospitalisation.PROSPERO IDCRD42022306560.     

Development and validation of a novel nomogram and risk score for biliary atresia in patients with cholestasis

BackgroundTimely discriminating biliary atresia (BA) from other causes of cholestasis is important but challenging.AimsTo develop a useful diagnostic nomogram and a simplified scoring system to diagnosing BA.Study designAll medical records of the patients who were consecutively admitted to our institution with cholestasis from March 2016 to December 2020 were retrospectively searched. The patients were allocated to the derivation cohort (n = 343) and the validation cohort (n = 246). Multivariable logistic regression models were used to construct the nomogram. The nomogram was validated in both cohorts. The simplified risk score was derived from the nomogram.ResultsThe nomogram was constructed based on presence of clay stool, gallbladder length, gallbladder emptying index, shear wave elastography value, and gamma-glutamyl transferase level. This model showed good calibration and discrimination ability, with the C-index of 0.968 (95% CI: 0.951–0.984). The discriminating ability is most prominent in the 61–90 days group, with AUC of 0.982 (95% CI: 0.955–1.000). The simplified risk score identified most patients with very high or low risk of BA, and was capable of exempting 64.3% non-BA patients from intraoperative cholangiogram procedure.ConclusionsThis novel diagnostic nomogram had good discrimination and calibration abilities. The simplified scoring system showed significant clinical utility.     

Growth differentiation factor 15 is an early predictor for persistent organ failure and mortality in acute pancreatitis

ObjectivesEarly prediction of persistent organ failure (POF) is crucial for patients with acute pancreatitis (AP). Growth differentiation factor 15 (GDF15), also known as macrophage inhibitory cytokine 1 (MIC-1), is associated with inflammatory responses. We investigated changes in plasma GDF15 and assessed its predictive value in AP.MethodsThe study included 290 consecutive patients with AP admitted within 36 h after symptoms onset. Clinical data obtained during hospitalization were collected. Plasma GDF15 levels were determined using enzyme-linked immunosorbent assays. The predictive value of GDF15 for POF was analyzed.ResultsThere were 105 mild, 111 moderately severe, and 74 severe AP patients. Plasma GDF15 peak level were measured on admission, and significantly declined on the 3rd and 7th day. Admission GDF15 predicted POF and mortality with areas under the curve (AUC) of 0.847 (95% confidence interval [CI] 0.798–0.895) and 0.934 (95% CI 0.887–0.980), respectively. Admission GDF15, Bedside Index of Severity in Acute Pancreatitis, and hematocrit were independent factors for POF by univariate and multivariate logistic regression, and the nomogram built on these variables showed good performance (optimism-corrected c-statistic = 0.921). The combined predictive model increased the POF accuracy with an AUC 0.925 (95% CI 0.894–0.956), a net reclassification improvement of 0.3024 (95% CI: 0.1482–0.4565, P < 0.001), and an integrated discrimination index of 0.11 (95% CI 0.0497–0.1703; P < 0.001).ConclusionsPlasma GDF15 measured within 48 h of symptom onset could help predict POF and mortality in AP patients.     

Malnutrition in patients with coronary artery disease: Prevalence and mortality in a 46,485 Chinese cohort study

Background and aimsMalnutrition is associated with poor prognosis in a wide range of illnesses. However, its long-term prognostic impact in general coronary artery disease (CAD) patients is not well known. We aim to report the prevalence and long-term mortality of malnutrition in the whole general population.Methods and resultsIn this retrospective cohort study, the controlling nutritional status (CONUT) score was applied to 46,485 consecutive patients undergoing coronary angiography (CAG) and diagnosed with CAD from January 2007 to July 2018. Patients were stratified as having no malnutrition (n = 19,780), mild (n = 21,092), moderate (n = 5286) and severe malnutrition (n = 327), based on CONUT score. Overall, mean age was 63.1 ± 10.7 years, and 75.8% of patients (n = 35,250) were male. 45.4% of patients were mildly malnourished and 12.1% were moderately or severely malnourished. During a median follow-up of 5.1 years (interquartile range: 3.0–7.7 years), 6093 (17.3%) patients died. After adjusting for confounders, malnutrition risk was associated with significantly increased risk for all-cause death (mild vs. normal, HR = 1.19,95% confidence interval [CI]: 1.12 to 1.28; moderate vs. normal, HR = 1.42,95% CI: 1.30 to 1.55; severe vs. Normal, HR = 1.95, 95% CI: 1.57 to 2.41) (p for trend<0.001). The similar result on all-cause mortality was also found in different subgroups stratified by gender, chronic kidney disease, anemia, percutaneous coronary intervention.ConclusionsMalnutrition is a common complication among patients with CAD, and is strongly associated with increased mortality. Further studies need to explore the efficacy of nutritional interventions on long-term prognosis among CAD patients.This study was registered at Clinicaltrials.gov as NCT04407936.     

