Valor pronóstico del diagnóstico principal en ancianos ingresados en una unidad geriátrica de agudos al alta y al año / Prognostic value of the primary diagnosis in elderly patients admitted to an acute geriatric unit at discharge and one year later

Objetivo. Analizar la asociación entre el diagnóstico principal que motiva el ingreso hospitalario en una unidad geriátrica de agudos (UGA) y el riesgo de mortalidad intrahospitalaria y al año del alta. Material y métodos. Estudio longitudinal de los pacientes que ingresaron en la UGA del Hospital Central de la Cruz Roja de Madrid durante 2009. El diagnóstico de ingreso se agrupó por grupos relacionados por el diagnóstico (GRD). La fecha de fallecimiento fue recogida del informe médico y del Índice Nacional de Defunciones del Ministerio de Sanidad. Como variable resultado se analizó la asociación entre diagnósticos al ingreso y deterioro funcional al alta (medido como una pérdida de 10 o más puntos entre el Índice de Barthel al alta respecto al previo al ingreso), mortalidad durante el ingreso, a los 3 meses y al año del alta. El análisis se ajustó por edad, sexo, comorbilidad, situación funcional y cognitiva, y niveles de albúmina sérica. Resultados. Se estudiaron 1.147 pacientes, con una edad media de 86,7 años (DE: ± 6,7), 66% eran mujeres. Fallecieron durante el ingreso un 10,1% y presentaron deterioro funcional al alta el 36,6%. La mortalidad postalta fue del 25,5% a los 3 meses y el 42,2% al año. La frecuencia de los principales diagnósticos al ingreso (entre paréntesis su mortalidad intrahospitalaria y al año) fueron insuficiencia cardiaca 21,4% (8,1 y 37,4%), neumonía no aspirativa 13,3% (12,3 y 46,4%) y neumonía aspirativa 4,7% (27,5 y 71%), bronconeumopatías 13,3% (6,6 y 38,2%), infección urinaria 10,2% (5,1 y 42,7%) e ictus (excluyendo AIT) 9,9% (13,3 y 46,9%). En el análisis multivariante solo el ingreso por neumonía aspirativa se asociaba de forma independiente con mayor riesgo de mortalidad intrahospitalaria (odds ratio-2,23; IC95% = 1,13-44,42) y el ingreso por ictus a la presencia de deterioro funcional al alta (odds ratio-6,01; IC95% = 3,42-10,57). Ningún diagnóstico se asoció de manera independiente con aumento del riesgo de muerte a los 3 meses y al año. Conclusiones. El ingreso por neumonía aspirativa conlleva un mayor riesgo de muerte en ancianos hospitalizados por patología médica aguda. Tras el alta, el riesgo aumentado de muerte debe ser atribuido a otros factores diferentes al diagnóstico (AU)

Objective. To analyse the relationship between the primary diagnosis on admission to an Acute Geriatric Unit (AGU) and the risk of hospital mortality and one year after discharge. Material and methods. A longitudinal study was conducted on patients admitted to the Central Hospital AGU Red Cross in Madrid in 2009. The admission diagnosis was grouped by Diagnosis Related Groups (DRGs). The date of death was collected from the medical charts and the National Death Index Ministry of Health report. The main outcome of study was the association between diagnoses on admission and functional impairment at discharge (measured as a loss of 10 or more points between the Barthel Index at discharge and that on admission), mortality during hospitalization, at 3 months and one year after discharge. The multivariate analysis was adjusted for age, sex, comorbidity, functional and cognitive status, and serum albumin. Results. The study included1147 patients, with a mean age of 86.7 years (SD ± 6.7), and 66% were women. During admission, 10.1% of patients died and 36.6% had functional impairment at discharge. After discharge, 25.5% died at 3 months, and 42.2% at one year. The distribution of the primary diagnoses at admission (between parentheses hospital mortality and at year) were heart failure, 21.4% (8.1% and 37.4%), pneumonia,13.3% (12.3% and 46.4%), and aspiration pneumonia, 4.7% (27.5%, y 71%), respiratory diseases,13.3% (6.6% and 38.2%), urinary infection,10.2% (5.1% and 42.7%), and stroke (excluding AIT), 9.9% (13.3% and 46.9%). In the multivariate analysis, only admissions due to aspiration pneumonia were independently associated with increased risk of hospital mortality (odds ratio, 2.23; 95% CI = 1.13 to 44.42), and stroke with increased risk of functional impairment at discharge (odds ratio, 6.01; 95% CI = 3.42-10.57). No diagnosis was independently associated with increased risk of death at 3 months and at year. Conclusions. Admission from aspiration pneumonia carries an increased risk of death in elderly patients hospitalised for acute medical conditions. After discharge, the risk of death must be attributed to factors other than the admission diagnosis (AU)

[Prognostic value of the primary diagnosis in elderly patients admitted to an acute geriatric unit at discharge and one year later]. / Valor pronóstico del diagnóstico principal en ancianos ingresados en una unidad geriátrica de agudos al alta y al año.

