Alterations in thyroid function tests in aged hospitalized patients: prevalence, aetiology and clinical outcome

Background Thyroid dysfunction is common in aged people and has recently been associated to mortality. Aims Our aims have been (1) to assess the prevalence of alterations in thyroid function tests in hospitalized patients over age 60 years and (2) to study the relationship between thyroid functional status and mortality during hospitalization. Methods We studied a group of 447 patients (62% women), aged 61–101 year, hospitalized during 2005. Thyroid dysfunction was assessed by measuring serum concentrations of thyrotrophin (TSH), free thyroxine (FT4), and free thriiodothyronine (FT3). Thyroid autoimmune status was evaluated through thyroid peroxidase (TPO) and thyroglobulin (TG) antibodies quantification. Results Twenty‐one patients (4·7%, 19 women) showed previously known thyroid dysfunction. 332 patients (74·3%) showed alterations in thyroid function tests. Euthyroid sick syndrome (ESS) was the derangement more frequently found (n = 278, 62·2%). After excluding ESS patients, 60 patients (13·4%) showed thyroid dysfunction: overt hypothyroidism, 14 (3·1%); subclinical hypothyroidism, 25 (5·6%); overt hyperthyroidism, 11 (2·5%), and subclinical hyperthyroidism, 10 patients (2·2%). Thyroid autoimmunity was positive in only 4·0% and 2·3% of patients, for TPOAb and TgAb, respectively. The presence of alterations in thyroid function tests was positively associated with the age of the patients and mortality during hospital stay (P < 0·001). Serum levels of FT3 were negatively related to death during hospitalization (OR 0·56; CI 95%, 0·38–0·81; P < 0·01). Conclusions About three quarters of patients admitted in our geriatric unit exhibited alterations in thyroid function tests. This finding was associated with elevated age and poor prognosis. The reduction of FT3 values was a powerful predictor for mortality during hospitalization in elderly patients.     

住院老年患者肌少症患病率及相关因素分析

目的观察住院老年患者肌少症患病率及相关影响因素。方法纳入2018年11月—2020年1月在江苏省省级机关医院的住院老年患者445例,所有研究对象完成生物电抗阻分析测定、6 m步速测试及握力测试,根据检测结果分为肌少症组(n=173)与无肌少症组(n=272),分析肌少症发生的影响因素。结果住院老年患者肌少症检出率为38.88%,男性37.77%、女性40.72%。与无肌少症组相比,肌少症组年龄更大(P=0.001),身体质量指数(BMI)更低(P<0.001),合并认知功能障碍、抑郁、营养不良和骨质疏松比例更高(P<0.001),合并糖尿病比例更低(P=0.005)。2组在性别、教育程度、吸烟、多重用药、跌倒等方面差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,年龄(OR=1.406,95%CI:1.050~1.884,P=0.022)、BMI(OR=0.223,95%CI:0.152~0.328,P<0.001)、抑郁(OR=3.925,95%CI:1.439~10.708,P=0.008)及骨质疏松(OR=2.626,95%CI:1.542~4.471,P<0.001)是住院老年患者肌少症的影响因素。结论应及时对住院的高龄、抑郁、骨质疏松症、低BMI患者进行肌少症筛查,防止躯体功能进一步退化。     

Liver cirrhosis in HIV-infected patients: prevalence, aetiology and clinical outcome

