1
|
Sow LM, Stöllberger C, Lazarevic P, Udovica S, Weidinger F. [Nonagenarians on an emergency department for internal medicine and cardiology : Comparison of comorbidities, disease course and survival with younger patients]. Z Gerontol Geriatr 2024:10.1007/s00391-024-02389-y. [PMID: 39731590 DOI: 10.1007/s00391-024-02389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 11/27/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND Little is known about how younger and older hospitalized patients differ with respect to reasons for admission, comorbidities, diagnostics, treatment and intercurrent problems. OBJECTIVE The aim of the study was to compare the previously named characteristics in the clinical profile of patients > 90 years old (nonagenarians) with a control group of patients 70-75 years old admitted to an emergency hospital department for internal medicine and cardiology. MATERIAL AND METHOD The study included all consecutive nonagenarians and gender-matched control patients who were admitted during 2011. The reason for admission, comorbidities, diagnostics, treatment, intercurrent problems and discharge medication were taken from the patient records. Data on 8‑year mortality were obtained by comparison of the death data. RESULTS Nonagenarians (n = 117; 81 females) had a mean age of 92 ± 2.5 years and the control patients 72 ± 1.6 years. Nonagenarians were hospitalized more often because of neurological symptoms (19% vs. 7%), suffered more from kidney failure (85% vs. 67%), heart failure (35% vs. 21%), malignancies (29% vs. 8%), dementia (28% vs. 4%) and stroke (15% vs. 6%), developed confusion more often (27% vs. 7%) and fell more often (15% vs. 0%) than control patients. Control patients had a higher body mass index (29 ± 5.3 vs. 24 ± 4.1). Nonagenarians received fewer diagnostic measures (1.6 vs. 2.3), more often intravenous fluid (77% vs. 51%), diuretics (31% vs. 18%) and physiotherapy (24% vs. 8%). Polypharmacy (> 5 medications) in the discharge letter was frequent in both groups (67% vs. 75%). The yearly mortality of the nonagenarians was 27% and of the control group 6%. CONCLUSION Acute internal diseases in nonagenarians are frequently manifested with neurological symptoms. In hospitalized nonagenarians, prevention of falls and delirium are of clinical relevance. Polypharmacy is a relevant problem in nonagenarians as well as in control patients.
Collapse
Affiliation(s)
- Lisa-Maria Sow
- 2. Med. Abteilung, Klinik Landstraße, Juchgasse 25, 1030, Wien, Österreich
| | | | - Patrick Lazarevic
- Center Wissenschaft, Bundesanstalt Statistik Österreich, Guglgasse 13, 1110, Wien, Österreich
| | - Simon Udovica
- 2. Med. Abteilung, Klinik Landstraße, Juchgasse 25, 1030, Wien, Österreich
| | - Franz Weidinger
- 2. Med. Abteilung, Klinik Landstraße, Juchgasse 25, 1030, Wien, Österreich
| |
Collapse
|
2
|
Mazurkiewicz M, Lizurej W, Mazurkiewicz L, Majewski A, Tobis S, Cymerys M. C-Reactive Protein and Albumin Levels as Useful Tools for Predicting In-Hospital Outcomes in Polish Nonagenarians. Clin Interv Aging 2023; 18:1547-1554. [PMID: 37727448 PMCID: PMC10506667 DOI: 10.2147/cia.s422895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose The admissions of nonagenarians to internal medicine wards are rising. The aim of this study was to analyse the causes of ward admission and blood and renal parameters as potential mortality predictors in this age group. Patients and Methods Out of 1140 patients, 111 nonagenarians aged 90+ admitted to the Internal Medicine Ward in one general hospital in Poznan in 2019 were studied. Medical records of these patients were analysed to find factors attributable to the hospitalisation. Results The leading causes of admission were infections and cardiovascular diseases, and the main causes of death were cardiovascular diseases. Elevated C-reactive protein (CRP) level was a statistically significant death predictor. Equally, decreased albumin level was found to be a mortality predictor. No such relationships were obtained for haematological or renal parameters. Conclusion Our study uniquely analysed a relatively large group of hospitalised nonagenarians and identified those who need particular attention in the ward by identifying those with the highest risk of death. CRP and albumin levels may serve as useful indicators of in-hospital mortality in this age group.