OBJECTIVE: To analyse the relationship between the primary diagnosis on admission to an Acute Geriatric Unit (AGU) and the risk of hospital mortality and one year after discharge MATERIAL AND METHODS: A longitudinal study was conducted on patients admitted to the Central Hospital AGU Red Cross in Madrid in 2009. The admission diagnosis was grouped by Diagnosis Related Groups (DRGs). The date of death was collected from the medical charts and the National Death Index Ministry of Health report. The main outcome of study was the association between diagnoses on admission and functional impairment at discharge (measured as a loss of 10 or more points between the Barthel Index at discharge and that on admission), mortality during hospitalization, at 3 months and one year after discharge. The multivariate analysis was adjusted for age, sex, comorbidity, functional and cognitive status, and serum albumin. RESULTS: The study included1147 patients, with a mean age of 86.7 years (SD±6.7), and 66% were women. During admission, 10.1% of patients died and 36.6% had functional impairment at discharge. After discharge, 25.5% died at 3 months, and 42.2% at one year. The distribution of the primary diagnoses at admission (between parentheses hospital mortality and at year) were heart failure, 21.4% (8.1% and 37.4%), pneumonia,13.3% (12.3% and 46.4%), and aspiration pneumonia, 4.7% (27.5%, y 71%), respiratory diseases,13.3% (6.6% and 38.2%), urinary infection,10.2% (5.1% and 42.7%), and stroke (excluding AIT), 9.9% (13.3% and 46.9%). In the multivariate analysis, only admissions due to aspiration pneumonia were independently associated with increased risk of hospital mortality (odds ratio, 2.23; 95% CI=1.13 to 44.42), and stroke with increased risk of functional impairment at discharge (odds ratio, 6.01; 95% CI=3.42-10.57). No diagnosis was independently associated with increased risk of death at 3 months and at year CONCLUSIONS: Admission from aspiration pneumonia carries an increased risk of death in elderly patients hospitalised for acute medical conditions. After discharge, the risk of death must be attributed to factors other than the admission diagnosis.

Mortalidad hospitalaria y situación funcional / Functional status and in-hospital mortality

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Repercusión asistencial y coste hospitalario de la infección por Staphylococcus aureus meticilina resistente en una unidad geriátrica de agudos / Staphylococcus aureus infection in an acute geriatric unit

Objetivo Conocer el riesgo de muerte, el deterioro funcional, la institucionalización y el coste hospitalario asociado a la infección por Staphylococcus aureus meticilina resistente (SAMR) en una unidad geriátrica de agudos (UGA). Material y métodos Recogida retrospectiva de datos de pacientes ingresados en una UGA durante 5 años (del 1-1-2001 al 1-1-2006). Se compara la mortalidad, la institucionalización y la pérdida funcional al alta, la estancia y los costes hospitalarios en pacientes con SAMR y en el resto de los pacientes sin SAMR. La infección por SAMR fue documentada por el Servicio de Microbiología por cultivo y antibiograma, junto con el diagnóstico clínico de infección hospitalaria recogida en la historia clínica. Resultados La muestra de estudio fue de 47 pacientes con SAMR (edad media de 86,15±5,5 años) y 4.281 pacientes sin SAMR (edad media de 85,25±6 años). Los pacientes con SAMR presentaron mayor mortalidad (25,5 vs. 7,7%; p<0,001); peor situación funcional al alta (índice de Barthel: 39,43±33,05 vs. 55,24±34,99; p<0,01) y mayor institucionalización (29 vs. 9%; p<0,001). También se objetivó una mayor estancia media (22,15±13,67 vs. 10,64±7,53 días; p<0,001) junto con un incremento del coste hospitalario por paciente (7.517,71±4.639,59 vs. 3.611,21±2.609,98 euros, p<0,001). En el análisis multivariante, tras ajustar por edad, sexo y situación funcional y mental previa al ingreso, la infección por SAMR se asoció de forma independiente a mayor riesgo de muerte (Odds ratio [OR] = 3,92; intervalo de confianza [IC] al 95%=1,95–7,86), deterioro funcional al alta (OR=2,4; IC al 95%=1,22–5,01) e institucionalización (OR=6,50; IC al 95%=2,60–12,22), con incremento importante de la estancia hospitalaria (coeficiente beta=11,55 días; IC al 95%=9,32–13,75). Conclusión La infección por SAMR en la UGA se asocia a una mayor mortalidad, pérdida funcional y más frecuente institucionalización al alta hospitalaria, con importante incremento de la estancia y del coste hospitalario (AU)