Liver disease is frequently seen in HIV+ patients as a result of coinfection with hepatitis B (HBV) or C (HCV) viruses, alcohol abuse and/or exposure to hepatotoxic drugs. The aim of this study was to assess the prevalence of liver cirrhosis, its main causes and clinical presentation in HIV+ patients. Observational, cross-sectional, retrospective study of all HIV+ individuals followed at one reference HIV outpatient clinic in Madrid. Liver fibrosis was measured in all cases using transient elastometry (FibroScan). All 2168 HIV+ patients on regular follow-up (76% males, 46% injecting drug users) were successfully examined by FibroScan) between October 2004 and August 2006. Liver cirrhosis was recognized in 181 (overall prevalence, 8.3%), and the main aetiologies were HCV, 82.3%; HBV, 1.6%; dual HBV/HCV, 2.8%; and triple HBV/HCV/ hepatitis delta virus (HDV) infection, 6.6%. The prevalence of cirrhosis differed among patients with distinct chronic viral hepatitis: HCV, 19.2%; HBV, 6.1%; HBV/HCV, 41.7%; and HBV/HCV/HDV, 66.7%. In 12 patients with cirrhosis (6.7%), no definite aetiology was recognized. Overall, cirrhotics had lower mean CD4 counts than noncirrhotics (408 vs 528 cells/microL respectively; P = 0.02), despite similar proportion of subjects with undetectable viraemia on highly active antiretroviral therapy. Clinical manifestations of liver cirrhosis were: splenomegaly, 61.5%; oesophageal varices, 59.8%; ascites, 22.6%; encephalopathy, 12.1%; and variceal bleeding, 6.1%. Liver cirrhosis and hepatic decompensation events are relatively frequent in HIV+ individuals. Chronic HCV and alcohol abuse, but not chronic HBV, play a major role. Transient elastometry may allow the identification of a significant number of HIV+ individuals with asymptomatic liver cirrhosis.     

Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome

BACKGROUND: Severe obesity is associated with hypoventilation, a disorder that may adversely affect morbidity and mortality. We sought to determine the prevalence and effects of obesity-associated hypoventilation in hospitalized patients. METHODS: Consecutive admissions to internal medicine services were screened over a 6-month period. In all eligible subjects with severe obesity (body mass index > or =35 kg/m2), we administered a sleep questionnaire, and performed neuropsychological, arterial blood gas, and pulmonary function testing. Hospital course and mortality at 18 months was also determined. RESULTS: Of 4,332 admissions, 6% (n = 277) of patients were severely obese, of whom 150 were enrolled, 75 refused to participate, and 52 met the exclusion criteria. Hypoventilation (mean [+/- SD] arterial partial pressure of carbon dioxide [PaCO2], 52 +/- 7 mm Hg) was present in 31% (n = 47) of subjects who did not have other reasons for hypercapnia. Decreased objective attention/concentration and increased subjective sleepiness were present in patients with obesity-associated hypoventilation compared with in severely obese hospitalized patients without hypoventilation (simple obesity group; mean PaCO2, 37 +/- 6 mm Hg). There were higher rates of intensive care (P = 0.08), long-term care at discharge (P = 0.01), and mechanical ventilation (P = 0.01) among subjects with obesity-associated hypoventilation. Therapy for hypoventilation at discharge was initiated in only 6 (13%) of the patients with obesity-associated hypoventilation. At 18 months following hospital discharge, mortality was 23% in the obesity-associated hypoventilation group as compared with 9% in the simple obesity group (hazard ratio = 4.0; 95% confidence interval: 1.5 to 10.4]. CONCLUSION: Hypoventilation frequently complicates severe obesity among hospitalized adults and is associated with excess morbidity and mortality.     

ORIGINAL ARTICLE: Complications and death among elderly patients undergoing pituitary tumour surgery

Background Preoperative determinants of surgical risk in elderly patients with pituitary tumour are not fully defined. The aim of this study was to quantify operative risk for these patients. Design and methods We performed a retrospective analysis of the Nationwide Inpatient Sample (1998–2005), a database containing discharge information from a stratified, random sample of 20% of all non‐federal hospitals in 37 states. Patients >65 years old who underwent pituitary tumour resection were identified by ICD‐9 coding. Primary outcome was inpatient death. Other outcomes included post‐operative complications, length of stay (LOS) and total charges. Results A total of 8400 patients (53·7% male) were identified. Mean age was 72·2. Mean co‐morbidity score was 5·3. A majority were white (82·0%) admitted to academic hospitals (69·5%) for elective procedures (55·7%). Inpatient mortality was 3·8%. The most common complication was fluid and electrolyte abnormalities (14·3%). Mean LOS was 8·5 days. In multivariate analysis, patients >80 years old had 30% greater odds of death, relative to 65–69 year old counterparts. Each complication increased LOS by an average of at least 4 days. These associations were statistically significant (P‐values <0·05). Conclusions New clinically relevant risk stratification information is now available to assist clinicians in operative decision‐making for elderly patients with pituitary tumour considering operative intervention.     

