Lower incidence of acute respiratory distress syndrome in community‐acquired pneumonia patients aged 85 years or older

Background and objective: The incidence of and risk factors for ARDS among elderly patients with community‐acquired pneumonia (CAP) have not been well characterized. Methods: The clinical details of 221 consecutive patients aged ≥65 years, who were admitted with CAP during the period April 2006 to June 2008, were investigated by review of patient charts. Clinical variables and laboratory data at admission for CAP were compared between patients with and without ARDS. Results: Eighteen patients (8.1%) developed ARDS 1–5 days after admission. The mortality rate was 44% in patients with ARDS and 10.3% in those without ARDS (P < 0.001). The incidence of ARDS was 8.5–20% among patients aged <85 years and 1.1% in patients aged ≥85 years (P < 0.001), while overall mortality rates were not significantly different among the age groups. Predictors for the development of ARDS included higher serum levels of CRP and glucose, lower PaO₂/fraction of inspired O₂ (FiO₂), PaCO₂ and HCO₃^‐, and the presence of systemic inflammatory response syndrome at admission. ARDS developed less frequently among patients with pneumonia associated with oropharyngeal aspiration (AP). Multivariate analysis indicated that lower age, serum glucose, pre‐existence of systemic inflammatory response syndrome and non‐oropharyngeal AP were significant risk factors for ARDS. The Pneumonia Severity Index and confusion, urea, respiratory rate, blood pressure, age ≥65 score were not correlated with the incidence of ARDS. Conclusions: Predictors for ARDS appeared to differ from the determinants of severity of CAP in the elderly. ARDS developed less frequently in patients aged ≥85 years and in those with oropharyngeal AP. It is important to identify subjects at high risk for ARDS upon admission and to observe them closely.     

Clinical results and issues of acute myeloid leukemia in elderly patients aged 75 years and older

Aim: Clinical outcomes of acute myeloid leukemia (AML) in elderly patients still remain unsatisfactory and the optimal treatment has yet to be clearly established. This report describes the results of a retrospective study of clinical outcomes and prognostic factors of AML in patients aged 75 years and older. In addition, we aimed to elucidate the situation of patients with AML accompanied by dementia, which has been largely ignored in previous studies. Methods: The subjects consisted of 31 patients with untreated AML (including previous myelodysplastic syndrome: AML/MDS). All patients underwent chemotherapy, with 25 undergoing conventional therapy and six undergoing low‐intensity therapy. Results: Complete remission was obtained in 16 of the 31 cases (51.6%), with a 3‐year survival rate of 11.5%. However, in seven cases, Alzheimer's disease (AD) was observed. Although we were able to perform induction therapy in each of these cases, consolidation therapy was difficult in cases of moderate AD. Conclusion: The results of this study suggest that even very elderly patients can benefit from chemotherapy. However, it is thought that the treatment selection for cases which are complicated by moderate to severe dementia should be determined carefully while considering the patient's quality of life. Geriatr Gerontol Int 2011; 11: 290–296 .     

Cardiovascular medications taken by patients aged >or=70 years hospitalized for acute coronary syndromes before hospitalization and at hospital discharge

A prospective study was performed in 177 patients, mean age 78±6 years, hospitalized with acute coronary syndromes. Obstructive coronary artery disease was documented by coronary angiography in 154 of 177 patients (87%). Coronary revascularization was performed in 96 of 177 patients (54%). Five of 177 patients (3%) died during hospitalization. Compared to use before hospitalization, at hospital discharge the use of aspirin increased from 43% to 84% ( p <0.001), the use of clopidogrel increased from 21% to 54% ( p <0.001), the use of β blockers increased from 38% to 76% ( p <0.001), the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increased from 42% to 70% ( p <0.001), the use of long-acting nitrates increased from 15% to 31% ( p <0.001), and the use of calcium channel blockers decreased from 28% to 23% ( p =NS). Dyslipidemia was present in 62% of the 177 patients. The use of statins increased from 34% before hospitalization to 63% at hospital discharge ( p <0.001).     

