Jingxian Liao

Delirium and mortality are major complications in elderly septic patients. Current prediction tools, like Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, often overlook metabolic stress and nutritional deficits. This study assessed the combined prognostic value of blood lactate (Lac), Mini Nutritional Assessment-Short Form (MNA-SF), and SOFA scores for delirium and 28-day mortality. A cohort of 304 elderly septic patients was retrospectively analyzed. Key predictors (Lac, MNA-SF, SOFA) were evaluated using Restricted Cubic Spline (RCS) and logistic regression. Receiver operating characteristic (ROC) curves and AUC values quantified predictive models, while mediation analysis explored the indirect effects of Lac on outcomes. Delirium was observed in 36.2% of patients, with a 28-day mortality rate of 24.7%. Elevated lactate (≥4.23 mmol/L) correlated with worse MNA-SF scores ( r = -0.284, P < .05). RCS showed a nonlinear association of Lac with delirium and mortality, with risks sharply rising beyond 4 mmol/L. Independent Lac (OR > 3.0 at 4 mmol/L) and combined Lac-MNA-SF-SOFA models yielded high predictive accuracies for both delirium (AUC = 0.922) and mortality (AUC = 0.853). Mediation analysis demonstrated that nutritional status (MNA-SF) and organ dysfunction (SOFA) explained 33.85% of Lac effect on delirium and 54.30% on mortality. Integrating Lac, MNA-SF, and SOFA scores enhances early stratification of delirium and mortality risks in septic elderly patients. Interventions focusing on metabolic and nutritional optimization can significantly improve prognosis. Routine Lac and MNA-SF screening offer actionable insights for personalized care, helping reduce complications, shorten hospital stays, and improve survival rates in this vulnerable population.

Objective: Ischemic stroke caused by large artery atherosclerosis (LAA) is a major subtype of ischemic stroke and poses a heavy public health burden. Plasma atherogenic index (AIP) reflects the balance between pro- and anti-atherogenic lipid components and has emerged as a potential biomarker of cardiovascular disease. The aim of this study was to investigate the role of AIP in predicting ischemic stroke caused by LAA.Methods: This retrospective, cross-sectional study involved 2,382 ischemic stroke patients. AIP values were measured, and subjects were further stratified according to AIP levels. Univariate and multivariate logistic regression analyses were conducted to explore the relationship between AIP and the risk of LAA. Restricted cubic spline (RCS) analysis was used to detect the potential non-linear relationship, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive ability of AIP. Subgroup analyses were carried out to identify specific populations with a higher risk of LAA.Results: Individuals with consistently high levels of AIP were at increased risk of developing LAA, and this risk increased progressively with increasing levels of AIP. RCS analyses showed a threshold of 0.10 for the AIP index, a significant increase in the probability of LAA above this threshold, and a non-linear relationship between AIP and LAA. Univariate and multivariate logistic regression analyses showed that, as a continuous variable, each unit increase in AIP was significantly associated with an elevated risk of LAA. When divided into quartiles, the risk of LAA was higher in Q4 compared with the lowest quartile (Q1), and ROC curve analyses confirmed that AIP had moderate sensitivity and specificity in predicting LAA. Subgroup analyses showed that among individuals with consistently high AIP levels, those aged ≥60 years with a history of diabetes and low-density lipoprotein cholesterol (LDL-C) < 3.4 mmol/L were at higher risk of developing LAA.Conclusion: Herein, we found that elevated AIP levels are significantly associated with increased LAA risk and are an important biomarker to help identify patients at high risk for LAA.

Background: Sepsis is a life-threatening condition with particularly high mortality rates among the elderly. This study investigates the dynamic monitoring of heparin-binding protein (HBP) levels as prognostic biomarkers to improve risk stratification and management in elderly septic patients.Methods: We conducted a retrospective cohort study involving patients aged 65 and older who were hospitalized for sepsis. Data were extracted from electronic medical records, including demographic, clinical, and laboratory information. We analyzed the relationship between dynamic HBP levels and 28-day mortality using linear mixed-effects models to assess the effects of time and prognostic groups.Results: Among 386 elderly septic patients, the 28-day mortality rate was 20.73%. HBP levels were significantly elevated at all time points in the mortality group compared to the survival group (p < 0.001). The linear mixed-effects model indicated that time, prognosis group, and their interaction significantly influenced HBP levels. In the survival group, HBP levels decreased significantly over time, whereas the mortality group exhibited a smaller reduction, with HBP levels remaining elevated overall. The prognostic predictive ability of HBP improved at various time points, with the combined model of HBP and C-reactive protein (CRP) showing time-varying area under the curve (AUC) values: 0.728 on day 10, 0.744 on day 15, and 0.803 on day 20. The time-dependent ROC curve demonstrated that the combined model consistently exhibited superior discriminative ability throughout the follow-up period. Additionally, the time-dependent Cox regression model indicated that dynamic HBP levels effectively predicted 28-day mortality risk across all subgroups (p < 0.001).Conclusion: Dynamic monitoring of HBP levels may aid in risk stratification and support clinical decision-making. Further prospective studies are required to evaluate its clinical utility and potential impact on patient management.