Delirium risk factors in elderly hospitalized patients

OBJECTIVE: Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients. MEASUREMENTS AND MAIN RESULTS: First, MEDLINE/CURRENT contents databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies. CONCLUSIONS: Despite methodologic limitations, certain risk factors for delirium seem to be consistent and could help identify high-risk patients. These risk factors include dementia, advanced age, and medical illness. Other risk factors appear to play a contributory role in the development of delirium in elderly hospitalized patients. Presented at the American Psychiatric Association annual meeting, New York, NY, May 1996. The authors thank Brigitte Beaudet, Audiovisual Department, and Dr. Jane McCusker, Department of Clinical Epidemiology, for their assistance in completing this article.     

Insomnia among hospitalized elderly patients: Prevalence, clinical characteristics and risk factors

Insomnia can determine an increase in falls and accidents, hospitalization and nursing home placement. The aims of our study are to evaluate prevalence, clinical characteristics and predictors of sleep disorders in elderly inpatients admitted to a Geriatric Acute Care Ward. This longitudinal observational study consecutively recruited patients aged 65 and older admitted to a Geriatric Acute Care Unit between January the 1st 2007 and June 31st 2007. During the 3rd day of length of stay (LOS), patients were asked if they suffered with sleep disorders. Patients reporting sleep disturbances during the first 3 days of LOS were included in the study. Patients were evaluated for insomnia, comorbidity, self-rated health, functional status, cognitive impairment and pain. Of the 280 subjects investigated, 80 referred sleep disorders during LOS with a prevalence of 36.7%. Patients with sleep problems scored significantly worse on the cumulative index rating scale (CIRS) severity index (p = 0.007), on the numeric rating scale (NRS) (p = 0.01) and on the activities of daily living (ADL) scale (p < 0.001). The CIRS severity index resulted the best predictor for insomnia related to hospitalization (OR 7.9, SE 0.85, p = 0.01). The knowledge of insomnia predictors might help in planning preventive strategies to improve patients’ global health status and quality of life.     

Prevalence of pain in elderly hospitalized patients

Several studies indicate that pain, although very common in the elderly, is under-treated, because it is considered as a concomitant effect of aging. This study aimed to evaluate the prevalence of pain among patients in eight Italian geriatric hospital departments, correlated to prescribed therapy. We enrolled 387 patients in the study, 367 of whom were evaluated. Each patient's recovery, co-morbidity, pain intensity, prescribed therapy, side effects, duration of pain, and efficacy of therapy were monitored during two 15-day periods from 15 July to end of August 2008, and from 1 October to 15 November 2008. The results of this study confirmed that hypertension, cardiopathic disease, diabetes, and chronic obstructive pulmonary disease (COPD) are common pathologies, and that pain is present in 67.3% of those recovered in geriatric departments. In general, however, pain is not treated. Indeed only 49% of those with pain had any type of treatment, which was adequate for the pain intensity. In fact 74.5% of patients considered the therapy to be of low or no efficacy. These data demonstrate the presence of pain in a high percentage of elderly patients, which is either not treated, or treated inadequately. Controlling pain is essential in elderly patients in order to allow a normal life and an active role in family and society. The main conclusion is that pain is often poorly considered in the elderly, thus leading to a dangerous under-treatment. We want to underline the crucial clinical impact of such under-treatment in elderly patients.     

Community-acquired legionella pneumonia in elderly patients: characteristics and outcome

