Mortality and bloodstream infections in geriatrics units.

The purpose of this retrospective study was to evaluate risk factors of mortality in bloodstream infections in old and very old people in a French geriatric unit (Paul Brousse Hospital, APHP). 167 older patients with bloodstream infections were included and two groups were compared according to age (60-85 years and ≥85 years). Information was collected for each patient: age, sex, diseases, urinary catheter, temperature, signs of severe sepsis, biological examinations, bacteria and antibiotic treatments. All bacteremias were nosocomial. There was no difference between groups for pathogen, source or prognosis. Mortality rate at 60 days was 32.3%. The risk factors for mortality were: low albumin rate (p<0.001), high C-reactive protein (CRP) (p=0.02) and moderate fever (p=0.006). Multivariate logistic regression showed that these three parameters were significantly associated with a risk of mortality. The parameter with the highest risk was a low albumin rate <30 g/l. Malnutrition may be a more long-term risk factor. A moderate fever probably results in a more frequent delay in diagnosis in this population. Our work supports that age is not a risk factor of mortality for bloodstream infections. However management of bacteremia has to be adapted to elderly.

Evolution and predictive factors of thyroid disorder due to interferon alpha in the treatment of hepatitis C.

AIM: To study predictive factors of thyroid dysfunction associated with interferon-alpha (IFNalpha) therapy in chronic hepatitis C (CHC) and to describe its long-term evolution in a large population without previous thyroid dysfunction. METHODS: We performed a follow-up of thyroid function and detection of thyroid antibodies in 301 patients treated for CHC with IFNalpha from 1999 to 2004. RESULTS: Thyroid disorder developed in 30/301 (10%) patients with a mean delay of 6 +/- 3.75 mo: 13 patients had hyperthyroidism, 11 had hypothyroidism, and 6 had biphasic evolution. During a mean follow-up of 41.59 +/- 15.39 mo, 9 patients with hyperthyroidism, 3 with hypothyroidism, and 4 with biphasic evolution normalized thyroid function in 7.88 +/- 5.46 mo. Recovery rate of dysthyroidism was not modified by treatment discontinuation, but was better for patients with negative thyroid antibodies before antiviral treatment (P = 0.02). Women had significantly more dysthyroidism (P = 0.05). Positive thyroid peroxidase and thyroglobulin antibodies were more frequent before antiviral treatment in patients who developed dysthyroidism (P < 0.0003 and P = 0.0003, respectively). In a multivariate model, low fibrosis was found to be a predictive factor of dysthyroidism (P = 0.039). CONCLUSION: In this monocentric population of CHC, dysthyroidism, especially hyperthyroidism, developed in 10% of patients. Low fibrosis was found to be a predictive factor of dysthyroidism. Thyroid disorder recovered in 16/30 patients (53%) and recovery was better in the non-autoimmune form.