Collapse
Affiliation(s)
- Michal Mazurkiewicz
- Department of Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Lizurej
- Department of Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Lukasz Mazurkiewicz
- Department of Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Arkadiusz Majewski
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Slawomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Cymerys
- Department of Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
3
|
Palacios-Fernandez S, Salcedo M, Belinchon-Romero I, Gonzalez-Alcaide G, Ramos-Rincón JM. Epidemiological and Clinical Features in Very Old Men and Women (≥80 Years) Hospitalized with Aortic Stenosis in Spain, 2016-2019: Results from the Spanish Hospital Discharge Database. J Clin Med 2022; 11:jcm11195588. [PMID: 36233458 PMCID: PMC9571913 DOI: 10.3390/jcm11195588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The aging population poses challenges for hospital systems. Aortic stenosis is among the most frequent diseases in very old patients. The aim of this study was to describe gender and age differences in the clinical characteristics of very old patients hospitalized with aortic stenosis (AoS) in Spain from 2016 to 2019. (2): Methods: A retrospective observational study analyzing data from the national surveillance system for hospital data. Variables analyzed were age group, sex, length of stay, deaths, and comorbidity. (3) Results: The analysis included 46,967 discharges. Altogether, 7.6% of the admissions ended in death. The main reason for admission was heart failure (34.3%), and this increased with age (80−84 years: 26% versus 95−99 years: 56.6%; p < 0.001). The main treatment procedure was the transcatheter aortic valve replacement (12.7%), performed in 14.3% of patients aged 80−84 versus 0.5% in patients aged 95−99 (p < 0.001). In the multivariable analysis, women were admitted with more comorbidities (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.06−1.20). Mortality was similar, albeit women were admitted less for syncope (OR 0.83, 95% CI 0.74−0.93). Women also underwent fewer coronary catheterizations (OR 0.81, 95% CI 0.77−0.87) and echocardiograms (OR 0.96, 95% CI 0.94−0.98). (4) Conclusions: Aortic stenosis leads to a high number of hospital admissions. Women with AoS presented more heart failure and less cardiovascular pathology than men. Also, women are admitted with fewer episodes of syncope and have fewer ultrasounds and catheterizations.
Collapse
Affiliation(s)
| | - Mario Salcedo
- Department of Internal Medicine, San Pedro Hospital, 26006 Logroño, Spain
| | | | | | - José-Manuel Ramos-Rincón
- Department of Clinical Medicine, Miguel Hernandez University, 03550 Alicante, Spain
- Department of Internal Medicine, Alicante General University Hospital-Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Correspondence:
| |
Collapse
|
4
|
Palacios-Fernandez S, Salcedo M, Gonzalez-Alcaide G, Ramos-Rincon JM. Time trends in hospital discharges in patients aged 85 years and older in Spain: data from the Spanish National Discharge Database (2000-2015). BMC Geriatr 2021; 21:371. [PMID: 34134638 PMCID: PMC8207637 DOI: 10.1186/s12877-021-02335-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/08/2021] [Indexed: 12/28/2022] Open
Abstract
Background The aging population is an increasing concern in Western hospital systems. The aim of this study was to describe the main characteristics and hospitalization patterns in inpatients aged 85 years or more in Spain from 2000 to 2015. Methods Retrospective observational study analyzing data from the minimum basic data set, an administrative registry recording each hospital discharge in Spain since 1997. We collected administrative, economic and clinical data for all discharges between 2000 and 2015 in patients aged 85 years and older, reporting results in three age groups and four time periods to assess differences and compare trends. Results There were 4,387,326 discharges in very elderly patients in Spain from 2000 to 2015, representing 5.32% of total discharges in 2000–2003 and 10.42% in 2012–2015. The pace of growth was faster in older age groups, with an annual percentage increase of 6% in patients aged 85–89 years, 7.79% in those aged 90–94 years, and 8.06% in those aged 95 and older. The proportion of men also rose (37.30 to 39.70%, p < 0.001). The proportion of patients that died during hospital admission decreased from 14.64% in 2000–2003 to 13.83% in 2012–2015 (p < 0.001), and mean length of stay from 9.98 days in 2000–2003 to 8.34 days in 2012–2015. Some of the most frequent primary diagnoses became even more frequent relative to the total number of primary diagnoses, such as heart failure (7.84 to 10.62%), pneumonia (6.36 to 7.36%), other respiratory diseases (3.87 to 8.49%) or other alterations of urinary tract (3.08 to 5.20%). However, there was a relative decrease in the proportion of femoral neck fractures (8.07 to 6.77%), neoplasms (7.65 to 7.34%), ischemic encephalopathy (6.97 to 5.85%), COPD (4.23 to 3.15%), ischemic cardiomyopathy (4.20 to 8.49%) and cholelithiasis (3.07 to 3.28%). Conclusions Discharges in the very elderly population are increasing in both relative and absolute terms in Spanish hospitals. Within this group, discharged patients are getting older and more frequently male. The mean length of stay and the proportion of patients that died during hospital admission are decreasing. Acute-on-chronic organ diseases, neoplasms, acute cardiovascular diseases, and infections are the most common causes of discharge. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02335-2.