OBJECTIVES: To compare the risk factors, clinical and laboratory features, and outcome of community-acquired pneumonia (CAP) caused by Legionella pneumophila in elderly (aged > or =65) and younger patients. DESIGN: Prospective enrollment of subjects with retrospective data analysis. SETTING: A 630-bed tertiary center in Badalona (Barcelona), Spain. PARTICIPANTS: A total of 158 patients diagnosed with CAP caused by L. pneumophila from 1994 to 2004: 104 younger than 65 and 54 aged 65 and older. MEASUREMENTS: Epidemiological, clinical, laboratory, and radiological data and the outcome of the two groups were compared using univariate and multivariate analysis. RESULTS: Underlying diseases, such as chronic pulmonary diseases, diabetes mellitus, neuromuscular diseases, and heart failure; risk of aspiration; and therapy with corticosteroids were significantly more frequent in patients aged 65 and older. Patients younger than 65 were more likely to be male and have toxic habits (cigarette smoking, alcoholism) and human immunodeficiency virus infection than older patients. Fever, nonrespiratory symptoms (diarrhea and headache), and some laboratory abnormalities (hyponatremia (serum sodium concentration <130 mmol/L) and high aspartate aminotransferase and creatinine kinase levels) were significantly less frequent in patients aged 65 and older than in younger patients. No significant differences were observed between the two groups in the frequency of higher-severity risk classes and intensive care unit admission or in outcome (complications and mortality). CONCLUSION: Elderly patients with CAP caused by L. pneumophila had a higher frequency of underlying comorbidities and presented less frequently with fever and classical nonrespiratory symptoms and laboratory abnormalities of Legionnaires' disease than younger patients, although greater severity of illness at onset and higher mortality were not significantly different between the two age groups.     

Severe hyperthyroidism: aetiology,clinical features and treatment outcome

Background Severe hyperthyroidism (SH) is a serious medical disorder that can compromise life. There have not been systematic studies in which SH has been evaluated in detail. Here, our aims were: (1) to analyse both clinical and analytical features and outcome in patients with SH and (2) to compare these data with those found in more usual forms of hyperthyroidism. Patients and methods All patients diagnosed of SH (free thyroxine, FT4 > 100 pmol/l, NR: 11–23) seen in our endocrinology clinic in the last 15 years were studied and compared with a sample of patients with mild (mH; FT4, 23–50 pmol/l) and moderate (MH; FT4, 51–100 pmol/l) hyperthyroidism. Aetiology, clinical analytical and imaging data at diagnosis, therapeutic response and outcome were registered. Results A total of 107 patients with overt hyperthyroidism (81 females, mean age ± SD 46·9 ± 16·1 years) were evaluated. We studied a historic group with SH (n = 21; 14 females, 40·9 ± 17·2 years) and, as a comparator group, we analyszed the data of 86 hyperthyroid patients (67 females, 48·4 ± 15·5·6 years, NS) comparable in age and gender. The comparator group was classified in MH (n = 37, 26 females, 47·2 ± 16·6 years) and mH (n = 49, 41 females, 49·4 ± 14·8 years). In comparison with mH group, SH patients were significantly (P < 0·05) younger and showed a greater proportion of first episode of thyroid hyperfunction (P < 0·05). Graves’ disease was the main aetiology in the three groups, but patients with SH showed the highest titre of TSH‐receptor antibodies (TRAb) (P < 0·001). Heart rate and size of goitre were higher in SH group than in mH and MH groups (P < 0·01). Atrial fibrillation was more frequently reported in SH group than in MH and mH groups (15·8%vs. 5·4% and 0%, respectively, P < 0·05). Results from logistic regression analysis showed that younger age [OR 0·958 (95% CI, 0·923–0·995), P = 0·026], presence of asthenia [OR 4·35 (1·48–12·78), P = 0·008] and higher heart rate [OR 1·03 (1·01–1·06), P = 0·013] were independent clinical variables associated to SH. SH patients showed similar biochemical parameters in comparison with mH group, except for increased serum aspartate aminotransferase (AST) (P < 0·01) and calcium (P < 0·05) levels, and decreased serum cholesterol (P < 0·05) and albumin (P < 0·05) concentrations. Logistic regression analysis showed that only AST [OR 1·07 (1·02–1·11), P = 0·005] was an independent biochemical variable associated to SH. No differences in the type of therapy, cure rate and time in achieving cure were found in SH subjects in relation to patients with milder forms of hyperthyroidism. FT4 was the only independent predictor of cure [OR 0·98 (CI 95%, 0·97–0·99), P < 0·05]. Conclusions Graves’ disease is the most common aetiology in patients with SH. This type of hyperthyroidism is usually de novo and is accompanied by more clinical signs, symptoms, and analytical derangements, as well as higher titres of TRAb at diagnosis than milder forms of hyperthyroidism. The present data are not able to show differences in treatment modality, time to achieve cure, and remission rate among patients with mild, moderate and severe hyperthyroidism.     

