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Praca recenzowana / peer-reviewed pape

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Measurement of Silver Nanolayer Absorption by the Body in an in Vivo Model of Inflammatory Gastrointestinal Diseases

Layers of silver particles are used in the studies on pathophysiology and treatment of diseases, both in pre-clinical and clinical conditions. Silver layers can be formed using different techniques and on different substrates. Deposition by magnetron sputtering on glass beads was used in this study. Silver absorption by the body was estimated by calculating the difference in thickness of the silver nanolayer deposited on a bead and measured before and after application of the bead in an animal model of gastrointestinal inflammation. Recommendations for the minimal thickness of silver nanolayer deposited on glass beads were worked out for further studies

The affective tone of narration and posttraumatic growth in organ transplant recipients

The aim of the study was to verify the hypothesis that positive affective tone of narratives is connected to the experience of posttraumatic growth among transplant patients. Kidney transplant patients (N = 51) and liver transplant patients (N = 48) participated in the study. In the first stage, about 10 weeks after transplant, the participants told two stories about important, freely chosen events from their lives. During the second meeting 10-12 months later we measured posttraumatic growth. Results indicated that the affective tone of narratives about past events was associated with the level of post-traumatic growth measured 10-12 months later. This proves that the affective tone of narratives about life, understood as a relatively constant individual characteristic, promote posttraumatic growth

The inventory, valorization, and geoconservation of caves in the Babia Góra and Przedbabiogórze Ranges

Artykuł przedstawia wyniki inwentaryzacji oraz waloryzacji jaskiń położonych w Paśmie Babiogórskim i Paśmie Przedbabiogórskim. Inwentaryzacja jaskiń prowadzona była przez różnych autorów w latach 1976-2015. W jej rezultacie zinwentaryzowano 104 jaskinie o łącznej długości 1270 m, w tym największą na obszarze badań Jaskinię Oblicę. Obiekty te poddane zostały waloryzacji w celu wytypowania obiektów wartych objęcia ochroną przyrody. Wyniki waloryzacji wykazały, iż najcenniejsze jaskinie znajdują się głównie w Paśmie Babiogórskim (17), podczas gdy w Paśmie Przedbabiogórskim występują jedynie dwie takie jaskinie. Spośród obiektów, które zdobyły największą ilość punktów, większość objęta jest ochroną przyrody w ramach Babiogórskiego Parku Narodowego. Niemniej kilka cennych przyrodniczo jaskiń, położonych w Paśmie Polic oraz Paśmie Jałowieckim, nie została objęta żadną formą ochrony. Zgrupowania jaskiń położonych na Okrąglicy oraz Łysinie powinny zostać w przyszłości objęte ochroną jako stanowiska dokumentacyjne, a najcenniejsze przyrodniczo: Jaskinia Oblica oraz Zbójska Dziura, powinny zostać uznane za pomniki przyrody.This paper refers to the results of taking an inventory and valorization of pseudokarst caves in two mountain areas: the Babia Góra Massif and the Przedbabiogórskie Range. The inventory of the caves was taken by various authors in 1976-2015. Consequently, 104 caves with a total length of 1,270 m were recorded, including the largest one - Oblica Cave. The valorization of the caves was made to determine the most valuable structures, and to select some of them for legal protection. The majority of the most of valuable caves are located in the Babia Góra Massif (17), and only two of them in the other study area (the Przedbabiogórskie Range). However, some of most valuable caves in the Babia Góra Massif (the Polica Range) and the Przedbabiogórskie Range (the Jałowiecki Range) are not legally protected. The groups of caves located in Okrąglica and Łysina landslides should be protected as documentation sites, and the most valuable caves, e.g. Oblica and Zbójska Dziura, should be protected as natural monuments

The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19

Purpose: Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. Methods: The COVIP study is a prospective international observational study that recruited ICU patients >= 70 years admitted with COVID-19 (NCT04321265). Several parameters including ADL (ADL; 0 = disability, 6 = no disability), Clinical Frailty Scale (CFS), SOFA score, intensive care treatment, ICU- and 3-month survival were recorded. A mixed-effects Weibull proportional hazard regression analyses for 3-month mortality adjusted for multiple confounders. Results: This pre-specified analysis included 2359 patients with a documented ADL and CFS. Most patients evidenced independence in their daily living before hospital admission (80% with ADL = 6). Patients with no frailty and no disability showed the lowest, patients with frailty (CFS >= 5) and disability (ADL < 6) the highest 3-month mortality (52 vs. 78%, p < 0.001). ADL was independently associated with 3-month mortality (ADL as a continuous variable: aHR 0.88 (95% CI 0.82-0.94, p < 0.001). Being "disable" resulted in a significant increased risk for 3-month mortality (aHR 1.53 (95% CI 1.19-1.97, p 0.001) even after adjustment for multiple confounders. Conclusion: Baseline Activities of Daily Living (ADL) on admission provides additional information for outcome prediction, although most critically ill old intensive care patients suffering from COVID-19 had no restriction in their ADL prior to ICU admission. Combining frailty and disability identifies a subgroup with particularly high mortality

Health-related quality of life in older patients surviving ICU treatment for COVID-19: results from an international observational study of patients older than 70 years

International audienceBackground health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective to quantify HRQoL in order to identify areas of interventions. Design prospective observation study. Setting admissions to European ICUs between March 2020 and February 2021. Subjects patients aged 70 years or older admitted with COVID-19 disease. Methods collected determinants include SOFA-score, Clinical Frailty Scale (CFS), number and timing of ICU procedures and limitation of care, Katz Activities of Daily Living (ADL) dependence score. HRQoL was assessed at 3 months after ICU admission with the Euro-QoL-5D-5L questionnaire. An outcome of ≥4 on any of Euro-QoL-5D-5L domains was considered unfavourable. Results in total 3,140 patients from 14 European countries were included in this study. Three months after inclusion, 1,224 patients (39.0%) were alive and the EQ-5D-5L from was obtained. The CFS was associated with an increased odds ratio for an unfavourable HRQoL outcome after 3 months; OR 1.15 (95% confidence interval (CI): 0.71–1.87) for CFS 2 to OR 4.33 (95% CI: 1.57–11.9) for CFS ≧ 7. The Katz ADL was not statistically significantly associated with HRQoL after 3 months. Conclusions in critically ill old intensive care patients suffering from COVID-19, the CFS is associated with the subjectively perceived quality of life. The CFS on admission can be used to inform patients and relatives on the risk of an unfavourable qualitative outcome if such patients survive

Management and outcomes in critically ill nonagenarian versus octogenarian patients

Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (>= 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 +/- 5 vs. 7 +/- 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions