Comparative Prognostic Accuracy of Clinical and Inflammation- or Nutrition-Based Scores in Older Adults with Community-Acquired Pneumonia

Merve Eksioglu,1 Burcu Azapoglu Kaymak,1 Ebru Unal Akoglu,1 Selman Faruk Akyıldız,1 Ramazan Sivil,2 Tuba Cimilli Ozturk1 1Department of Emergency Medicine, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey; 2Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, TurkeyCorrespondence: Merve Eksioglu, Department of Emergency Medicine, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Hastane Sokak No: 1/9 İçerenköy, Ataşehir, Istanbul, 34752, Turkey, Tel +90 216 578 30 00; +90 505 295 36 87, Email [email protected]: This study aimed to assess the prognostic accuracy of the Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), and C-reactive protein/albumin ratio (CAR) in predicting 30-day mortality and intensive care unit (ICU) admission compared with the Pneumonia Severity Index (PSI) and CURB-65 in older adults with community-acquired pneumonia (CAP).Patients and Methods: This retrospective, single-center cohort study was conducted in a tertiary emergency department. Patients aged ≥ 65 years with CAP were included. Exclusion criteria were hospital- or ventilator-associated pneumonia, pneumonia mimics, and immunocompromised status. GPS and mGPS were calculated using CRP > 10 mg/L and albumin < 35 g/L. ROC and logistic regression analyses were performed.Results: A total of 349 patients (mean age: 77.96 ± 8.42 years; 52.7% men) were included. The 30-day mortality and ICU admission rates were 19.5% and 27.2%, respectively. For predicting mortality, the GPS showed an AUC of 0.753 (95% CI: 0.690– 0.816), sensitivity of 75.0%, specificity of 73.3%, PPV of 43.9%, and NPV of 92.4%. mGPS had an AUC of 0.747 (95% CI: 0.679– 0.814), sensitivity 77.9%, specificity 73.3%, PPV 45.2%, and NPV 93.2%. The CAR yielded an AUC of 0.677 (95% CI: 0.604– 0.751), sensitivity of 82.4%, specificity of 45.6%, PPV of 29.5%, and NPV of 91.4%. For ICU admission, the AUCs were 0.770 (GPS), 0.757 (mGPS), and 0.676 (CAR). The PSI demonstrated the highest predictive accuracy (AUC: 0.884 for mortality, 0.919 for ICU admission), followed by CURB-65 (AUC: 0.848 and 0.879, respectively). Independent predictors of 30-day mortality included acute confusion, lower PaO2/FiO2 ratio, low systolic blood pressure, reduced hemoglobin levels, and Alzheimer’s disease or dementia.Conclusion: The PSI and CURB-65 demonstrated superior prognostic accuracy. GPS and mGPS showed moderate performance, whereas CAR exhibited the lowest overall discriminative ability for both outcomes.Keywords: geriatric emergency care, community-acquired pneumonia, prognostic scores, pneumonia severity index, PSI, glasgow prognostic score, GPS, C-reactive protein to albumin ratio, CA

Nodular duodenitis in patients with end-stage renal disease (ESRD)

[No abstract available

Factors Associated With Multiple Falls Among Elderly Patients Admitted to Emergency Department

Background: Fall related injuries constitute a significant part of emergency department admissions of geriatric patients. Recurrent falls are also not uncommon. The aim of this study is to evaluate the factors that might be related with multiple falls among the elderly patients admitted to emergency department. Methods: The study was conducted between 1st May 2014 and 31 October 2014 at a tertiary education and research hospital in Istanbul, Turkey. All the patients over 65 years who admitted to emergency department due to falls were included. Patients and/or their relatives were asked to answer the questions searching for possible factors that may interfere with their multiple falls. Results: During the study period 308 patients over 65 years old admitted to emergency department. 51% were between 65 and 79 years old and 49% were >80 years old. The women constituted the 70.1% of the cases. The majority of the cases described the mechanism of injury as stumbling and fall (72.4%). Factors related with multiple falls were as follows: being between 65 and 79 ages, being physically active before the fall event, having chronic cardiovascular and neurologic diseases and being on benzodiazepine and SSRI medication. Conclusion: Physically active and relatively younger elderlies fall more frequently. As the most commonly described mechanism was stumbling and fall, the importance of environmental risk factors is emphasized. Patients with cardiovascular and neurological diseases should be further evaluated for increased fall risk and indications of benzodiazepines and SSRI's in elderly people should be well evaluated