Relationship between pre-stroke frailty status and short-term functional outcome in older patients with acute stroke–A mediation analysis-

AimThe aim of this study was to investigate the effects of pre-stroke frailty status on short-term functional outcome in older patients with acute stroke.MethodsIn this prospective longitudinal study, we assessed the pre-stroke frailty status (robust, prefrail, or frail) by the Frailty Screening Index, disease severity by the National Institutes of Stroke Scale (NIHSS), and short-term functional outcome by the modified Rankin Scale (mRS) at discharge from acute hospital in patients with older stroke. We considered poor functional outcome to be a mRS >2. Logistic regression analysis and mediation analysis were used to investigate the relationships among pre-stroke frailty status, disease severity, length of stay (LOS), and short-term functional outcome.ResultsA total of 232 patients were enrolled in this study. The NIHSS and LOS were significantly different between groups (p<0.001, p = 0.01, respectively), but there was no relationship between frailty status and short-term functional outcome (p = 0.22). Based on the logistic regression analyses after adjusting for potential confounders, the NIHSS (odds ratio (OR): 1.75, 95% confidence interval (CI): 1.44–2.14, p<0.001) and LOS (OR: 1.07, 95%CI: 1.03–1.11) were independently associated with a poor functional outcome. In the mediation analysis, the NIHSS (β=0.137, p<0.001) and LOS (β=0.09, p<0.004) were significant mediators between pre-stroke frailty status and poor functional outcome.ConclusionsThe relationship between pre-stroke frailty status and short-term functional outcome was mediated by disease severity and LOS in older patients with acute stroke.     

Utility of the Nutritional Screening in Predicting Adverse Outcome of Patients With Overweight/Obesity and Acute Heart Failure

BackgroundUndernutrition is a negative predictor of adverse outcomes in patients with heart failure (HF). Despite the survival advantage of elevated body mass index (BMI) in patients with HF, BMI does not necessarily reflect a favorable nutritional status. In the present study, we investigated the clinical impact of nutritional screening in patients with HF and overweight/obesity.MethodsWe examined the data from 170 patients with overweight or obesity status (defined as BMI ≥ 25 kg/m²) who admitted for acute HF. Their controlling nutritional status (CONUT) score was calculated on admission. The CONUT score is regarded as an index of the nutritional status.ResultsThe median duration of follow-up was 1096 days (interquartile range, 805–1096 days). Undernutrition was identified in 66.5% of the patients. Kaplan–Meier survival analysis demonstrated that patients with undernutrition had a higher incidence of all-cause death and readmission due to HF than those without undernutrition. Multivariate Cox regression analysis revealed that the CONUT score, but not BMI and the geriatric nutritional risk index, was independently correlated with poor prognosis.ConclusionsUndernutrition is highly prevalent and independently predicts poor outcomes in patients with overweight/obesity and acute HF.     

