DASC-21 score and the risk of in-hospital death in elderly patients with heart failure.

AIM: We investigated whether the Dementia Assessment Sheet for Community-based Integrated Care System-21 Items (DASC-21), a questionnaire that assesses cognitive function, including activities of daily living (ADL), was predictive of in-hospital death and prolonged hospital stay in elderly patients hospitalized for heart failure. METHODS: We retrospectively assessed the DASC-21 score at the time of admission, in-hospital death, length of hospital stay, and change in the Barthel index in 399 patients hospitalized for heart failure between 2016 and 2019. RESULTS: The mean patient age was 85.8 ± 7.7 years (61.3% women). The median DASC-21 score was 38 (64.7% higher than 31). On multivariate logistic regression analysis, a higher DASC-21 score was associated with an increased risk of in-hospital death (odds ratio [OR] = 1.045 per 1 point increase, 95% confidence interval [CI]: 1.010-1.081, P = 0.012), even after adjusting for confounding factors, including atrial fibrillation, ejection fraction, and B-type natriuretic peptide. Difficulties (3 or 4) with the self-management of medication in instrumental ADL inside the home (OR = 3.28, 95% CI: 1.05-10.28, P = 0.042), toileting (OR = 3.66, 95% CI: 1.19-11.29, P = 0.024), grooming (OR = 6.47, 95% CI: 2.00-20.96, P = 0.002), eating (OR = 7.96, 95% CI: 2.49-25.45, P < 0.001), and mobility in physical ADL (OR = 5.99, 95% CI: 1.85-19.35, P = 0.003) were identified as risk factors for in-hospital death. Patients in the highest tertile of the DASC-21 score had a significantly longer hospital stay (P = 0.006) and a greater reduction in the Barthel index (P < 0.001). CONCLUSIONS: In elderly patients hospitalized for heart failure, higher DASC-21 scores were associated with an increased risk of in-hospital death, prolonged hospital stay, and impaired ADL. Geriatr Gerontol Int 2024; 24: 546-553.

Changes in prognostic nutritional index during hospitalization and outcomes in patients with acute heart failure.

Although the prognostic nutritional index (PNI) is reported as a prognosticator in patients with heart failure (HF), that is evaluated usually on one occasion, and any changes in PNI during hospitalization are not considered. This study aimed to assess between changes in the PNI during hospitalization and outcomes in patients with acute HF. We enrolled 141 patients (median age, 84 years, 75 male) admitted to our hospital for the treatment of acute HF. The PNI was calculated on admission and at discharge based on the original report. According to the PNI change during hospitalization, patients were classified as either improved (PNI at discharge ≥ PNI on admission) or deteriorated (PNI at discharge < PNI on admission). Primary outcomes were all-cause death or unplanned hospitalization due to HF within the first year. Forty-nine events occurred (19 deaths, 30 HF hospitalizations). The event-free survival rate determined by Kaplan-Meier analysis was significantly higher in patients in the improved group (log-rank test, P < 0.0001), regardless of the PNI value on admission. Multivariate analysis showed that younger age (HR 1.06, 95% CI 1.01-1.11, P = 0.016), higher body mass index (HR 0.90, 95% CI 0.82-0.98, P = 0.021) and the PNI in the improved group (HR 0.30, 95% CI 0.14-0.57, P = 0.0006) were independently associated with favorable outcomes. In conclusion, changes in nutritional status during hospitalization, evaluated using the PNI on admission and at discharge, were independently associated with 1-year outcomes in patients with acute HF.

Association Between Albumin-Bilirubin Score at Admission and In-Hospital Mortality in Patients with Acute Heart Failure.

Liver dysfunction is one of the most recognized complications in patients with acute heart failure (HF) and therefore a liver function score may be useful for risk-stratification in those patients. Recently, the albumin-bilirubin (ALBI) score was developed as a new model to assess liver function in liver disease. We explored the association between the ALBI score at admission and in-hospital mortality in patients with acute HF.We enrolled 262 patients (median age, 86 years, 137 males) who were admitted to our hospital for treatment of acute HF. The following data were recorded: vital signs, laboratory data including B-type natriuretic peptide (BNP) level, echocardiographic data at admission, demographic and clinical characteristics, and treatment and prognostic information. The Get With the Guidelines-Heart Failure (GWTG-HF) risk score was calculated as an established risk model for each patient. The primary outcome was all-cause in-hospital mortality.During hospitalization, 37 patients (14.1%) died. The in-hospital mortality rate was significantly higher in patients with ALBI scores > -2.25 compared with patients with ALBI scores ≤ -2.25 (21.1% versus 4.5%, respectively; P = 0.0001). Multivariate analysis revealed that the GWTG-HF score (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.25, P < 0.0001), BNP level (OR 1.0007, 95% CI 1.0003-1.001, P = 0.0003) and ALBI score (OR 6.0, 95% CI 1.8-19.6, P = 0.0017) were independently associated with in-hospital mortality.Our results indicated that the ALBI score was independently associated with in-hospital mortality in patients hospitalized for acute HF.

Effect of Wave Reflection and Arterial Stiffness on the Risk of Development of Hypertension in Japanese Men.