ObjectiveThe aim of this study was to determine the risk of mortality, functional decline and institutionalization, as well as the hospital cost associated with patients with methicillin-resistant Staphylococcus aureus (MRSA) infection in an Acute Geriatric Unit (AGU).Material and methodsWe retrospectively gathered data on patients admitted to the AGU over a 5-year period (from 1/1/2001 to 1/1/06). Mortality, institutionalization, functional impairment at discharge, length of hospital stay, and hospital costs were compared between patients with and without MRSA. MRSA infection was documented by the microbiology department using culture and antibiogram, as well as by clinical diagnosis of hospital infection registered in the medical record.ResultsData were obtained from 47 patients with MRSA (mean age 86.15±5.5 years) and from 4281 patients without MRSA (mean age 85.25±6 years). MRSA-infected patients had higher mortality (25.5% vs. 7.7%, p<0.001), worse functional status at discharge (Barthel index 39.43±33.05 vs. 55.24±34.99, p<0.01) and more frequent institutionalization (29% vs. 9%, p<0.001). Longer length of hospital stay (22.15±13.67 vs. 10.64±7.69 days, p<0.001) and higher hospital cost per patient (7517.71±4639.59 vs 3611.21±2609.98 €, p<0.001) were also observed. In the multivariate analysis adjusted by age, sex, and baseline functional and cognitive status, MRSA infection was independently associated with higher mortality (OR=3.92; 95% CI=1.95–7.86), worse functional status at discharge (OR=2.48; 95% CI=1.22–5.01), institutionalization at discharge (OR=6.50; 95% CI=2.60–12.22), and substantial increase in length of hospital stay (Beta coefficient=11.55 days; 95% CI=9.32–13.75).ConclusionMRSA infection in the AGU is associated with higher mortality, worse functional status at discharge and a higher incidence of institutionalization, as well as significantly longer length of stay and higher hospital costs(AU)

[Staphylococcus aureus infection in an acute geriatric unit]. / Repercusión asistencial y coste hospitalario de la infección por Staphylococcus aureus meticilina resistente en una unidad geriátrica de agudos.

OBJECTIVE: The aim of this study was to determine the risk of mortality, functional decline and institutionalization, as well as the hospital cost associated with patients with methicillin-resistant Staphylococcus aureus (MRSA) infection in an Acute Geriatric Unit (AGU). MATERIAL AND METHODS: We retrospectively gathered data on patients admitted to the AGU over a 5-year period (from 1/1/2001 to 1/1/06). Mortality, institutionalization, functional impairment at discharge, length of hospital stay, and hospital costs were compared between patients with and without MRSA. MRSA infection was documented by the microbiology department using culture and antibiogram, as well as by clinical diagnosis of hospital infection registered in the medical record. RESULTS: Data were obtained from 47 patients with MRSA (mean age 86.15+/-5.5 years) and from 4281 patients without MRSA (mean age 85.25+/-6 years). MRSA-infected patients had higher mortality (25.5% vs. 7.7%, p<0.001), worse functional status at discharge (Barthel index 39.43+/-33.05 vs. 55.24+/-34.99, p<0.01) and more frequent institutionalization (29% vs. 9%, p<0.001). Longer length of hospital stay (22.15+/-13.67 vs. 10.64+/-7.69 days, p<0.001) and higher hospital cost per patient (7517.71+/-4639.59 vs 3611.21+/-2609.98 euro, p<0.001) were also observed. In the multivariate analysis adjusted by age, sex, and baseline functional and cognitive status, MRSA infection was independently associated with higher mortality (OR=3.92; 95% CI=1.95-7.86), worse functional status at discharge (OR=2.48; 95% CI=1.22-5.01), institutionalization at discharge (OR=6.50; 95% CI=2.60-12.22), and substantial increase in length of hospital stay (Beta coefficient=11.55 days; 95% CI=9.32-13.75). CONCLUSION: MRSA infection in the AGU is associated with higher mortality, worse functional status at discharge and a higher incidence of institutionalization, as well as significantly longer length of stay and higher hospital costs.

[Comparison of equations to estimate the glomerular filtration in people aged 75 or older without known renal disease]. / Comparación del uso de las ecuaciones de estimación del filtrado glomerular renal en personas de 75 años o más sin enfermedad renal conocida.