Collapse
Affiliation(s)
| | - Mario Salcedo
- Department of Internal Medicine, San Pedro Hospital, Logroño, Spain
| | | | - Jose-Manuel Ramos-Rincon
- Department of Internal Medicine, General University Hospital of Alicante-ISABIAL, Alicante, Spain.,Department of Clinical Medicine, Miguel Hernandez University of Elche, Alicante, Spain
| |
Collapse
|
5
|
Ramos-Rincón JM, Fernández-Gil A, Merino E, Boix V, Gimeno A, Rodríguez-Diaz JC, Valero B, Sánchez-Martínez R, Portilla J. The quick Sepsis-related Organ Failure Assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: A retrospective observational study. Sci Rep 2019; 9:15075. [PMID: 31636319 PMCID: PMC6803690 DOI: 10.1038/s41598-019-51439-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 10/01/2019] [Indexed: 01/09/2023] Open
Abstract
People over 80 years old are now the fastest-growing age group. Bloodstream infections (BSI) in these patients may present with specific characteristics. The objective of this study was to analyze independent factors affecting in-hospital mortality (IHM) due to BSI in very elderly patients (≥80 years of age) and to compare the clinical presentation of BSI in patients aged 80–89 years versus those aged 90 or more. Retrospective, cross-sectional and observational study of BSI in patients aged 80 years or older. The study used IHM as the primary outcome. Stepwise multiple logistic regression models were used to identify associations between potential predictors and IHM. Of the 336 included patients, 76.8% (n = 258) were in the 80–89-year age group and 23.2% (n = 78) in the 90+ age group; 17.3% (n = 58) of patients died during admission. This outcome was independently associated with quick Sepsis Related Organ Failure Assessment (qSOFA) of 2 or more (adjusted odds ratio [aOR] 4.7, 95% confidence interval [CI] 2.3–9.4; p < 0.001). Other predictors included an origin of BSI outside the urinary tract (aOR 5.5, 95% CI 2.4–12.6; p < 0.001), thrombocytopenia (aOR 4.9, 95% CI 1.8–13.4; p = 0.002), hospital-acquired infection (aOR 3.0, 95% CI 1.2–7.5; p = 0.015), and inappropriate empiric antibiotics (aOR 2.0, 95% CI 1.1–3.9; p = 0.04). IHM was 23.1% in the 90+ age group and 15.5% in patients aged 80 to 89 (p = 0.012). However, the 90+ age group was more likely to have a score of at least 2 on the qSOFA (29.9% vs. 19.1%, p = 0.043) and Pitt bacteremia scales (44.9% vs. 30.2%; p = 0.02), as well as chronic kidney disease (56.4% vs. 36.0%; p = 0.001) and altered mental state (40.3% vs. 25.7%; p = 0.013). In conclusion: A qSOFA score of 2 or more and a BSI originating outside the urinary tract were independent predictors of IHM. The 90+ age group was at higher risk than the 80–89-year age group of having a qSOFA score and Pitt bacteremia score of 2 or more as well as an altered mental state.
