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Higashikawa T, Ito T, Ito T, Mizuno T, Ishigami K, Kuroki K, Maekawa N, Usuda D, Yoshida M, Morita T, Hamada K, Yano H, Takeshima K, Haraguchi T, Yamada S, Yamada S, Ushimoto T, Sangen R, Izumida T, Kiyosawa J, Ono T, Iguchi M, Wato Y, Nakahashi T, Kasamaki Y, Fukuda A, Kanda T, Morimoto S, Okuro M. Procalcitonin, brain natriuretic peptide and albumin as markers to predict prognosis in hospitalized older Japanese patients with a risk of infection. Geriatr Gerontol Int 2024. [PMID: 38690756 DOI: 10.1111/ggi.14887] [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: 10/04/2023] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
AIM Whether serum concentration of procalcitonin (PCT), brain natriuretic peptide (BNP) and albumin (Alb) have an association with the outcome of hospitalized older patients is unclear. We investigated clinical outcomes and any predictive factors in hospitalized Japanese older patients with a risk of infection. METHODS In the retrospective study, 820 Japanese patients were followed up for 30 days or until death. During the observation period, 656 patients survived and 164 patients died. The predictive factors of death were analyzed according to demographic and clinical variables. RESULTS The survival rate was decreased as the serum PCT increased from <0.5 to ≥10 ng/mL, as was also the case with BNP from <300 to ≥300 pg./mL, whereas low Alb (<2.5 g/dL) showed a lower survival rate than high Alb (≥2.5 g/dL; P < 0.01). Using the Cox regression model, the multivariable-adjusted hazard ratios (95% confidence interval) were as follows: PCT 0.5-2 versus <0.5 ng/mL: 1.61(1.04-2.49), PCT 2-10 versus <0.5 ng/mL: 1.91(1.15-3.16), PCT ≥10 versus <0.5 ng/mL: 2.90(1.84-4.59), high BNP 1.26 (0.89-1.76) and low Alb 0.68 (0.52-0.87). The mortality rate increased as the number of scores (PCT + BNP + Alb) increased. CONCLUSIONS Concentration-dependent high PCT, high BNP and low Alb were positive risk factors associated with poor prognosis in hospitalized older patients with a risk of infection. Geriatr Gerontol Int 2024; ••: ••-••.
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Affiliation(s)
- Toshihiro Higashikawa
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
- Department of Geriatric Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Toru Ito
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Tomohiko Ito
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Takuro Mizuno
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Keiichirou Ishigami
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Kengo Kuroki
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Naoto Maekawa
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Michiteru Yoshida
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Takuro Morita
- Department of Geriatric Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Kazu Hamada
- Department of Geriatric Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Hiroshi Yano
- Department of Geriatric Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Kento Takeshima
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Takatoshi Haraguchi
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Shinya Yamada
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Sohsuke Yamada
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Tomoyuki Ushimoto
- Department of Emergency Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Ryusho Sangen
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Toshihide Izumida
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Jun Kiyosawa
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Taisuke Ono
- Department of Geriatric Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Masaharu Iguchi
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Yukihiro Wato
- Department of Emergency Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Takeshi Nakahashi
- Department of Geriatric Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Yuji Kasamaki
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Akihiro Fukuda
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Tsugiyasu Kanda
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Shigeto Morimoto
- Department of Geriatric Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Masashi Okuro
- Department of Geriatric Medicine, Kanazawa Medical University, Kahoku-gun, Japan
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Putot A, Guyot C, Manckoundia P, Van Wymelbeke-Delannoy V. Association of body mass index with long-term outcomes in older adults hospitalized for COVID-19: an observational study. Sci Rep 2024; 14:7512. [PMID: 38553629 PMCID: PMC10980698 DOI: 10.1038/s41598-024-58388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
Both underweight and obesity have been associated with poor prognosis in COVID-19. In an older populations of patients hospitalized for SARS-CoV-2 infection, we aimed to evaluate the association between body mass index (BMI) and short and long-term prognosis. Among 434 consecutive patients aged ≥ 70 years and hospitalized for suspected COVID-19 at a university hospital, 219 patients (median age of 83 years, 53% male) testing positive for COVID-19 and for whom BMI was recorded at admission, agreed to participate. Among them, 39 had a BMI < 20 kg/m2, 73 had a BMI between 20 and 24.9 kg/m2 and 107 had a BMI ≥ 25 kg/m2. After adjustment for confounders, BMI < 20 kg/m2 was associated with a higher risk of one-year mortality (hazard ratio (HR) [95% confidence interval]: 1.75 [1.00-3.05], p = 0.048), while BMI ≥ 25 kg/m2 was not (HR: 1.04 [0.64-1.69], p = 0.9). However, BMI was linearly correlated with both in-hospital acute respiratory failure (p = 0.02) and cardiovascular events (p = 0.07). In this cohort of older patients hospitalized for COVID-19, low BMI, rather than high BMI, appears as an independent risk factor for death after COVID-19. The pathophysiological patterns underlying this excess mortality remain to be elucidated.
