Clinical frailty is insufficient to predict 2-year mortality in older patients undergoing transcatheter aortic valve replacement

Background. Decision making on transcatheter aortic valve replace- ment (TAVI) is challenging in older patients. The predictive value for mortality of the Clinical Frailty Scale (CFS) is unclear. This study analyzed risk factors of 2-year mortality in older patients undergoing TAVI. Methods: Retrospective cohort study of consecutive older patients (C 75 years) with a comprehensive geriatric assessment (CGA) who underwent TAVI at our university hospital between 2012 and 2019. The CFS was derived from the CGA: not frail (1–4), mildly frail5, moderately frail6or severely frail7. Predictors of two-year mortality were determined using multi-variable logistic regression, with several independent variables either scores (e.g. Euroscore.2, NYHA, Charlson, Lawton, Katz, MNA-SF, BMI) or co-morbidities (e.g. dementia, falls, diabetes, atrial fibrillation, congestive heart failure, severe renal failure). Results: The 345 patients (median age 87 years, 54% women) were not frail (31.6%), mildly frail (37.1%) and moderately/severely frail (31.3%). A trend was observed in 2-year mortality rates between frailty classes i.e. non-frail (23%), mildly frail (24%) and moder- ately/severely frail (30%). In multivariable analysis, two-year mortality rate was not associated with CFS but with four variables, namely, age (OR 1.08 per year, p = 0.02), atrial fibrillation (OR 2.34, p = 0.003), hemoglobin (OR 0.84, p = 0.037) and time-period (2017–2019 vs. 2012–2016: OR 0.46, p = 0.005). Conclusion: The CFS is insufficient to predict 2-year mortality in older patients undergoing a TAVI. Clinical frailty should therefore not preclude a TAVI in these patients. The strong association between atrial fibrillation and mortality should be further studied in this population

In-hospital mortality rates in older COVID-19 inpatients: a literature review

Background: Little is known at the end of spring 2020 about in- hospital mortality (IHM) rates of older inpatients with COVID-19. Valid IHM rate calculations require a cohort study design with complete follow-up of all patients until hospital discharge. The aim of this study was to describe IHM rates in older patients (C 65 years) with COVID-19. Methods: Medical literature review from December 1, 2019 to June 17, 2020 of cohort studies including older patients (OP) with COVID- 19. The outcome was the patient’s vital status (death or alive) upon hospital discharge. Results: Twenty cohort studies selected and compared OP with the outcome at a certain hospital date (censoring bias). Four cohort studies completed the OP hospital follow-up, allowing calculation of the IHM rate. The IMH rate was 26.2% in 65 OP of the Pulmonary hospital in Wuhan [1], 34.5% in 55 OP of the Zhongnan hospital in Wuhan [2], 35.3% in 17 OP of the Dabieshan Medical Center in Huanggang [3] and 41.0%% in 117 OP of the Chelsea & Westminster hospital in London [4]. Pooling these four cohorts (710 COVID-19 inpatients), we calculated an average IHM rate of 35.4% [95% CI 29.6–41.3%] in the 254 OP, which was six times higher than the IHM rate of 5.9% [95% CI 3.6–8.2%] in the 456 younger patients. Conclusion: Few COVID-19 cohort studies which included older patients have reported the vital status of all patients at hospital dis- charge. Completed cohorts are deeply needed to determine the IHM rates in this high risk population

Exposure to sars-cov-2 in hospital environment: Working in a covid-19 ward is a risk factor for infection

Aims. Health care workers (HCWs) are at risk of acquiring the Severe Acute Respiratory Syndrome Coronavirus 2 Infection (SARS-CoV-2). The aim of the study is to determine the SARS-CoV-2 positivity rates during the first epidemiologic peak among HCWs of a south Belgian hospital and to identify risks factors for infection. Methods. All hospital staff who worked during the first epidemiological peak were asked to answer a questionnaire regarding demographical data, function, type of working unit, type of contact with patients, eventual symptomatology, and the positivity of reverse transcription-polymerase chain reaction (RT-PCR) testing or immunoassay. Results. A total of 235 questionnaires were collected; 90 (38%) HCWs tested positive for SARS-CoV-2 from either RT-PCR or immunoassay testing. The positivity rate of HCWs between wards was statistically different (p = 0.004) and was higher in COVID-19 wards than Intensive Care Unit (ICU) and Emergency Department (ED). A total of 114 (49%) HCWs presented SARS-CoV-2-compatible symptomatology; 79 (88%) were positive on either RT-PCR or immunoassay testing; 74 (37%) HCWs were unable to work during the studied period; 5 were hospitalized. No deaths were reported. Multivariate logistic regression modeling showed that having symptoms was highly associated with test positivity (OR 23.3, CI 11.1, 53.1, p-value < 0.001). Working in a COVID-19 ward against working in ICU or ED was also predictive of positivity among HCWs (OR 3.25, CI 1.50, 7.28, p-value = 0.003). Discussion and Conclusions. This study shows a higher positivity rate compared to already reported positivity rates among HCWs. Reported differences in positivity rates depend on many factors, such as local crisis intensity, screening strategy, training in use of self-protective equipment, and study selection bias. HCWs working in COVID-19 wards, in comparison to ED and ICU, seemed at greater risk of being infected in this study. This could be explained by the disparity of HCWs’ experience in handling self-protective equipment and knowledge in infection prevention. Hence, care should be taken in proper training for less-experienced HCWs during hospital epidemics. The latter could increase HCWs’ protection and consequently decrease work absenteeism, ensuring enhanced continuity of patient care during hospital crisis. Rapid quarantine of symptomatic HCWs could reduce contamination rates, as having symptoms was highly associated with test positivity in this study.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Performance of different low-flow oxygen delivery systems