Collapse
Affiliation(s)
- José M Ramos-Rincón
- Department of Internal Medicine. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain. .,Miguel Hernández University of Elche. San Joan d'Alacant Campus, Alicante, Spain.
| | - Adela Fernández-Gil
- Miguel Hernández University of Elche. San Joan d'Alacant Campus, Alicante, Spain
| | - Esperanza Merino
- Infectious Diseases Unit. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Vicente Boix
- Miguel Hernández University of Elche. San Joan d'Alacant Campus, Alicante, Spain.,Infectious Diseases Unit. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Adelina Gimeno
- Microbiology Service. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Juan C Rodríguez-Diaz
- Microbiology Service. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Beatriz Valero
- Department of Internal Medicine. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Rosario Sánchez-Martínez
- Department of Internal Medicine. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Joaquín Portilla
- Department of Internal Medicine. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain.,Miguel Hernández University of Elche. San Joan d'Alacant Campus, Alicante, Spain.,Infectious Diseases Unit. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| |
Collapse
|
6
|
Huang W, Sun Y, Xing Y, Wang C. Functional impairment and serum albumin predict in-hospital mortality in nonagenarians with acute infection: a retrospective cohort study. BMC Geriatr 2019; 19:269. [PMID: 31615427 PMCID: PMC6794842 DOI: 10.1186/s12877-019-1301-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 09/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background Acute infection leads to substantial mortality in the nonagenarian population. However, the predictive efficacies of functional status and biochemical indexes for in-hospital mortality in these patients remain to be determined. Methods A single-center, retrospective cohort study was performed. Consecutive nonagenarian patients who were admitted to our department from January 1, 2014 to December 31, 2016 for acute infectious diseases were included. Baseline data for medical history, functional status, and biochemical indexes were obtained on admission. The outcomes of these patients during hospitalization were recorded. Predictors of in-hospital mortality were identified via logistic regression analyses. Results A total of 162 patients were included, and 46 patients died (17.2%) during hospitalization. Univariate analysis showed that the prevalence rates of atrial fibrillation (32.1%) and malignant disease (26.5%) were higher in nonagenarian patients who died during hospitalization than in those who discharged. Multivariate logistic regression analyses identified malignant disease (odds ratio [OR] 2.73, 95% confidence interval [CI]: 1.10–6.78), ADL category (OR 0.82, 95% CI: 0.75–0.89) and serum albumin (OR 0.86, 95%CI 0.78–0.95) as independent predictors of in-hospital mortality in nonagenarian patients hospitalized for acute infection. Conclusions Functional impairment as well as serum albumin may be independent predictors of in-hospital mortality in nonagenarian patients hospitalized for acute infectious diseases. Stratification of patients according to Barthel Index score and serum albumin is very necessary.
Collapse
Affiliation(s)
- Wei Huang
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China
| | - Ying Sun
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China.
| | - Yunli Xing
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China
| | - Cuiying Wang
- Department of Geriatrics and Gerontology. Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road Xicheng District, Beijing, People's Republic of China
| |
Collapse
|
7
|
Chivite D, Formiga F. Nonagenarians in Internal Medicine: Another 21st century epidemic. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
Singer M, Conde-Martel A, Hemmersbach-Miller M, Ruiz-Hernández J, Arencibia Borrego J, Alonso Ortiz B. Mortality hospital of nonagenarian patients in Internal Medicine. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Chivite D, Formiga F. Nonagenarios en Medicina Interna: otra epidemia del siglo XXI. Rev Clin Esp 2018; 218:70-71. [DOI: 10.1016/j.rce.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 01/07/2018] [Indexed: 11/25/2022]
|
10
|
Singer M, Conde-Martel A, Hemmersbach-Miller M, Ruiz-Hernández JJ, Arencibia Borrego J, Alonso Ortiz B. Mortality hospital of nonagenarian patients in Internal Medicine. Rev Clin Esp 2017; 218:61-65. [PMID: 29224908 DOI: 10.1016/j.rce.2017.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/19/2017] [Accepted: 10/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe the predictors of hospital mortality in nonagenarian patients. PATIENTS AND METHOD We retrospectively studied 421 patients aged 90 years or older hospitalised in a department of internal medicine. Using logistic regression, we analysed the association between demographic, clinical and functional parameters and hospital mortality. RESULTS The mean age was 92.5 years (SD±2.5), and 265 (62.9%) of the patients were women. The main diagnoses were infectious diseases (257 patients, 61%) and heart failure (183, 43.5%), and the mean stay was 11.9 days (SD±8.6). During the hospitalisation, 96 patients died (22.8%). The predictors of mortality were age (P=.002), functional state (P=.006), comorbidity (P=.018) and diagnoses of pneumonia (P=.001), sepsis (P=.012) and respiratory failure (P<.001). CONCLUSION The hospital mortality of nonagenarian patients treated in internal medicine exceeds 20% and is associated with pneumonia, comorbidity burden and functional impairment.
