Low Serum Klotho Concentration is Associated with Worse Cognition, Psychological Components of Frailty, Dependence, and Falls in Nursing Home Residents

Serum alpha-klotho (s-klotho) protein has been linked with lifespan, and low concentrations of s-klotho have been associated with worse physical and cognitive outcomes. Although its significance in aging remains unclear, s-klotho has been proposed as a molecular biomarker of frailty and dependence. This study is a secondary analysis of data from a clinical trial performed in a population of 103 older individuals living in 10 nursing homes in Gipuzkoa (Spain). We aimed to elucidate associations between s-klotho (as measured by enzyme-linked immunosorbent assay) and body composition, physical fitness, and cognition, as well as frailty and dependence (determined using validated tests and scales). In addition, we investigated the association of s-klotho concentration with falls in the six months following the initial assessment. Low s-klotho levels were associated with a lower score in the psychological component of the Tilburg Frailty Indicator, a worse score in the Coding Wechsler Adult Intelligence Scale, and a greater dependence in activities of daily living. Moreover, participants with lower s-klotho concentrations suffered more falls during the 6 months after the assessment. Future translational research should aim to validate klotho's putative role as a biomarker that could identify the risk of aging-related adverse events in clinical practice.This work was supported by grants from the Basque government (ELKARTEK15/39, ELKARTEK16/57, ELKARTEK17/61, RIS16/07, SAN17/11), the Euskampus Fundazioa Foundation, and the Convention between UPV/EHU and the Gipuzkoa Provincial Council (Gipuzkoa Eraikiz). Haritz Arrieta and Chloe Rezola were supported by two fellowships from the University of the Basque Country (UPV/EHU

Haemodynamic, Biochemical and Respiratory Implications of total Bronchoalveolar Lavage in Pulmonary Alveolar Proteinosis

Introduction: Total bronchoalveolar lavage (BAL) continues to be the treatment of choice for alveolar proteinosis (AP), facilitating the removal of lipoprotein material. The purpose of this article is to evaluate the impact of haemodynamic, biochemical, and respiratory parameters, as well as the complications and evolution of patients undergoing this procedure. Methods: Retrospective, observational, and descriptive study of BAL. The technique was performed in the Intensive Care Unit. Blood gases, blood pressure, central venous pressure, body temperature, and fluid balance were analyzed. Results: Including eight patients, thirty-eight BAL were performed from 2008 to 2021. The mean instillation of saline at each session was 13.464 ± 4.002 ml per lung. No significant changes were observed before and after BAL in heart rate and blood pressure. Mean central venous pressure increased by 2.59 cm H20. The pO2 initial was 126 mmHg with a final mean of 69.7 mmHg, with statistical significance. The pCO2, HCO3 and pH parameters remained stable. Complications were observed during fifteen of the thirty-eight BAL (nine with arterial hypotension, three with glottic oedema, one acute pulmonary oedema, one pneumothorax, and one cardiorespiratory arrest). In terms of evolution, one case had a clinical-radiological resolution, one case of exits, one required lung transplantation, and the remaining five remained stable. Conclusion: This study demonstrates that the procedure, is well tolerated haemodynamically and that the biochemical alterations to which the patient is subjected are not compromised. With few complications and good results in delaying the progression of AP

Ward mortality after ICU discharge: A multicenter validation of the Sabadell score

Background: Tools for predicting post-ICU patients' outcomes are scarce. A single-center study showed that the Sabadell score classified patients into four groups with clear-cut differences in ward mortality. Objective and design: To validate the Sabadell score using a prospective multicenter approach. Setting: Thirty-one ICUs in Spain. Patients and methods: All patients admitted in the 3-month study period. We recorded variables at ICU admission (age, sex, severity of illness, and do-not-resuscitate orders), during the ICU stay (ICU-specific treatments, ICU-acquired infection, and acute renal failure), and at ICU discharge (Sabadell score). Statistical analyses included one-way ANOVA and multiple regression analysis with ward mortality as the dependent variable. Results: We admitted 4,132 patients (mean age 61.5 ± 16.7 years) with mean predicted mortality of 23.8 ± 22.7%; 545 patients (13%) died in the ICU and 3,587 (87%) were discharged to the ward. Overall ward mortality was 6.7%; ward mortality was 1.5% (36/2,422) in patients with score 0 (good prognosis), 9% (64/725) in patients with score 1 (long-term poor prognosis), 23% (79/341) in patients with score 2 (short-term poor prognosis), and 64% (63/99) in patients with score 3 (expected hospital death). Variables associated with ward mortality in the multivariate analysis were predicted risk of death (OR 1.016), ICU readmission (OR 5.9), Sabadell score 1 (OR 4.7), Sabadell score 2 (OR 15.7), and Sabadell score 3 (OR 107.2). Conclusion: We confirm the ability of the Sabadell score at ICU discharge to define four groups of patients with very different likelihoods of hospital survival.Peer reviewe

Limitation of life support techniques at admission to the intensive care unit : A multicenter prospective cohort study

To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals' characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients' characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0-8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59-2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7-44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days

Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study

Abstract Purpose To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. Methods This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals’ characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients’ characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. Results We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0–8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59–2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7–44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. Conclusions The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days

Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study

Purpose: To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. Methods: This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals’ characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients’ characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. Results: We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0–8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59–2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7–44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. Conclusions: The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days

Additional file 1: of Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study

Table S1. Hospital characteristics. Table S2. Patient characteristics. Table S3. Reasons for limitations on life support at admission to the ICU. Table S4. Bivariate analysis. Patient characteristics associated with LLST. Crude odds ratio (OR) and 95% confidence interval. Table S5. Bivariate analysis. Hospital characteristics associated with LLST. Crude odds ratio (OR) and 95% confidence interval. Figure S1. Thirty-day overall survival function according to the specific support measures limited and the type of limitation. (RTF 56201 kb