BACKGROUND: The delivery of a high and consistent fraction of inspired O2 (FiO2) is imperative to treat severe acute hypoxemia. [...

A Modified Aerosol Mask Could Significantly Save Oxygen Supplies during SARS COV 2 Pandemic

info:eu-repo/semantics/publishe

OLD-TAVR score to predict 2-year mortality in patients aged 75 years and more undergoing transcatheter aortic valve replacement

Purpose Decision-making on transcatheter aortic valve replacement (TAVR) in patients aged 75 years and older is complex. It could be facilitated by the identification of predictors of long-term mortality. This study aimed to identify predictors of 2-year mortality to develop a 2-year mortality risk score. Methods Cohort study of consecutive patients aged ≥ 75 years who underwent TAVR after a comprehensive geriatric assessment (CGA) at our university hospital between 2012 and 2019. Predictors of 2-year mortality were determined using multivariable Cox regression. A point-based predictive model was developed based on risk factors and subsequently internally validated by fivefold cross-validation. Results The 345 patients (median age 87 years, 54% women) were fit/vulnerable (32%), mildly frail (37%), or moderately/ severely frail (31%). The overall 2-year mortality rate was 26%, predicted by atrial fibrillation, hemoglobin ≤ 10 g/dL, age ≥ 87 years, BMI ≤ 24, eGFR ≤ 50 ml/min, and moderate/severe frailty. The risk score (range 0–12), named OLD-TAVR score, for 2-year mortality showed good discriminative power (AUC 0.70) and remained consistent after fivefold crossvalidation (cvAUC 0.69). A risk score ≥ 8 (prevalence 20%) predicted a 45% (95%CI: 34–58%) two-year mortality, with high specificity (86%) and good positive predictive power (+ LR 2.43). Conclusion A 2-year mortality risk score (OLD-TAVR score) for very old patients undergoing TAVR was developed based on six bio-clinical items. A score ≥ 8 identified patients in whom 2-year mortality was very high and thereby the TAVR futile. Trial registration number and date of registration Study protocol B403, 26/09/2022, retrospectively registered

Early Prediction of High-Flow Oxygen Therapy Failure in COVID-19 Acute Hypoxemic Respiratory Failure: A Retrospective Study of Scores and Thresholds.

Background High-flow oxygen therapy (HFOT) has been widely used as an effective alternative to invasive mechanical ventilation (IMV) in some critically ill patients with COVID-19 pneumonia. This study aimed to compare different tools, including the respiratory rate and oxygenation (ROX) index, to predict HFOT failure in this setting. Methodology This single-center retrospective observational study was conducted from September to December 2020 and assessed COVID-19 patients who required HFOT as the first treatment at admission; HFOT failure was defined as IMV use. Prognostic scoring tools were as follows: the Sequential Organ Failure Assessment (SOFA), Acute Physiology And Chronic Health Evaluation (APACHE) II, and Simplified Acute Physiology Score (SAPS) III scores; C-reactive protein; lung consolidation percentage on chest CT; mean partial pressure of oxygen in arterial blood (PaO)/fraction of inspired oxygen (FiO) ratio; and ROX index and modified ROX index, calculated using PaO instead of blood oxygen saturation, within the first 24 hours after admission to the intensive care unit (ICU). These scores were analyzed using a multivariate Cox proportional hazard model; optimal cutoffs were computed using the R system for statistical computing. Results The study enrolled 52 patients, 31 (60%) of whom experienced HFOT failure. The best predictors of HFOT failure measured 24 hours after HFOT initiation were as follows: PaO/FiO (threshold 123.6, sensitivity 87%, specificity 81%, hazard ratio [HR] 7.76, and 95% confidence interval [CI] 2.39-17.1); ROX index (threshold 5.63, sensitivity 68%, specificity 95%, HR 6.18, and 95% CI 2.54-13.4); and modified ROX index (threshold 4.94, sensitivity 81%, specificity 90%, HR 8.16, and 95% CI 3.16-21.5) ( < 0.001 for all). Conclusions Early assessment of the ROX index, modified ROX index, and PaO/FiO ratio can adequately predict, with high accuracy, HFOT failure in COVID-19 patients. Because thresholds remain debated and are still not sufficiently validated, we advocate using them with caution for clinical decision-making in this context