High LACE index scores are associated with disproportionate excess deaths in hospital amongst patients with COVID-19

Risk factors for COVID-19-related outcomes have been variably reported. We used the standardised LACE index to examine admissions and in-hospital mortality associated with COVID-19. Data were collected in the pre-pandemic period (01-04-2019 to 29-02-2020) from 10,173 patients (47.7% men: mean age ± standard deviation = 68.3 years ± 20.0) and in the pandemic period (01-03-2019 to 31-03-2021) from 12,434 patients. With the latter, 10,982 were without COVID-19 (47.4% men: mean age = 68.3 years ± 19.6) and 1452 with COVID-19 (58.5% men: mean age = 67.0 years ± 18.4). Admissions and mortality were compared between pre-pandemic and pandemic patients, according to LACE index. Admission rates rose disproportionately with higher LACE indices amongst the COVID-19 group. Mortality rates amongst the pre-pandemic, pandemic non-COVID-19 and COVID-19 groups with LACE index scores < 4 were 0.7%, 0.5%, 0%; for scores 4–9 were 5.0%, 3.7%, 8.9%; and for scores ≥ 10 were: 24.2%, 20.4%, 43.4%, respectively. The area under the curve receiver operating characteristic for predicting mortality by LACE index was 76% for COVID-19 and 77% for all non-COVID-19 patients. The risk of age and sex-adjusted mortality did not differ from the pre-pandemic group for COVID-19 patients with LACE index scores < 4. However, risk increased drastically for scores from 4 to 9: odds ratio = 3.74 (95% confidence interval = 2.63–5.32), and for scores ≥ 10: odds ratio = 4.02 (95% confidence interval = 3.38–4.77). In conclusion, patients with LACE index scores ≥ 4 have disproportionally greater risk of COVID-19 hospital admissions and deaths, in support of previous studies in patients without COVID-19. However, of importance, our data also emphasise their increased risk in patients with COVID-19. Because the LACE index has a good predictive power of mortality, it should be considered for routine use to identify high-risk COVID-19 patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-022-03015-8

Impact of healthcare-associated infections within 7-days of acute stroke on health outcomes and risk of care-dependency:a multi-centre registry-based cohort study

Healthcare-associated infections (HCAIs) in patients admitted with acute conditions remain a major challenge to healthcare services. Here, we assessed the impact of HCAIs acquired within 7-days of acute stroke on indicators of care-quality outcomes and dependency. Data were prospectively collected (2014–2016) from the Sentinel Stroke National Audit Programme for 3309 patients (mean age = 76.2 yr, SD = 13.5) admitted to four UK hyperacute stroke units (HASU). Associations between variables were assessed by multivariable logistic regression (odds ratios, 95% confidence intervals), adjusted for age, sex, co-morbidities, pre-stroke disability, swallow screening, stroke type and severity. Within 7-days of admission, urinary tract infection (UTI) and pneumonia occurred in 7.6% and 11.3% of patients. Female (UTI only), older age, underlying hypertension, atrial fibrillation, previous stroke, pre-stroke disability, intracranial haemorrhage, severe stroke, and delay in swallow screening (pneumonia only) were independent risk factors of UTI and pneumonia. Compared to patients without UTI or pneumonia, those with either or both of these HCAIs were more likely to have prolonged stay (&gt; 14-days) on HASU: 5.1 (3.8–6.8); high risk of malnutrition: 3.6 (2.9–4.5); palliative care: 4.5 (3.4–6.1); in-hospital mortality: 4.8 (3.8–6.2); disability at discharge: 7.5 (5.9–9.7); activity of daily living support: 1.6 (1.2–2.2); and discharge to care-home: 2.3 (1.6–3.3). In conclusion, HCAIs acquired within 7-days of an acute stroke led to prolonged hospitalisation, adverse health consequences and risk of care-dependency. These findings provide valuable information for timely intervention to reduce HCAIs, and minimising subsequent adverse outcomes

Changes in characteristics and outcomes of patients undergoing surgery for hip fractures following the initiation of orthogeriatric service:Temporal trend analysis