Collapse
Affiliation(s)
- M Singer
- Universidad de Las Palmas de Gran Canaria, Las Palmas, España
| | - A Conde-Martel
- Universidad de Las Palmas de Gran Canaria, Las Palmas, España; Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España.
| | - M Hemmersbach-Miller
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| | - J J Ruiz-Hernández
- Universidad de Las Palmas de Gran Canaria, Las Palmas, España; Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| | - J Arencibia Borrego
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| | - B Alonso Ortiz
- Universidad de Las Palmas de Gran Canaria, Las Palmas, España; Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| |
Collapse
|
11
|
Peris J, Bellot P, Roig P, Reus S, Carrascosa S, González-Alcaide G, Palazón JM, Ramos JM. Clinical and epidemiological characteristics of pyogenic liver abscess in people 65 years or older versus people under 65: a retrospective study. BMC Geriatr 2017; 17:161. [PMID: 28732474 PMCID: PMC5521099 DOI: 10.1186/s12877-017-0545-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To analyse the clinical, epidemiological, microbiological and prognostic differences of pyogenic liver abscess (PLA) in older (≥ 65 years of age) versus younger patients (< 65 years). METHODS Multicentre, retrospective cohort study in all patients with PLA admitted to two Spanish hospitals from January 2000 to January 2014. Cases were divided into two age groups (< 65 years and ≥65 years) for comparison of clinical, epidemiological and microbiological characteristics as well as treatment. RESULTS Of 98 patients analysed, 40 patients were younger than 65, and 58 were aged 65 or older. Significant associations in the older group were found with female sex (adjusted odds ratio [ORa] 9.0; 95% CI 1.4, 56), non-cryptogenic origin (ORa 14.5; 95% CI 1.6, 129), absence of chronic liver disease (ORa 14; 95% CI 1.3, 155), Escherichia coli infection (ORa 7.7; 95% CI 1.03, 58), and incidence of complications (ORa 2.3; 95% CI 1.04, 5.4). Mortality was 8.2% overall, although all deaths occurred in the older group (8/58; 13.8%) (p = 0.02). DISCUSSION Our results are in consonance with other published studies. Older patients with PLA tend to present more anomalies in the biliary tract (Kai et. al, World J Gastroenterol 18: 2948-295, 2012, Rahimian et. al, Clin Infect Dis 39:1654-9, 2004, Seeto, Medicine (Baltimore) 75:99-113, 1996, Kao et.al, Aliment Pharmacol Ther 36:467-76, 2012, Lai et. al, Gastroenterology 146:129-37, 2014), while younger patients are more often male and present more commonly with previous liver disease (especially related to alcohol) and cryptogenic PLA. CONCLUSION In patients aged 65 or older, PLA was more common in women and in those with a history of biliary disease, and E. coli was the most frequent bacterium. Mortality was also higher in the older group.
Collapse
Affiliation(s)
- Jorge Peris
- Deparment of Internal Medicine, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
| | - Pablo Bellot
- Gastroenterology and Hepatology Service, Hospital General Universitario de Alicante, Alicante, Alicante, Spain
| | - Pablo Roig
- Deparment of Internal Medicine, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
| | - Sergio Reus
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Alicante, Spain
| | - Sara Carrascosa
- Family Medicine Department, Campello Health Centre, El Campello, Alicante, Spain
| | - Gregorio González-Alcaide
- Department of History of Science and Documentation, University of Valencia, Valencia, Valencia, Spain
| | - José M Palazón
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
- Gastroenterology and Hepatology Service, Hospital General Universitario de Alicante, Alicante, Alicante, Spain
| | - José M Ramos
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain.
