Background Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU). Methods A monocentric, retrospective, observational study of all patients aged ≥ 75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables. Results A total of 345 patients were included (56% female, mean age 85 +/- 6.5 years). Mean FIM score was 66 +/- 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68% and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores. Conclusions In the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.
Background Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU).MethodsA monocentric, retrospective, observational study of all patients aged ≥ 75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables.Results A total of 345 patients were included (56% female, mean age 85 +/- 6.5 years). Mean FIM score was 66 +/- 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68% and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores.Conclusions In the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.
Fusobacterium necrophorumis a Gram-negative anaerobic bacterium that can lead to severe infection in young patients even without immunodeficiency. Due to the length of time for isolation and speciation of this Gram-negative bacillus (typically 5–8 days), and its potential mortality, broad-spectrum antibiotic therapy should be started without delay. With a cervical thrombosis, even on an unusual site and with a standard condition such as tonsillitis, Lemierre syndrome should be considered. We report a case of Lemierre syndrome in a previously healthy young woman.
Rationale:Gaucher disease (GD) is a rare genetic lysosomal storage disorder inherited in an autosomal recessive pattern. GD is due to the deficiency of a lysosomal enzyme, acid beta-glucosidase (or glucocerebrosidase). Type 1 Gaucher disease (GD1) is characterized by thrombocytopenia, anemia, an enlarged spleen, and liver as well as bone complications (Erlenmeyer flask deformity, osteoporosis, lytic lesions, pathological and vertebral fractures, bone infarcts, and avascular necrosis leading to degenerative arthropathy). The diagnosis is usually made in first decades but is sometimes delayed. Parkinson disease, neoplasia, and immune system abnormalities may be associated with GD1.Patient concerns:A patient known for hepatosplenomegaly with hyperferritinemia, anemia, and thrombocytopenia was admitted for Lewy body dementia and bullous pemphigoid.Diagnoses:Type 1 Gaucher disease.Intervention:No specific treatment started.Outcomes:patient died ten months later due to pneumonia.Lessons:To the best of our knowledge, this is the first case of the association between GD1, bullous pemphigoid, and Lewy body dementia. We discuss the central role of alpha-synuclein in these pathologies.
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