Hyponatraemia in acute brain disease.

Hyponatraemia (HN) can result from a wide range of mechanisms, and therapy must be individualized. Two theories of the origin of HN in acute brain disease have prevailed. The first is the cerebral salt wasting syndrome (CSWS), where excessive natriuresis caused by some unknown cerebral natriuretic factor lowers the total sodium pool of the body and hence the plasma concentration. The second theory is the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), where an increase in total body water is caused by unphysiological secretion of ADH, lowering the concentration of sodium in the plasma. A third possibility is 'sodium shift', i.e. a displacement of sodium from the extracellular to the intracellular space with a simultaneous movement of potassium in the opposite direction. The morbidity and mortality associated with HN only arise in cases where the rate of development of HN was 0.5 mmol h-1 or more. Symptoms respond promptly when the HN is quickly corrected with furosemide and 3% sodium chloride.     

Multiple myeloma in elderly patients: presenting features and outcome

Few studies have been performed regarding multiple myeloma (MM) in elderly patients. We report a retrospective series of 130 unselected patients with MM aged 75 yr or more at diagnosis. Presenting features were identical to those reported in younger patients, except for a higher rate of infection. Heavy comorbidity was characteristic of unselected geriatric patients. Ninety-four patients received conventional chemotherapy. The response rate was 62%. Treatment toxicity was mild. Median survival was 22 months. Durie-Salmon (DS) clinical stages II and III MM were severe and often led to death, while significantly more patients with DS stage I MM died from unrelated causes (p<0.0001). Univariate analysis showed that age > or = 85 yr, performance status > or = 2, creatinine level > or = 120 micromol/l, beta 2 microglobulin level > 4 mg/l, C-reactive protein level > 6 mg/l, platelet count < 100 x 10(9)/l, presence of infection and lack of response to chemotherapy were adverse prognostic factors for survival. In Cox multivariate regression analysis, age > or = 85 yr (p<0.0001), performance status > or = 2 (p<0.0001) and creatinine level > or = 120 micromol/l (p<0.0001) were independent factors in predicting short survival. This study provides evidence that in patients with symptomatic MM age should not be considered as a major obstacle to active treatment. Prospective clinical trials are needed in this population of patients and should include an assessment of quality of life.     

Deep venous thrombosis in elderly hospitalized patients: prevalence and clinical features

BACKGROUND AND AIMS: It is not known whether old age influences the clinical outcome of deep venous thrombosis (DVT) in patients admitted to acute internal medicine wards. This study aimed at evaluating the effect of age on the prevalence and clinical features of DVT in patients admitted to acute medical wards in a general hospital. METHODS: All patients with a discharge diagnosis of DVT during a 4-year period from 1999 to 2002 were identified. Age, gender, main and secondary diagnoses, diagnostic procedures, and length of stay (LOS) were recorded. The severity index was calculated by the All Patients Refined-Diagnostic Related Groups (APR-DRG) grouper and graded as mild, moderate, severe or extreme. RESULTS: 310 patients with DVT were identified: 163 males and 147 females. Mean age was 62 +/- 16 years, with a range of 17-94 years. 174 patients (56%) were over 65 years old (mean age = 74.2 +/- 6.2, range 65-94 years) and 136 (44%) were young or adults (mean age = 48.3 +/- 12.9, range 17-64 years). The overall prevalence of DVT was 1.51%, with no differences between males and females (1.46 vs 1.56%, p = NS). In elderly subjects, the prevalence of DVT was significantly higher than in young or adult patients (1.7 vs 1.2%, p = 0.005) and was more frequently associated with pulmonary embolism (12 vs 7%, p < 0.05) and less with neoplasms (10 vs 30%, p < 0.05) than in young patients. Diagnostic procedures performed during the hospital stay were similar for elderly and young patients whereas LOS was significantly longer in elderly than young patients (14.1 +/-11.5 vs 11.7 +/- 9 days, p < 0.05). The APR-DRG severity index was significantly higher in elderly than in young patients (p < 0.05). CONCLUSIONS: Elderly patients with DVT reveal higher prevalence and have different clinical features than young or adult patients. Further studies are needed to better evaluate predisposing conditions and clinical outcomes of DVT in old age.     