The Blue Book published by the British Orthopaedic Association and British Geriatrics Society, together with the introduction of National Hip Fracture Database Audit and Best Practice Tariff, have been influential in improving hip fracture care. We examined ten-year (2009–2019) changes in hip fracture outcomes after establishing an orthogeriatric service based on these initiatives, in 1081 men and 2891 women (mean age = 83.5 ± 9.1 years). Temporal trends in the annual percentage change (APC) of outcomes were identified using the Joinpoint Regression Program v4.7.0.0. The proportions of patients operated beyond 36 h of admission fell sharply during the first two years: APC =  − 53.7% (95% CI − 68.3, − 5.2, P = 0.003), followed by a small rise thereafter: APC = 5.8% (95% CI 0.5, 11.3, P = 0.036). Hip surgery increased progressively in patients > 90 years old: APC = 3.3 (95% CI 1.0, 5.8, P = 0.011) and those with American Society of Anaesthesiologists grade ≥ 3: APC = 12.4 (95% CI 8.8, 16.1, P  90 years old: APC =  − 7.1 (95% CI − 12.6, − 1.3, P = 0.024). Prolonged length of stay (> 23 days) declined from 2013: APC =  − 24.6% (95% CI − 31.2, − 17.4, P < 0.001). New discharge to nursing care declined moderately over 2009–2016 (APC =  − 10.6, 95% CI − 17.2, − 2.7, P = 0.017) and sharply thereafter (APC =  − 47.5%, 95%CI − 71.7, − 2.7, P = 0.043). The rate of patients returning home was decreasing (APC =  − 2.9, 95% CI − 5.1, − 0.7, P = 0.016), whilst new discharge to rehabilitation was increasing (APC = 8.4, 95% CI 4.0, 13.0; P = 0.002). In conclusion, the establishment of an orthogeriatric service was associated with a reduction of elapsed time to hip surgery, a progressive increase in surgery carried out on high-risk adults and a decline in adverse outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00223-021-00906-4

Reduced Voluntary Running Performance is Associated with Impaired Coordination as a Result of Muscle Satellite Cell Depletion in Adult Mice

BACKGROUND: Satellite cells, or muscle stem cells, have been thought to be responsible for all muscle plasticity, but recent studies using genetically modified mouse models that allow for the conditional ablation of satellite cells have challenged this dogma. Results have confirmed the absolute requirement of satellite cells for muscle regeneration but surprisingly also showed that they are not required for adult muscle growth. While the function of satellite cells in muscle growth and regeneration is becoming better defined, their role in the response to aerobic activity remains largely unexplored. The purpose of the current study was to assess the involvement of satellite cells in response to aerobic exercise by evaluating the effect of satellite cell depletion on wheel running performance. RESULTS: Four-month-old female Pax7/DTA mice (n = 8-12 per group) were satellite cell depleted via tamoxifen administration; at 6 months of age, mice either remained sedentary or were provided with running wheels for 8 weeks. Plantaris muscles were significantly depleted of Pax7+cells (≥90 % depleted), and 8 weeks of wheel running did not result in an increase in Pax7+ cells, or in myonuclear accretion. Interestingly, satellite cell-depleted animals ran ~27 % less distance and were 23 % slower than non-depleted animals. Wheel running was associated with elevated succinate dehydrogenase activity, muscle vascularization, lipid accumulation, and a significant shift toward more oxidative myosin heavy chain isoforms, as well as an increase in voltage dependent anion channel abundance, a marker of mitochondrial density. Importantly, these changes were independent of satellite cell content. Interestingly, depletion of Pax7+ cells from intra- as well as extrafusal muscle fibers resulted in atrophy of intrafusal fibers, thickening of muscle spindle-associated extracellular matrix, and a marked reduction of functional outcomes including grip strength, gait fluidity, and balance, which likely contributed to the impaired running performance. CONCLUSIONS: Depletion of Pax7-expressing cells in muscle resulted in reduced voluntary wheel running performance, without affecting markers of aerobic adaptation; however, their absence may perturb proprioception via disruption of muscle spindle fibers resulting in loss of gross motor coordination, indicating that satellite cells have a yet unexplored role in muscle function