BACKGROUND AND OBJECTIVE: To compare the glomerular filtration rate (GFR) of patients aged 75 and older without known renal disease estimated by the MDRD-4-IDMS (MDRD) formula, urine 24h creatinine clearance (24h-CC) and Cockroft-Gault (CG) formula. PATIENTS AND METHODS: There were included 70 persons aged 75 and older from the geriatric external consultation. We compared the MDRD against the CG and the 24h-CC. RESULTS: Means of GFR were: 24h-CC: 56,60 + or - 22,79 ml/min/1.73 m(2) and CG: 54,27 + or - 15,25 ml/min/1.73 m(2), significantly lower than with MDRD: 69,78 + or - 18,53 ml/min/1.73 m(2) (p<0.001). Age was correlated with the difference between CG and MDRD (coefficient of correlation: 0,59; r(2):0,34; p<0,001). Moderate agreement was obtained between MDRD with CG (k coefficient = 0.37; CI95%=0.19-0.55) and MDRD with 24-CC (k coefficient = 0.39; CI95% = 0.22-0.57). CONCLUSIONS: The MDRD and CG formulas to estimate the FGR in people aged 75 and older are not interchangeable. There are needed specific studies in old people to establish the most precise formula.

[Therapeutic trial in suspected bronchiolitis obliterans organizing pneumonia (BOOP) in the elderly]. / Ensayo terapéutico ante sospecha de bronquiolitis obliterante con neumonía organizada (BONO) en el anciano.

We present four cases of patients admitted to an acute geriatric unit with a presumptive diagnosis of bronchiolitis obliterans organizing pneumonia between 2001 and 2005. Because of the difficulty of performing transbronchial biopsy in these patients, who showed a variety of clinical presentations, the suspected diagnosis was based on clinical and radiological findings and a favorable response to empirical corticosteroid treatment. The clinical and radiological features of this entity in the elderly, as well as the therapeutic options, are reviewed.

Ensayo terapéutico ante sospecha de bronquiolitis obliterante con neumonía organizada (BONO) en el anciano / Therapeutic trial in suspected bronchiolitis obliterans organizing pneumonia (BOOP) in the elderly

Se presentan 4 casos de pacientes ingresados entre 2001 y 2005 en una unidad geriátrica de agudos hospitalaria con diagnóstico de presunción de bronquiolitis obliterante con neumonía organizada (BONO). En esos pacientes, ante la dificultad de la realización de la biopsia transbronquial, con diversidad de presentación clínica, se realizó el diagnóstico de sospecha de BONO sobre la base de los hallazgos clínicos, radiológicos y la respuesta favorable a tratamiento empírico con corticoides. Se realiza una revisión clínica, radiológica y terapéutica de esa afección en el anciano

We present four cases of patients admitted to an acute geriatric unit with a presumptive diagnosis of bronchiolitis obliterans organizing pneumonia between 2001 and 2005. Because of the difficultyof performing transbronchial biopsy in these patients, who showed a variety of clinical presentations, the suspected diagnosis was based on clinical and radiological findings and a favorable response to empirical corticosteroid treatment. The clinicaland radiological features of this entity in the elderly, as well as the therapeutic options, are reviewed

Neumatosis intestinal y gas en el territorio venoso portomesentérico en el paciente anciano: etiología, fisiopatología y significado clínico / Pneumatosis intestinalis and portomesenteric venous gas in the elderly: aetiology, physiopathology and clinical significance

La presencia de gas en el territorio venoso portomesentérico y en la pared intestinal, es una entidad infrecuente en el paciente adulto; sin embargo, con el avance del diagnóstico por imagen y el rápido crecimiento de la población anciana, cada vez son más frecuentes los casos publicados en la literatura médica. La etiología más frecuente es la isquemia mesentérica, potencialmente más letal en esta edad. Presentamos el caso de enterocolitis necrosante secundaria a isquemia mesentérica en una mujer de 80 años de edad, que se diagnosticó tras analizar el cuadro clínico y los hallazgos radiológicos. La paciente falleció tras un deterioro rápidamente progresivo. Revisamos los aspectos etiológicos, las manifestaciones clínicas, las pruebas diagnósticas y las opciones terapéuticas de esta entidad en el paciente geriátrico

Pneumatosis intestinalis and portomesenteric venous gas in adults is a rare entity. However, because of the advances in diagnostic imaging and the rapid growth of the elderly population, more cases are being reported in adults. The most frequent cause of hepatic portal venous gas is extensive bowel necrosis, which is potentially fatal in this age group. We present an 80-year-old woman with clinical and radiological signs of portal venous gas and pneumatosis intestinalis secondary to ischaemic necrotizing enterocolitis. The patient's general condition rapidly deteriorated with subsequent fatality. We review the aetiology, clinical manifestations, diagnostic tests and therapeutic options of this disease in the elderly

Presencia de especialista en geriatría en los centros que atienden a pacientes con demencia / Presence of a geriatrics specialist in centres dealing with patients suffering from senile dementia

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Atención sociosanitaria y atención geriátrica / Health care and geriatric care

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