Prognostic role of nutritional status in elderly patients hospitalized for COVID-19: a monocentric study

BackgroundSymptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection incidence is higher in the elderly patients. Pre-existing geriatric conditions such as comorbidity and frailty seem related to worse hospital outcomes.AimsTo assess the role of nutritional status as an independent prognostic factor for in-hospital death in elderly patients.MethodsConsecutive elderly patients (age > 65 years) hospitalized for novel coronavirus disease (COVID-19) were enrolled. Demographics, laboratory and comorbidity data were collected. Nutritional status was evaluated using the Geriatric Nutri-tional Risk Index (GNRI). Uni- and multivariate Cox regression analyses to evaluate predictors for in-hospital death were performed.ResultsOne hundred and nine hospitalized elderly patients (54 male) were consecutively enrolled. At univariate analysis, age (HR 1.045 [CI 1.008\u20131.082]), cognitive impairment (HR 1.949 [CI 1.045\u20133.364]), C-reactive protein (HR 1.004 [CI 1.011\u20131.078]), lactate dehydrogenases (HR 1.003 [CI 1.001\u20131.004]) and GNRI moderate\u2013severe risk category (HR 8.571 [CI 1.096\u201367.031]) were risk factors for in-hospital death, while albumin (HR 0.809 [CI 0.822\u20130.964]), PaO2/FiO2 ratio (HR 0.996 [CI 0.993\u20130.999]) and body mass index (HR 0.875 [CI 0.782\u20130.979]) were protective factors. Kaplan\u2013Meier survival curves showed a significative higher survival in patients without GNRI moderate or severe risk category (p = 0.0013).At multivariate analysis, PaO2/FiO2 ratio (HR 0.993 [CI 0.987\u20130.999], p = 0.046) and GNRI moderate\u2013severe risk category (HR 9.285 [1.183\u201372.879], p = 0.034) were independently associated with in-hospital death.ConclusionNutritional status assessed by GNRI is a significative predictor of survival in elderly patients hospitalized for COVID-19. The association between GNRI and PaO2/FiO2 ratio is a good prognostic model these patients

Prognostic significance of diabetes and stress hyperglycemia in acute stroke patients

Background Hyperglycemic non-diabetic stroke patients have a worse prognosis than both normoglycemic and diabetic patients. Aim of this study was to assess whether hyperglycemia is an aggravating factor or just an epiphenomenon of most severe strokes. Methods In this retrospective study, 1219 ischemic or hemorrhagic stroke patients (73.7 +/- 13.1 years) were divided into 4 groups: 0 = non-hyperglycemic non-diabetic, 1 = hyperglycemic non-diabetic, 2 = non-hyperglycemic diabetic and 3 = hyperglycemic diabetic. Hyperglycemia was defined as fasting blood glucose >= 126 mg/dl (>= 7 mmol/l) measured the morning after admission, while the diagnosis of diabetes was based on a history of diabetes mellitus or on a glycated hemoglobin >= 6.5% (>= 48 mmol/mol), independently of blood glucose levels. All diabetic patients, except 3, had Type 2 diabetes. The 4 groups were compared according to clinical history, stroke severity indicators, acute phase markers and main short term stroke outcomes (modified Rankin scale >= 3, death, cerebral edema, hemorrhagic transformation of ischemic lesions, fever, oxygen administration, pneumonia, sepsis, urinary infection and heart failure). Results Group 1 patients had more severe strokes, with larger cerebral lesions and higher inflammatory markers, compared to the other groups. They also had a high prevalence of atrial fibrillation, prediabetes, previous stroke and previous arterial revascularizations. In this group, the highest frequencies of cerebral edema, hemorrhagic transformation, pneumonia and oxygen administration were obtained. The prevalence of dependency at discharge and in-hospital mortality were equally high in Group 1 and Group 3. However, in multivariate analyses including stroke severity, cerebral lesion diameter, leukocytes and C-reactive protein, Group 1 was only independently associated with hemorrhagic transformation (OR 2.01, 95% CI 0.99-4.07), while Group 3 was independently associated with mortality (OR 2.19, 95% CI 1.32-3.64) and disability (OR 1.70, 95% CI 1.01-2.88). Conclusions Hyperglycemic non-diabetic stroke patients had a worse prognosis than non-hyperglycemic or diabetic patients, but this group was not independently associated with mortality or disability when size, severity and inflammatory component of the stroke were accounted for