- Department of Internal Medicine, Hospital General Universitario de Alicante Alicante, Alicante, Alicante, Spain.
| |
Collapse
|
12
|
Aramburu-Bodas Ó, Garrachón-Vallo F. Nuevos modelos asistenciales en medicina interna: respondiendo a la necesidad de una atención integral a los pacientes. Rev Clin Esp 2016; 216:22-5. [DOI: 10.1016/j.rce.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
|
13
|
Gironé G, Mateo C, Gaya V, Usó J, Mínguez C, Roca B, Ramos JM. Admissions for imported and non-imported parasitic diseases at a General Hospital in Spain: A retrospective analysis. Travel Med Infect Dis 2015; 13:322-8. [PMID: 26003567 DOI: 10.1016/j.tmaid.2015.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze imported and non-imported parasitic diseases as a cause of admission to a general hospital. METHODS A retrospective analysis of hospital admissions for parasitic diseases between 2004 and 2013 performed by means of hospital information systems at a public hospital in the city of Castellón (Spain). RESULTS During the period covered in this study, there were 204,349 admissions, 213 of which were for parasitic diseases (prevalence: 1.04/1000 admission). 129 were neglected parasitic tropical diseases and 61 were imported parasitic diseases. The main parasitic diseases were hydatidosis (24.9%), visceral leishmaniasis (22.5%) and malaria (12.2%). There was a decrease in admissions for visceral leishmaniasis in the 2004-2008 period from 27.7% to 15.9% in the 2009-2013 period (p < 0.001), and an increase in admissions for malaria from 5.0% to 21.3% (p < 0.001). 38 (20.3%) of the 187 patients with parasitic diseases were HIV infected. HIV infection was more common in patients with toxoplasmosis (94.1%; p < 0.001), cryptosporidiosis (66.7%; p < 0.02) and visceral leishmaniasis (46.4%; p = 0.003). There were 34 (18.2%) children with parasitic diseases. Twelve of the 28 patients with visceral leishmaniasis (42.9%; p < 0.001), and 11 of the 17 patients with soil-transmitted diseases were children (64.7%; p < 0.001). The cause of death in eight patients was parasitic disease related (mortality rate: 4.3%). The mortality rate for visceral leishmaniasis was significantly higher (14.3%; p = 0.01). CONCLUSION The main cause is endemic parasitic diseases such as hydatidosis. Visceral leishmaniasis decreased during the period covered by the study, but malaria increased.
Collapse
Affiliation(s)
- Guillermo Gironé
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Claudia Mateo
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Víctor Gaya
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Jordi Usó
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Carlos Mínguez
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - Bernardino Roca
- Department of Internal Medicine, Hospital Universitari General de Castelló, Catelló, Spain
| | - José M Ramos
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain.
| |
Collapse
|
14
|
An unusual case of pancytopenia in a nonagenarian: visceral leishmaniasis. Aging Clin Exp Res 2014; 26:671-2. [PMID: 24756922 DOI: 10.1007/s40520-014-0219-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Abstract
Older patients referred for further investigation of pancytopenia is common in internal medicine and geriatric clinics and it is important to consider a wide range of underlying diagnoses. We present an unusual case of febrile pancytopenia in a nonagenarian who was diagnosed with visceral leishmaniasis. This is a rare and unusual diagnosis in nonagenarians, although the leishmaniasis is endemic on the Mediterranean coast of Spain. It is important to identify it because it is treatable and curable.
Collapse
|
15
|
Martín-Sánchez FJ, Lázaro Nogal M, González Del Castillo J, González Armengol JJ, Ribera Casado JM. Nonagenarians: questions and answers. Eur J Intern Med 2014; 25:e53-4. [PMID: 24268839 DOI: 10.1016/j.ejim.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 10/30/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, Spain.
| | | | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, Spain
| | - Juan Jorge González Armengol
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital San Carlos, Madrid, Spain
| | | |
Collapse
|
16
|
Ramos JM, Sánchez-Martínez R. Nonagenarians: questions and answers. Reply. Eur J Intern Med 2014; 25:e55. [PMID: 24321193 DOI: 10.1016/j.ejim.2013.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- José M Ramos
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain; Department of Medicine, Miguel Hernández University of Elche, San Juan Campus, Spain.
| | - Rosario Sánchez-Martínez
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain; Department of Medicine, Miguel Hernández University of Elche, San Juan Campus, Spain
| |
Collapse
|