BACKGROUND: We conducted analyses of repeated-measures data to examine whether pressure wave reflection acts additively or synergistically with arterial stiffness in the pathogenesis of hypertension. METHODS AND RESULTS: In 3172 middle-aged (42±9 years) healthy Japanese men without hypertension at the study baseline, systolic and diastolic blood pressures, brachial-ankle pulse wave velocity, and radial augmentation index were measured annually during a 9-year study period. Of these, 474 participants (15%) developed hypertension by the end of the study period. Binary logistic regression analysis demonstrated significant individual odds ratios for both baseline brachial-ankle pulse wave velocity and radial augmentation index for the development of hypertension. The rate of onset of hypertension during the study period was highest in the participant group with high values for both brachial-ankle pulse wave velocity and radial augmentation index at study baseline (262 of 965 participants: 27%). The generalized estimating equation analysis revealed that both radial augmentation index (estimate=0.06, SE=0.03, P=0.05) and brachial-ankle pulse wave velocity (estimate=0.07×10-1, SE=0.02×10-1, P<0.01) showed significant longitudinal association with new onset of hypertension, with no significant interaction. CONCLUSIONS: In Japanese men, abnormal wave reflection and increased arterial stiffness may be additively associated with the risk of new onset of hypertension. Abnormal wave reflection and elevated central blood pressure may be longitudinally associated with increase in arterial stiffness, and this longitudinal association may be a mechanism underlying the additive effect of these 2 variables on the risk of new onset of hypertension.

The Contribution of Inflammation to the Development of Hypertension Mediated by Increased Arterial Stiffness.

BACKGROUND: The mechanisms underlying the possible contribution of chronic inflammation to the development of hypertension remain unclear. We examined the longitudinal association of inflammation with the progression of vascular and/or renal abnormalities in the development of hypertension. METHODS AND RESULTS: In 3274 middle-aged Japanese men without hypertension at the study baseline, brachial-ankle pulse wave velocity, blood pressure, estimated glomerular filtration rate, and serum CRP (C reactive protein) levels were measured annually during a 9-year period. During this study period, 474 participants (14.5%) developed hypertension. Analysis of the repeated-measures data revealed that sustained elevation of serum CRP levels was associated with a longitudinal increase of the brachial-ankle pulse wave velocity. A linear mixed model analysis revealed that higher log-transformed serum CRP values (log CRP) at each measurement were associated with a higher annual increase of the brachial-ankle pulse wave velocity (estimate=32.553±11.635 cm/s per log CRP, P=0.018), and that higher values of the brachial-ankle pulse wave velocity at each measurement were associated with a higher annual elevation of blood pressure (estimate=0.025±0.002 mm Hg per log CRP, P<0.001). CONCLUSIONS: In middle-aged Japanese men without hypertension at study baseline, long-term active inflammation appears to be associated with a longitudinal increase of arterial stiffness. In turn, this longitudinal increase of arterial stiffness appears to be associated with longitudinal elevation of blood pressure to the hypertensive range. Thus, systemic inflammation may play a role in the pathogenesis of hypertension by the progression of arterial stiffness.

Comparison of the clinical significance of single cuff-based arterial stiffness parameters with that of the commonly used parameters.

BACKGROUND: We examined the following: (1) whether the new simple markers related to the arterial stiffness/central hemodynamics [i.e. arterial pressure-volume index (API) and arterial velocity pulse index (AVI)] are clinically interchangeable with the commonly used markers [brachial-ankle pulse wave velocity (baPWV) and radial augmentation index (rAI)]; (2) whether the new simple markers reflect vascular damage as reliably as the commonly used markers; (3) which cardiovascular risk factors are reflected by these new simple markers. METHODS: API, AVI, baPWV, and rAI were measured simultaneously in consecutive patients admitted for the management of cardiovascular disease and/or cardiovascular risk factors (n=322). RESULTS: The API was correlated with the baPWV (R=0.492, p<0.001) and the AVI correlated with the rAI (R=0.462, p<0.001). The API, AVI, baPWV, and rAI were higher in the patients admitted for coronary angiography (CAG group: n=152) than in those admitted for reasons other than coronary angiography (nonCAG group: n=170). After adjustments for confounding factors, only the AVI was found to be higher in the CAG group than in the nonCAG group. Multivariate linear regression analysis revealed that age and the systolic blood pressure were independently associated with the API and AVI after adjustments. CONCLUSION: In patients with cardiovascular diseases or cardiovascular risk factors, the new simple markers and the commonly used markers are not interchangeable for assessing vascular damage and/or cardiovascular risk. Further study is proposed to examine whether AVI is higher in subjects with cardiovascular disease than in those without a history of cardiovascular disease. Similar to the case for the commonly used markers, age and the blood pressure significantly influenced both the new markers; therefore, age and the blood pressure need to be taken into account while interpreting the changes in these new simple markers.

An epigenetic aberration increased in intergenic regions of cloned mice.

The causes of frequent abnormal phenotypes and low success rate in mammalian cloning are poorly understood. Although epigenetic aberration is suspected to be a cause, its connection to the phenotypes has yet to be investigated. To measure the level of reprogramming of an epigenetic mark, acetylation at lysine 9 of histone H3 (H3K9Ac), in cloned mice, we examined its conservation between two cloned mice derived from distinct cell nuclei and their natural donors by utilizing whole-genome tiling arrays and quantitative PCR. Pairwise comparison of the H3K9Ac enrichment profile between the four mice revealed that H3K9Ac is less conserved in intergenic regions than in promoter regions of protein-coding genes. Intriguingly, the variation of H3K9Ac enrichment in intergenic regions is the most prominent in comparison of the two clones, possibly reflecting an additive effect of aberrant reprogramming of this epigenetic information occurring specifically in each of the two clones.