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Affiliation(s)
- Alain Putot
- Service de Médecine Interne et Maladies Infectieuses, Hôpitaux du Pays du Mont Blanc, Sallanches, France.
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), Université de Bourgogne Franche Comté, Besançon, France.
- Service de Médecine Interne Gériatrie, Pôle Personnes Agées, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France.
| | - Charline Guyot
- Unité de Recherche Nutrition, Pôle Personnes Agées, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
| | - Patrick Manckoundia
- Service de Médecine Interne Gériatrie, Pôle Personnes Agées, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
- INSERM U1093 Cognition Action Plasticité, Université de Bourgogne Franche Comté, Besançon, France
| | - Virginie Van Wymelbeke-Delannoy
- Unité de Recherche Nutrition, Pôle Personnes Agées, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
- Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000, Dijon, France
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Udompongpaiboon P, Reangvilaikul T, Vattanavanit V. Predicting mortality among patients with severe COVID-19 pneumonia based on admission vital sign indices: a retrospective cohort study. BMC Pulm Med 2023; 23:342. [PMID: 37700259 PMCID: PMC10496301 DOI: 10.1186/s12890-023-02643-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pneumonia remains a major public health concern. Vital sign indices-shock index (SI; heart rate [HR]/systolic blood pressure [SBP]), shock index age (SIA, SI × age), MinPulse (MP; maximum HR-HR), Pulse max index (PMI; HR/maximum HR), and blood pressure-age index (BPAI; SBP/age)-are better predictors of mortality in patients with trauma compared to traditional vital signs. We hypothesized that these vital sign indices may serve as predictors of mortality in patients with severe COVID-19 pneumonia. This study aimed to describe the association between vital sign indices at admission and COVID-19 pneumonia mortality and to modify the CURB-65 with the best performing vital sign index to establish a new mortality prediction tool. METHODS This retrospective study was conducted at a tertiary care center in southern Thailand. Adult patients diagnosed with COVID-19 pneumonia were enrolled in this study between January 2020 and July 2022. Patient demographic and clinical data on admission were collected from an electronic database. The area under the receiver operating characteristic (AUC) curve analysis was used to assess the predictive power of the resultant multivariable logistic regression model after univariate and multivariate analyses of variables with identified associations with in-hospital mortality. RESULTS In total, 251 patients with COVID-19 pneumonia were enrolled in this study. The in-hospital mortality rate was 27.9%. Non-survivors had significantly higher HR, respiratory rate, SIA, and PMI and lower MP and BPAI than survivors. A cutoff value of 51 for SIA (AUC, 0.663; specificity, 80%) was used to predict mortality. When SIA was introduced as a modifier for the CURB-65 score, the new score (the CURSIA score) showed a higher AUC than the Acute Physiology and Chronic Health Evaluation II and CURB-65 scores (AUCs: 0.785, 0.780, and 0.774, respectively) without statistical significance. CONCLUSIONS SIA and CURSIA scores were significantly associated with COVID-19 pneumonia mortality. These scores may contribute to better patient triage than traditional vital signs.
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Affiliation(s)
- Piyaphat Udompongpaiboon
- Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Teeraphat Reangvilaikul
- Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Veerapong Vattanavanit
- Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
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Influence of Nutritional Parameters on the Evolution, Severity and Prognosis of Critically Ill Patients with COVID-19. Nutrients 2022; 14:nu14245363. [PMID: 36558522 PMCID: PMC9783074 DOI: 10.3390/nu14245363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
This study evaluated the clinical and nutritional status, the evolution over three days, and the relationship between nutritional, inflammatory, and clinical parameters of critically ill patients with COVID-19. A longitudinal study was conducted in the Intensive Care Unit of the Virgen de las Nieves University Hospital in Granada (Spain). The study population comprised patients with a positive polymerase chain reaction test for COVID-19 presenting critical clinical involvement. Clinical outcomes were collected, and inflammatory and nutritional parameters (albumin, prealbumin, transferrin, transferrin saturation index, cholesterol, triglycerides and Controlling Nutritional Status (CONUT) score) were determined. A total of 202 critical patients with COVID-19 were selected, presenting highly altered clinical-nutritional parameters. The evolution experienced by the patients on the third day of admission was a decrease in albumin (p < 0.001) and an increase in prealbumin (p < 0.001), transferrin (p < 0.002), transferrin saturation index (p < 0.018), and cholesterol (p < 0.001). Low levels of albumin, prealbumin (on the third day) and high CONUT score (on the third day) showed an association with higher mortality. Nutritional variables were inversely correlated with clinical and inflammatory parameters. Critically ill patients with COVID-19 have poor nutritional status related to a poor prognosis of disease severity and mortality.
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