A strange case of fever and polyarthralgia in patient with fibromyalgia syndrome: a case report of large vessel vasculitis

Large vessels vasculitis a heterogeneous group of chronic inflammation disorders affecting the aorta and its main branches. the two main forms are takayasu\u2019s arteritis and Giant cell arteritis. in recent years, this distinction does not seem so obvious due to many overlapping in pathogenesis, clinical and therapeutic management. We present a case of large vessel vasculitis in a 57-year-old woman with hypertension and long history of fibromyalgia syndrome. She was referred to our Unit for fever and polyarthralgia. the microbiological examinations performed were all negative, and the autoanti-body pattern was also negative. abdominal computer tomography showed abdominal aortic thickening with progressive contrast enhancement. Fluorodeoxyglucose positron emission tomography showed significant hypermetabolism of common carotid arteries, succlavie, aortic arch and abdominal aorta. it was treated with a methylprednisolone 1 mg/kg body weight for 7 days with remission of symptoms. Fluorodeoxyglucose positron emission tomography was repeated after 3 months of low dose steroid therapy and has shown a reduction in the capture of fluorodeoxyglucose. Our case highlights the importance of good collection of clinical history and imaging in the diagnosis of large vessel vasculitis. in particular fluorodeoxyglucose positron emission tomography is useful for diagnosis and to evaluate the response to therapy. A long history of fibromyalgia should not exclude suspect of these conditions

Prognostic role of nutritional status in elderly patients hospitalized for COVID-19

We read with great interest the article by Lidoriki et al.[1] aboutnutritional and functional status as a prognostic factors in elderly pa-tients with novel coronavirus disease 2019 (COVID-19).The authors, mentioning previous studies[2,3], propose a prog-nostic association between nutritional and functional status of patientsand prognosis after COVID-19 infection.We want to share our preliminary data which seem to confirm thishypothesis which we believe strongly

Prognostic value of non-alcoholic fatty liver disease in the elderly patients

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the liver manifestation of metabolic syndrome, a risk factor for mortality and cardiovascular morbidity, but we ignore the role of steatosis per se in survival, and there is very little information about this condition in the geriatric patient. AIMS: With the present study, we investigated the independent prognostic value of NAFLD on overall mortality in the elderly. METHODS: Within the Pianoro Project, involving people\u2009 65\u200965 years, anamnestic, clinical and laboratoristic data related to NAFLD, insulin resistance, diabetes/hyperglycemia, hypertension, obesity and dyslipidemia were collected in 804 subjects (403 male, 401 female). These subjects were followed up for mortality for a median time of 12.6 years. A multivariate analysis was performed to evaluate the prognostic value of the covariates. RESULTS: At Kaplan-Meier estimator the presence of NAFLD seems to be associated to a lower mortality, and survival tends to increase with the increasing of steatosis grade. Cox's analysis found that survival is increased for subjects having hypercholesterolemia (RR\u2009=\u20090.565), NAFLD (RR\u2009=\u20090.777), hypertension (RR\u2009=\u20090.711) and in female (RR\u2009=\u20090.741), while it is decreased for the older subjects (RR\u2009=\u20093.046), in patients with hypertriglyceridemia (RR\u2009=\u20091.699) and for diabetics (RR\u2009=\u20091.797). The variables BMI and HDL-cholesterol have no role. CONCLUSION: The data obtained in our study show that NAFLD is not associated to overall mortality in the elderly population

Accuracy of Lung Ultrasound in Patients with Acute Dyspnea: The Influence of Age, Multimorbidity and Cognitive and Motor Impairment

Discriminating between causes of dyspnea may be difficult, particularly in the elderly. The aim of this retrospective study of 83 inpatients with acute dyspnea was to assess the influence of age, multimorbidity and cognitive or motor impairment on the diagnostic accuracy of lung ultrasound (LUS) in discriminating acute heart failure (AHF) from noncardiogenic dyspnea (NCD). Univariate analysis indicates that LUS misdiagnosis was associated with the following parameters: history of stroke (p = 0.037), lower activity of daily living (p = 0.039), higher modified-Rankin scale (mRS) (p = 0.027) and need of two operators to complete LUS because of reduced patient compliance (p = 0.030). Regression analysis identified only history of stroke (p = 0.048) as an independent predictor of LUS misdiagnosis. This study supports LUS usefulness to differentiate AHF from NCD. Our data suggest that diagnostic accuracy of LUS is affected by history of stroke as a proxy for severe motor impairment but not by age, cognitive impairment and multimorbidity