Immediate and long-term results of percutaneous coronary angioplasty in patients aged 70 years or older

Percutaneous coronary angioplasty (PTCA) nowadays appears asan attractive alternative to coronary artery by-pass graftingnot only in young adults, but also in elderly patients. Theaim of this study was to investigate the primary success, complicationsand long-term efficacy of PTCA in a consecutive series of 63patients aged 70 years or over. Results are analysed in comparisonto a younger group of423 subjects who were submitted to PTCAduring the same period of time. In the older group, PTCA wasapplied to 108 lesions. The angiographic success rate was 88%.Primary success was 87%, with a majority (91%) of complete revascularization.Failure of the procedure was recorded in eight patients (13%).Complications of PTCA were observed in three patients, (amongthese: one death). The outcome was excellent: out of 55 patientswith successful angioplasty, 52 (94.6%) were asymptomatic atthe time of hospital discharge. At follow-up (close to one year),84.6% of the patients remained asymptomatic. The comparisonwith the younger group of patients showed no difference in termsof primary success, failure rate or incidence of complications.We therefore conclude that PTCA can be performed with safetyand efficiency in patients aged 70 years or over.     

Kidney function and discrimination of cardiovascular risk in middle‐aged men

Objective. To define the optimal glomerular filtration rate (GFR) cut off for discriminating the risk of myocardial infarction or cardiovascular death. Design. Prospective longitudinal observational study. Setting. A community‐based cohort. Participants. A total of 2176 nondiabetic 50‐year‐old men without cardiovascular disease. Methods. The men were followed until age 70. GFR was estimated at baseline using the Cockcroft–Gault formula. The optimal GFR cut‐off points for discriminating risk of a fatal or nonfatal myocardial infarction and cardiovascular death were defined as the GFR levels maximizing integrated discrimination improvement (IDI). Main outcome measures. Fatal or nonfatal myocardial infarction, cardiovascular death. Results. During follow‐up, 264 men experienced a fatal or nonfatal myocardial infarction, and 218 died of cardiovascular disease. The IDI‐defined optimal GFR cut offs in this study were 98 mL min^?1 for discriminating myocardial infarction risk and 92 mL min^?1 for discriminating risk of cardiovascular death. In Cox proportional hazard models adjusting for established risk factors, the myocardial infarction risk was substantially higher in men with GFR below versus above 98 mL min^?1 [hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.3–2.3, P < 0.001], and the risk of cardiovascular death was doubled in men with GFR below versus above 92 mL min^?1 (HR 2.1, 95% CI 1.5–3.0, P < 0.001). Conclusion. The GFR cut‐off point for optimal discrimination of cardiovascular risk in the general population may be higher than previously suggested.     

Effectiveness of blood transfusions and risk factors for mortality in children aged from 1 month to 4 years at the Bon Marché Hospital,Bunia, Democratic Republic of the Congo

Objective To assess the effectiveness of blood transfusions in a hospital of north‐eastern Democratic Republic of the Congo. Methods Prospective study of children admitted for severe anaemia. During admission, data were collected on clinical condition and haemoglobin levels, before and after blood transfusion. A linear regression model was built to explore factors associated with haemoglobin level after transfusion. Risk factors for mortality were explored through multivariate logistic regression. Results Haemoglobin level (Hb) was below 4 g/dl in 35% (230/657), between 4 and 6 g/dl in 58% (348/657) and at least 6 g/dl in another 6% (43/657) of the transfused children. A transfusion of 15 ml/kg of whole blood increased the Hb from 4.4 to 7.8 g/dl. Haemoglobin level after transfusion was associated with baseline Hb, quantity of delivered blood and history of previous transfusions. Overall case‐fatality rate was 5.6% (37/657). Risk factors for deaths were co‐morbidities such as chest infection, meningitis or malnutrition, Hb ≥ 6 g/dl, impaired consciousness or jugular venous distention on admission, and provenance. Conclusion Transfusion was a frequent practice, the use of which could clearly have been rationalised. While indications should be restricted, quantities of transfused blood should be adapted to needs.