Serum albumin level and long-term outcome in acute heart failure.

Objective: Hypoalbuminemia is common in heart failure (HF), especially in elderly patients. It is associated with an increased risk of death. The present study sought to examine the prognostic significance of serum albumin level in the prediction of long-term mortality in patients admitted for acute HF.Methods and results: We examined the association between albumin and hospital mortality in a cohort of 509 patients admitted for acute HF. None of the patients had infectious disease, severe arrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation), required invasive ventilation or presented with acute coronary syndrome or primary valvular disease. Sixty-nine patients (14%) died during the 1-year follow-up. With multivariable analysis, haemoglobin level (p = .003), systolic blood pressure (p = .004) and serum albumin level (p = .003) emerged as independent predictors of long-term mortality. Hypoalbuminemia (<35.7 g/L) had a hazard ratio of 2.01 (95% CI 1.24-3.25) and haemoglobin of 2.6 (95% CI 1.29-5.22) for predicting long-term mortality.Conclusions: Serum albumin level measured at admission, especially if combined with anaemia, can serve as a simple prognostic factor in acute HF for predicting long-term outcome.

Assessment of the energy expenditure of Belgian nursing home residents using indirect calorimetry.

OBJECTIVES: The aim of this study was to assess the energy expenditure of Belgian nursing home residents using indirect calorimetry and compare the energy expenditure with energy intake. METHODS: Indirect calorimetry was performed in nursing home residents to estimate their basal metabolism. The basal metabolism was multiplied by a physical activity level coefficient and energy expenditure that was related to thermogenesis (i.e., 10% of the total amount of energy ingested over 24 h) was added. In this way, we obtained the total energy expenditure of each nursing home resident. The nutritional intake of each resident was calculated using the precise food-weighing method over a 3-d period. The difference between energy expenditure and consumption was calculated for each patient and the mean of the difference in the population was calculated. These quantitative variables were compared by means of analysis of variance. RESULTS: A total of 25 subjects were included in this study (88.1 ± 5.8 y; 84% women). The estimated mean basal metabolism was 1087.2 ± 163.2 kcal. The physical activity level was 1.29 ± 0.1 on average and the energy expenditure due to thermogenesis was 163.1 ± 28.9 kcal. Thus, the mean daily energy expenditure was 1575.2 ± 210.6 kcal, which was within the range of the actual calculated energy intake of the residents (1631.5 ± 289.3 kcal; P = 0.33). CONCLUSIONS: The estimated energy intake of Belgian nursing home residents seems appropriate for their energy expenditure.

Pitfalls in the measurement of muscle mass: a need for a reference standard.

BACKGROUND: All proposed definitions of sarcopenia include the measurement of muscle mass, but the techniques and threshold values used vary. Indeed, the literature does not establish consensus on the best technique for measuring lean body mass. Thus, the objective measurement of sarcopenia is hampered by limitations intrinsic to assessment tools. The aim of this study was to review the methods to assess muscle mass and to reach consensus on the development of a reference standard. METHODS: Literature reviews were performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis working group on frailty and sarcopenia. Face-to-face meetings were organized for the whole group to make amendments and discuss further recommendations. RESULTS: A wide range of techniques can be used to assess muscle mass. Cost, availability, and ease of use can determine whether the techniques are better suited to clinical practice or are more useful for research. No one technique subserves all requirements but dual energy X-ray absorptiometry could be considered as a reference standard (but not a gold standard) for measuring muscle lean body mass. CONCLUSIONS: Based on the feasibility, accuracy, safety, and low cost, dual energy X-ray absorptiometry can be considered as the reference standard for measuring muscle mass.

The authors reply: Letter on: "Pitfalls in the measurement of muscle mass: a need for a reference standard" by Clark et al.