Mini Nutritional Assessment (short form) and functional decline in older patients admitted to an acute medical ward

BACKGROUND AND AIMS: Protein and/or energy malnutrition is common in hospitalized older patients and is associated with poor outcomes. Among recommended nutritional screening tools, contrasting data exist about the usefulness of the Mini Nutritional Assessment Short-Form (MNA-SF). We evaluated whether the MNA-SF, alone or integrated with serum albumin levels, is a reliable predictor of functional decline in older patients. METHODS: We studied 275 elderly patients (mean age 76.5, 60.7% males) admitted to an acute medical ward of a tertiary-care teaching hospital over a 12-month period. In this observational study, we evaluated nutritional status, with the MNA-SF alone or integrated with albumin. Data were collected at admission and related to laboratory and geriatric assessment features, and length of stay (LOS). Functional decline (defined as a loss >or=10% in terms of Barthel Index score at discharge compared with 2 weeks before admission) was considered as outcome. RESULTS: The MNA-SF estimated 46% patients at risk of malnutrition. These subjects had worse clinical features (lower total cholesterol and albumin levels), longer LOS (13.3 vs 11.2 days, p=0.014) and considerable functional decline (OR 4.25, 95% CI 1.83-9.9, p=0.001). Integrating the MNA-SF with albumin values, we obtained an effective instrument to detect older inpatients with protein-energy malnutrition, at higher risk of undergoing functional decline (OR 16.19, 95% CI 4.68-56.03, p<0.0001). CONCLUSIONS: The MNA-SF is a useful screening tool for hospitalized elders at risk of malnutrition. It is associated with poor clinical outcomes and is able to predict functional decline. Together with hypoalbuminemia, it better identifies patients with true protein-energy malnutrition.     

Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis

Background and aimsCorona virus diseases 2019 (COVID-19) pandemic spread rapidly. Growing evidences that overweight and obesity which extent nearly a third of the world population were associated with severe COVID-19. This study aimed to explore the association and risk of increased BMI and obesity with composite poor outcome in COVID-19 adult patients.MethodsWe conducted a systematic literature search from PubMed and Embase database. We included all original research articles in COVID-19 adult patients and obesity based on classification of Body Mass Index (BMI) and composite poor outcome which consist of ICU admission, ARDS, severe COVID-19, use of mechanical ventilation, hospital admission, and mortality.ResultsSixteen studies were included in meta-analysis with 9 studies presented BMI as continuous outcome and 10 studies presented BMI as dichotomous outcome (cut-off ≥30 kg/m²). COVID-19 patients with composite poor outcome had higher BMI with mean difference 1.12 (95% CI, 0.67–1.57, P < 0.001). Meanwhile, obesity was associated with composite poor outcome with odds ratio (OR) = 1.78 (95% CI, 1.25–2.54, P < 0.001) Multivariate meta-regression showed the association between BMI and obesity on composite poor outcome were affected by age, gender, DM type 2, and hypertension.ConclusionObesity is a risk factor of composite poor outcome of COVID-19. On the other hand, COVID-19 patients with composite poor outcome have higher BMI. BMI is an important routine procedure that should always be assessed in the management of COVID-19 patients and special attention should be given to patients with obesity.     

Prognostic significance of urinary protein and urinary ketone bodies in acute ischemic stroke

Background and aimsPrior studies have shown an association between positive urinary protein and an elevated risk of long-term mortality in patients with acute ischemic stroke (AIS); however, data on the short-term prognostic significance of urinary protein and urinary ketone bodies in patients with AIS is sparse.Methods and resultsA total of 2842 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included. Patients were divided into urinary protein positive and negative, urinary ketone bodies positive and negative by urine dipstick. Cox and logistic regression models were used to estimate the effect of urinary protein and urinary ketone bodies on all cause in-hospital mortality and poor outcome upon discharge (modified Rankin Scale score ≥3) in AIS patients. Patients with positive urinary protein was associated with a 2.74-fold and 1.62-fold increase in the risk of in-hospital mortality (adjusted HR 2.74; 95% CI, 1.54–4.89; P-value = 0.001) and poor outcome upon discharge (aOR, 1.62; 95% CI 1.26–2.08; P-value <0.001) in comparison to negative urinary protein after adjusting for potential covariates. Moreover, Patients with positive urinary ketone bodies was associated with 2.11-fold in the risk of poor outcome upon discharge (aOR 2.11; 95% CI 1.52–2.94; P-value <0.001) but not in-hospital mortality (P-value = 0.066) after adjusting for potential covariates.ConclusionsUrinary protein at admission was independently associated with in-hospital mortality and poor functional outcome at hospital discharge in acute stroke patients and urinary ketone bodies also associated with poor functional outcome at hospital discharge.     