Multiple myeloma in elderly patients: prognostic factors and outcome

Abstract:  Objectives : Purpose of this study was to compare prognostic factors and outcome of patients with multiple myeloma (MM) aged >70 yr at diagnosis with those of younger patients. We also applied the recently proposed International Staging System (ISS) for MM in these patients. Patients and methods : Among 1,162 newly diagnosed, symptomatic MM patients included in our database, 357 (31%) were >70 yr of age. Clinical and laboratory variables were evaluated in patients >70 yr and in younger patients and were assessed for possible correlation with survival in patients >70 yr of age. Results : Most clinical and laboratory features were similar in the two groups of patients but older patients presented more frequently with advanced ISS ( P  = 0.02). Despite similar response rates to primary treatment, younger patients survived longer than patients >70 yr of age (40 vs. 28 months, P  = 0.001). There was a longer survival of younger patients than that of older patients diagnosed with ISS stage 1 (median 71 vs. 54 months, P  = 0.007) and ISS stage-2 patients (median: 38 vs. 26 months, P  = 0.0008) but for patients with ISS stage 3 median survival was similarly poor in the younger and older age group (21 and 20 months, P  = 0.283). Other variables associated with impaired prognosis were severe anemia, extensive bone marrow plasmacytosis and elevated serum LDH. Conclusions : Older patients with MM present more often with advanced ISS and have significantly shorter survival than younger patients. The ISS retained its prognostic significance within the group of elderly patients.     

The prevalence and aetiology of long-term L-dopa side-effects in elderly parkinsonian patients

Fifty-one elderly parkinsonian patients (mean age 80 years) on long-term (greater than 5 years) L-dopa therapy were identified from the patients within the three geriatric units in Edinburgh. Side-effects were identified in 57% of patients and tended to be mild in severity. Mean duration of disease was 10.2 years in those with side-effects and 6.7 years in those without (p less than 0.01). Past and present L-dopa side-effects are more likely to be caused by disease progression than by L-dopa therapy. It is therefore recommended that L-dopa should be prescribed at disease onset to elderly Parkinsonian patients.     

Protein-energy undernutrition and life-threatening complications among the hospitalized elderly

OBJECTIVE: To determine whether elderly patients with protein-energy undernutrition at admission are at increased risk for subsequent life-threatening events after controlling for illness severity. DESIGN: Prospective cohort study. SETTING: University-affiliated Department of Veterans Affairs hospital. PATIENTS: Five hundred eighty-six nonterminal patients (mean age 74 +/- 6 [SD] years, 98% male, 86% white) with a length of stay of 3 days or more. MAIN OUTCOME MEASURES: Life-threatening complications. RESULTS: Subsequent to admission, 37 subjects (6.3%) experienced at least 1 life-threatening complication. All of the putative nutrition variables examined and many non-nutrition, illness severity measures were strongly correlated with the risk of a life-threatening complication by univariate analyses (P <.05 for all analyses). After controlling for illness severity, admission serum albumin, prealbumin, and cholesterol were no longer significantly correlated with the outcome. In contrast, weight loss (>5% within 6 months), body mass index, mid-arm circumference, and suprailiac skinfold thickness remained strong independent predictors. The adjusted relative risk of a life-threatening complication ranged from 2.9 (95% confidence interval [CI], 1.3 to 6.4) for a body mass index <22 kg/m2 to 7.1(95% CI, 2.0 to 25.7) for a suprailiac skinfold thickness in the lower tertile for the study population. The putative nutrition and illness severity variables were highly intercorrelated. CONCLUSIONS: There is a complex interrelationship between nutritional status, illness severity, and clinical outcomes among the hospitalized elderly. The serum secretory proteins and cholesterol are correlated with other indicators of illness severity and adverse outcomes, but may not be good markers of nutritional risk. In contrast, weight loss, a low body mass index, and other indicators of lean and fat mass depletion appear to place the patient at increased risk for adverse outcomes independent of illness severity. Whether it is possible to reverse such established nutritional deficits and reduce complication risk in the acute care setting remains to be determined.