However, semantics aside, we think that DXA can indeed serve as a reference standard for measuring muscle mass. Obviously, CT and MRI are advanced techniques that can and have been used to obtain important information such as muscle size/volume and more recently amount and distribution of intra- and intermuscular adipose tissue. Also individual muscles can be assessed separately. However, with respect to muscle mass, the comparison of DXA with CT/MRI is rather difficult because DXA and QCT/MRI measure different physical parameters.

Serum albumin level and hospital mortality in acute non-ischemic heart failure.

AIMS: Hypoalbuminemia is common in heart failure (HF), especially in elderly patients. It is associated with an increased risk of death. The present study sought to examine the prognostic significance of serum albumin level in the prediction of hospital mortality in patients admitted for acute non-ischemic HF. METHODS AND RESULTS: We examined the association between albumin and hospital mortality in a cohort of 546 patients admitted for acute non-ischemic HF. None of the patients had infectious disease, severe arrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation), required invasive ventilation, or presented with acute coronary syndrome or primary valvular disease. Thirty-six patients (7%) died during the hospital stay. These patients were significantly older (78 ± 9 vs. 72 ± 12 years; P = 0.006), had higher heart rate (P < 0.0001), increased creatinine level (P = 0.01), lower systolic and diastolic blood pressures (P < 0.05), elevated leucocyte count (P = 0.001), and lower albumin levels (31.3 ± 5.6 g/L vs. 36.9 ± 4.1 g/L; P < 0.001). With multivariable analysis, age (P = 0.01), heart rate (P < 0.0003), diastolic blood pressure (P < 0.01), leukocyte count (P = 0.009), and serum albumin level (P < 0.0001) emerged as independent predictors of hospital mortality. Hypoalbuminemia (<34 g/L) yielded the best sensitivity (78.8%) and specificity (75%) for predicting hospital death. CONCLUSIONS: Serum albumin level measured at admission can serve as a simple prognostic factor in acute non-ischemic HF. Hypoalbuminemia is associated with increased risk of hospital mortality, especially in elderly patients.

[Promoting factors of laryngeal penetrations in elderly]. / Facteurs favorisant les pénétrations laryngées en gériatrie.

BACKGROUND: Swallowing disorders are common among elderly patients. Laryngeal penetration is among the most serious complications, resulting in airway obstruction, aspiration pneumonia or pneumonitis. Early diagnosis is therefore very important. OBJECTIVE: The main objective of this study is to identify factors associated with anamnestic and clinical onset of laryngeal penetration. METHODOLOGY: The study population is constituted of 127 consecutive patients hospitalized in our geriatric department. All following parameters were assessed: the patient's home, the reason for hospitalization, the medical history, treatment, anthropometric and biological parameters (nutritional status), a comprehensive geriatric assessment, a speech-language ability assessment and water swallow test according to DePippo method. All these parameters were correlated with the outcome of nasopharyngeal endoscopy. RESULTS: A total of 127 patients (mean age of 84 ±â€Š5 years) (average score of MMSE of 22) were evaluated. Most of them came from their home. The mean values of the Katz and Lawton scales were 9 ±â€Š5.5 and 27 ±â€Š8, respectively. About two third of patients had mood disorders (GDS > 1). A laryngeal penetration was present in 44% of cases. It occurred more frequently in patients taking neuroleptics, in those with a history of stroke, in case of extra-pyramidal syndrome or when the MMSE was pathological. The temporo-spatial disorientation, the presence of a salivary flow, the inability to perform adequately the different items of the speech-language evaluation and the failure to achieve proper water swallowing test were also related to the presence of laryngeal penetrations. With multivariate analysis, after adjusting for all significant variables, abnormal water swallowing test (P = 0.0002, OR 13) emerged as the sole independent parameter associated with laryngeal penetrations. CONCLUSION: Laryngeal penetration is associated with hospital mortality and impaired geriatric status. It could thus represent a marker of the overall frailty. In a frail geriatric population, the water-swallowing test helps to identify patients at risk of laryngeal penetration.