Hospitalization-associated disability in older adults with valvular heart disease: incidence, risk factors and its association with care processes

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Incidence and risk factors for hospitalization-associated functional decline in older patients with valvular heart disease

Purpose: Determine the incidence and risk factors for hospitalization-associated functional decline in older patients with valvular heart disease. Methods: A prospective cohort study consecutively including patients aged 70 years and older with valvular heart disease admitted to the cardiology and cardiac surgery wards of the University Hospitals Leuven from 01 October to 30 November 2015. Functional status was measured with the Katz Index of Activities of Daily Living (ADL) at baseline, hospital discharge and 30 days post-discharge. Trained research nurses assessed the presence of risk factors using patient interviews on hospital admission and electronic patient records. Results: After 1 month recruitment, 19 patients have been included. Ten were admitted for valve surgery, 6 for valve surgery combined with Coronary Artery Bypass Graft, 2 for Transcatheter Aortic Valve Implantation and 1 because of symptomatic valve disease. Median age was 76 (IQR=8). Eleven patients have been assessed at hospital discharge. Seven (63.6%) declined in ADL between admission and discharge. These patients experienced a median loss of 2 points (range 1–4), and a mode of 2 new onset disabilities (range 1–4). Six patients declined in bathing ability, 4 in transfer, and 2 in dressing and toileting, with no patients declining in continence or feeding. Conclusions: Preliminary results indicate a substantial decline in ADL between hospital admission and discharge, with a hierarchical decline of more complex ADL. The prospective cohort study is currently running and recruitment is ongoing. Final results are expected in January 2016 and will be presented at the meeting.status: publishe

A Dual UHPLC-HRMS-Based Fecal Metabolomics and Lipidomics Analysis and Automated Data Processing Pipeline for Comprehensive Gut Phenotyping

In recent years, feces has surfaced as the matrix of choice for investigating the gut microbiome-health axis because of its non-invasive sampling and the unique reflection it offers of an individual’s lifestyle. In cohort studies where the number of samples required is large, but availability is scarce, a clear need exists for high-throughput analyses. Such analyses should combine a wide physicochemical range of molecules with a minimal amount of sample and resources, and downstream data processing workflows that are as automated and time efficient as possible. We present a dual fecal extraction and UHPLC-HR-Q-Orbitrap-MS-based workflow that enables widely targeted and untargeted metabolome and lipidome analy-sis. A total of 836 in-house standards were analyzed, of which 360 metabolites and 132 lipids were consequently detected in feces. Their targeted profiling was validated successfully with respect to repeatability (78% CV0.9), while also enabling holistic untargeted fingerprinting (15 319 features, CV<30%). To automate targeted processing, we optimized an R-based targeted peak extraction (TaPEx) algorithm relying on a database comprising retention time and mass-to-charge ratio (360 metabolites and 132 lipids), with batch-specific quality control curation. The latter was benchmarked towards vendor-specific targeted and untargeted software and our IPO/XCMS-based untargeted pipeline in Lifelines Deep cohort samples (n = 97). TaPEx clearly outperformed the untargeted approaches (81.3 vs. 56.7-66.0% compounds detected). Finally, our novel dual fecal metabolomics-lipidomics-TaPEx method was successful-ly applied to Flemish Gut Flora Project cohort (n = 292) samples, leading to a sample-to-result time reduction of 60%