Slower Decline in C-Reactive Protein after an Inflammatory Insult Is Associated with Longer Survival in Older Hospitalised Patients

Background Enhancing biological resilience may offer a novel way to prevent and ameliorate disease in older patients. We investigated whether changes in C-reactive protein (CRP), as a dynamic marker of the acute inflammatory response to diverse stressors, may provide a way to operationalize the concept of resilience in older adults. We tested this hypothesis by examining whether such changes could predict prognosis by identifying which individuals are at greater risk of 6-month mortality. Methods Analysis of prospective, routinely collected datasets containing data on hospitalization, clinical chemistry and rehabilitation outcomes for rehabilitation inpatients between 1999 and 2011. Maximum CRP response during acute illness and CRP recovery indices (time and slope of CRP decay to half maximum, and t

Association between bisphosphonate therapy and outcomes from rehabilitation in older people

Background Bisphosphonate therapy may have actions beyond bone, including effects on cardiovascular, immune and muscle function. We tested whether bisphosphonate treatment is associated with improved outcomes in older people undergoing inpatient rehabilitation. Methods Analysis of prospectively collected, linked routine clinical datasets. Participants were divided into never users of bisphosphonates, use prior to rehabilitation only, use after rehabilitation only, and current users (use before and after rehabilitation). We calculated change in 20-point Barthel scores during rehabilitation, adjusting for comorbid disease and laboratory data using multivariable regression analysis. Cox regression analyses were performed to analyse the association between bisphosphonate use and time to death or hospitalisation. Results 2797 patients were included in the analysis. Current bisphosphonate users showed greater improvement in Barthel score during rehabilitation than non-users (5.0 points [95%CI 4.3–5.7] vs 3.8 [95%CI 3.6–3.9]), but no difference compared to those receiving bisphosphonates only after discharge (5.1 [95%CI 4.6–5.5]). Previous bisphosphonate use was significantly associated with time to death (adjusted hazard ratio 1.41 [95%CI 1.15–1.73]) but less strongly with time to combined endpoint of hospitalisation or death (adjusted hazard ratio 1.18 [95%CI 0.98–1.48]). Use after discharge from rehabilitation was associated with reduced risk of death (adjusted hazard ratio 0.64 [95%CI 0.55–0.73]; hazard ratio per year of bisphosphonate prescription 0.98 [95%CI 0.97–0.99]). Conclusion Bisphosphonate use is unlikely to be causally associated with improved physical function in older people, but continuing use may be associated with lower risk of death

Association Between Kidney Function, Rehabilitation Outcome, and Survival in Older Patients Discharged From Inpatient Rehabilitation

BackgroundChronic kidney disease (CKD) is common in older people, but it is unclear if it affects survival and rehabilitation outcomes independent of comorbid conditions and physical function in this population.Study DesignCohort analysis of prospective, routinely collected, linked clinical data sets.Setting & ParticipantsPatients discharged from a single inpatient geriatric rehabilitation center over a 12-year period.PredictorsAdmission estimated glomerular filtration rate (eGFR) category as a predictor of improvement in the 20-point Barthel score (activities of daily living measure) during rehabilitation; discharge eGFR category and Barthel score as predictors of survival postdischarge.OutcomesSurvival postdischarge was modeled using Cox regression analyses, unadjusted and adjusted for age, sex, morbidities (ischemic heart disease, chronic obstructive pulmonary disease, stroke, diabetes, and heart failure), Barthel score and eGFR category on discharge, and serum calcium, hemoglobin, and albumin levels. The effect of admission eGFR category on change in Barthel score during admission was modeled using analysis of covariance, adjusted for admission, Barthel score, and comorbid conditions.Results3,012 patients were included; mean age, 84 years. 2,394 patients died during a mean follow-up of 8.3 years. Compared with patients with eGFR of 60 to 89 mL/min/1.73 m2, adjusted HRs for death were 1.26 (95% CI, 1.13-1.40), 1.45 (95% CI, 1.29-1.63), and 1.68 (95% CI, 1.42-1.99) for eGFR categories of 45 to 59, 30 to 44, an

Correlation between CRP markers, Barthel scores and length of stay.

<p>Correlation between CRP markers, Barthel scores and length of stay.</p

Multivariate Cox Regression Model: CRP measurements as predictors of death within 6 months.

<p>Multivariate Cox Regression Model: CRP measurements as predictors of death within 6 months.</p

Univariate Cox Regression Model: Predictors of death within 6 months.

<p>Univariate Cox Regression Model: Predictors of death within 6 months.</p

6-month survival by quartiles of maximum C-reactive protein.

<p>6-month survival by quartiles of maximum C-reactive protein.</p

6-month survival by quartiles of time for C-reactive protein to fall to half maximum level.

<p>6-month survival by quartiles of time for C-reactive protein to fall to half maximum level.</p

Baseline Population Characteristics of Cohort of Patients Analyzed (n = 3723 unless otherwise stated).

<p>Baseline Population Characteristics of Cohort of Patients Analyzed (n = 3723 unless otherwise stated).</p