Time-dependent prognostic factors of 6-month mortality in frail elderly patients admitted to post-acute care

OBJECTIVE: To determine the association between functional and nutritional changes caused by an acute illness requiring hospitalisation and 6-month mortality. DESIGN: Hospital-based prospective longitudinal cohort study. SETTING: Acute care centre (Hospital General de Vic, Barcelona Province, Spain). Post-acute care centre (Hospital de la Santa Creu de Vic, Barcelona Province, Spain). SUBJECTS: Hundred sixty five patients aged 75 years and older, hospitalised for an acute event. METHODS: Functional status (Barthel and Lawton Indices), cognitive status (Short Portable Mental Status Questionnaire), nutritional status (Mini Nutritional Assessment, albumin, cholesterol), depressive symptoms (Geriatric Depression Scale), co-morbidity (Charlson Index) and self-rated health status were collected upon admission to the post-acute care centre. Functional and nutritional status were assessed 1, 3 and 6 months after admission by a trained staff of geriatricians. Six-month mortality was the main outcome variable. Survival analysis was performed with functional and nutritional status as time-dependent variables. RESULTS: The mean age of the cohort was 83.3 years (SD 5.1) and 68.5% were female. Six-month mortality was 29.1% (95% CI: 22.2-36.7). The variables associated with mortality in bivariate analysis were: gender, Barthel Index (2 weeks before admission), Lawton Index (2 weeks before admission), Charlson Index, Barthel Index (time-dependent), Mini Nutritional Assessment (MNA) (time-dependent) and cognitive status. The variables associated with mortality in multivariate analysis were: gender, Barthel Index (2 weeks before admission), Charlson Index and MNA (time-dependent). CONCLUSIONS: Functional and nutritional changes due to an acute illness have a statistical and clinical prognostic value and should be assessed along with other well-known relevant prognostic factors.     

Impact of serum phosphate on severity and functional outcomes after ischemic stroke in young adults

Background and aimsSerum phosphate is an essential nutrient that plays multiple physiological roles in cardiovascular function. The aim of this study was to investigate the association between serum phosphate and stroke severity and prognosis in ischemic stroke and transient ischemic attack (TIA) among young adults.Methods and resultsWe retrospectively recruited patients with acute ischemic stroke and TIA aged 18–45 years. The primary outcome was 90-day poor functional outcome (modified Rankin Scale score of 2–6). The secondary outcomes included stroke severity (NIHSS ≥5 was defined as moderate to severe stroke) and poor functional outcome at hospital discharge. A total of 687 patients with a mean age of 36.8 years were enrolled. Lower serum phosphate levels were significantly associated with more severe stoke (P for trend = 0.017). Compared with the fourth quartile, the odds ratio (95% CI) of the first quartile was 1.85 (1.19–3.22) for moderate to severe stroke. After adjusting for confounders other than stroke severity, the odds ratio (95% CI) of the first quartile was 1.74 (1.06–2.86) for poor functional outcome at hospital discharge and 1.90 (1.09–3.31) at 90-day follow-up compared with the fourth quartile. However, the significant association between serum phosphate and poor functional outcomes disappeared after stroke severity was further adjusted.ConclusionsSerum phosphate is more likely a marker of stroke severity than a contributor to poor functional outcomes after ischemic stroke and TIA in young adults. Lower serum phosphate levels were associated with more severe stroke.     

Decline in the performance of activities of daily living over three years of follow-up in nonagenarians: The NonaSantfeliu study

PurposeAmong individuals of similar age, some appear to be resistant to decline in physical function while others appear more vulnerable. This paper aimed to identify the risk factors that serve as predictors of loss in basic and instrumental activities of daily living (ADL) in nonagenarians without a previously severe disability over a 36-month follow-up.Subjects and methodsA sample of 63 nonagenarians with a Barthel Index (BI) > 59 and Lawton Index (LI) ≥ 1 was evaluated. Subjects with a 10-point or greater decline in the BI over the follow-up period were compared with the remainder. Those with a decline of greater than 1 point on the LI were also compared with the rest. Finally, subjects who showed a decline on both measures were compared with the remainder.ResultsBI scores decreased by 57.1%. Multiple logistic regression analysis showed a significant association between prior poor LI score and less functional loss on the BI (OR 0.62, 95% CI 0.46–0.83). A decline with respect to the LI was observed in 52.3% of cases. Regression analysis showed an association between lower baseline LI score and functional decline on the LI (OR 0.28, 95% CI 0.15–0.51). Twenty-five (39.6%) nonagenarians experienced a decrease on both (BI and LI). Regression analysis showed that patients with lower LI experienced less functional decline on the BI and in terms of instrumental ADL (OR 0.46, 95% CI 0.31–0.66).ConclusionAmong nonagenarians, subjects with higher prior scores on instrumental ADL scales are the most likely to show a more important loss in their functional status.     

Accuracy of the BAR score in the prediction of survival after liver transplantation

Introduction and aimThe Balance of Risk (BAR) Score, a simple scoring system that combines six independent donor and recipient variables to predict outcome after liver transplantation (LT), was validated in a large U.S./European cohort of patients. This study aims to assess the performance of the BAR score to predict survival after liver transplantation and determine the factors associated with short and long-term survival in Latin-American patients.Material and methodsA retrospective cohort study was performed in 194 patients [112 (55.4%) males; mean age 52 ± 14 years] who underwent 202 LT during the period 2003–2015. Demographic, clinical, pathological and surgical variables, as well as mortality and survival rates, were analyzed. The BAR score was investigated through a receiver operating characteristics (ROC) curve with the calculation of the area under the curve (AUC) to evaluate the predictive score power for 3-month, 1 and 5-year mortality in a matched donor–recipient cohort. Youden index was calculated to identify optimal cutoff points.ResultsThe AUC of BAR score in predicting 3-month, 1-year and 5-year mortality were 0.755 (CI95% 0.689–0.812), 0.702 (CI95% 0.634–0.764) and 0.610 (CI95% 0.539–0.678) respectively. The best cut-off point was a BAR score ≥15 points. In the multivariate analysis BAR score <15 was associated with higher survival rates at 3 months and 1 and 5-years.ConclusionsBAR score <15 points is an independent predictor of better short and long-term survival in Latin-American patients undergoing LT. The BAR scoring system has an adequate diagnostic capacity allowing to predict 3 and 12-month mortality.     

Functional decline and mortality in long-term care settings: Static and dynamic approach

Background/PurposeFunctional impairment is known to be associated with higher mortality risk and adverse health outcomes. However, little is known about whether functional decline could predict mortality among the elderly in the long-term care setting.MethodsThis is a prospective cohort study in two veteran homes in northern Taiwan with active use of the minimum data set (MDS). Evaluation tools retrieved from the MDS, including MDS Resource Utilization Group-III for Activities of Daily Living (RUG-III ADL), MDS Cognitive Scale, MDS Social engagement, triggers for resident assessment protocol (RAP) and Pain scale, were utilized for the analysis.ResultsA total of 1125 male participants were included in this study. The mean age of the participants was 83.1 ± 5.1 years, and 65 (5.8%) developed physical functional decline within a 6-month period. Participants with functional decline [odds ratio (OR) 2.305, 95% confidence interval (CI) 1.002–5.303], poor baseline functional status (OR 1.116, 95% CI 1.002–1.242), positive RAP triggers for dehydration (OR 13.857, 95% CI 3.07–62.543), and underlying chronic lung diseases (OR 2.279, 95% CI 1.149–4.522), depression (OR 2.994, 95% CI 1.161–7.721), and cancer (OR 3.23, 95% CI 1.078–9.682) were more likely to have an additional 12-month mortality. By contrast, Parkinsonism (OR 3.875, 95% CI 1.169–12.841), increase in sum of RAP triggers (OR 6.096, 95% CI 2.741–13.562), and positive RAP triggers for cognitive loss (OR 3.164, 95% CI 1.612–6.212) and mood (OR 2.894, 95% CI 1.466–5.71) are strong predictors for functional decline within 6 months.ConclusionPhysical function decline within 6 months predicted the subsequent 1-year mortality, whereas increased sum of RAP triggers and positive trigger for cognitive loss and mood were associated with functional decline.