The prognostic significance of dynamic changes in the albumin-to-C-reactive protein ratio (ACR) in elderly patients with community-acquired pneumonia (CAP) has not been fully elucidated. This study aims to evaluate the utility of ACR as a dynamic biomarker for predicting 28-day mortality and enhancing risk stratification in this high-risk population. A retrospective cohort study was conducted on 437 elderly CAP patients (≥65 years). Serum albumin and C-reactive protein (CRP) levels were measured at admission (T0), 24 hours (T1), and 3 days (T2) post-admission. ACR was calculated for each time point, and its prognostic value was assessed using advanced statistical methods. The 28-day mortality rate was 16.7%. ACR levels were consistently lower in non-survivors across all time points (P < 0.001). RCS analysis revealed a nonlinear relationship between ACR and mortality risk. Time-varying ROC analysis demonstrated that ACR consistently outperformed CRP in predicting mortality, with superior area under the curve (AUC) values at all time points. Random-effects modeling indicated minimal inter-individual variability in ACR (random effects variance: 0.030; standard deviation: 0.175). Time-varying Cox regression confirmed a strong negative association between dynamic ACR changes and mortality risk, with a C-statistic of 0.833 (P < 0.001). Dynamic monitoring of ACR is a robust and clinically applicable tool for predicting short-term mortality in elderly CAP patients. By integrating markers of inflammation and nutritional status, ACR facilitates early identification of high-risk patients and supports personalized treatment strategies. These findings highlight the potential of ACR as a novel biomarker for improving clinical outcomes in this vulnerable population.

Malnutrition and insulin resistance are linked to complications like delirium, yet their impact on elderly heart failure patients remains underexplored. This study investigates how nutritional status and the triglyceride-glucose (TyG) index influence delirium in this population. We conducted a retrospective study involving patients aged 75 and older with decompensated heart failure. Delirium was assessed using the Confusion Assessment Method (CAM), and nutritional status was evaluated with the Mini Nutritional Assessment Scale-Short Form (MNA-SF). The TyG index was calculated as: TyG index = ln [triglycerides (mg/dL) x fasting glucose (mg/dL) / 2]. The study included 412 patients (mean age 84.30 +/- 5.16 years; 56.31% male), with 24.03% experiencing delirium during hospitalization. After adjusting for confounders, a higher TyG index was significantly associated with increased delirium risk (OR = 1.549, 95% CI: 1.102-2.178, P = 0.012), while a higher MNA-SF score correlated with reduced risk (OR = 0.793, 95% CI: 0.662-0.949, P = 0.011). Kaplan-Meier analysis showed significant differences in cumulative survival based on nutritional status and TyG index (Log-Rank test: chi(2)= 65.604, P < 0.001). Mediation analysis indicated that nutritional status partially mediated the relationship between the TyG index and delirium, and vice versa. Malnutrition and elevated TyG index levels increase delirium risk in elderly heart failure patients, underscoring the need for effective nutritional management and metabolic regulation.

Purpose: This study proposes a multiple mediation model to evaluate the association among diminished physical performance, malnutrition, inflammation, and delirium in seniors with community-acquired pneumonia. Patients and Methods: This retrospective cohort study included elderly patients hospitalized for community-acquired pneumonia at the Geriatrics Department of the Second People’s Hospital of Lianyungang from January 1, 2020, to January 1, 2024. Logistic regression analysis was conducted to examine the associations among physical performance, nutritional status, C-reactive protein (CRP) levels, and delirium. Mediation models assessed the effects of nutritional status and CRP on the relationship between physical performance and delirium, with subgroup analyses based on diabetes status. Results: A total of 379 patients were included, with a mean age of 80.0± 7.4 years, and 51.7% were male. The incidence of delirium during hospitalization was 28.5% (n=108). Subgroup analyses revealed significant correlations between physical performance, nutritional status, and CRP (P< 0.001), regardless of diabetes status. After adjusting for confounding variables, CRP was positively associated with delirium, while MNA-SF and SPPB scores showed negative correlations with delirium risk (OR=0.852, 95% CI: 0.730– 0.995; OR=0.580, 95% CI: 0.464– 0.727, P< 0.05). Mediation analyses indicated that MNA-SF scores and CRP significantly mediated the association between SPPB and delirium. Specifically, pathways “SPPB→ MNA-SF→ delirium”, “SPPB→ CRP→ delirium”, and “SPPB→ MNA-SF→ CRP→ delirium” demonstrated significant mediating effects in patients without diabetes, while only the pathway “SPPB→ MNA-SF→ CRP→ delirium” was significant in those with diabetes. Conclusion: Older patients with community-acquired pneumonia and poor physical performance are more susceptible to delirium, with nutritional status and inflammation as key mediators.

Background: Community-acquired pneumonia (CAP) is a significant health issue among the elderly, with severe cases (SCAP) having high mortality rates. This study assesses the predictive significance of the stress hyperglycemia ratio (SHR) in elderly SCAP patients and its impact on outcomes in both diabetic and non-diabetic patients. Methods and materials: This retrospective study included 406 SCAP patients aged 65 or older from the Second People’s Hospital of Lianyungang (January 2020 to December 2023). Data collected included demographics, medical history, vital signs, and lab results. SHR was calculated from initial blood glucose and estimated average glucose (HbA1c). Statistical analyses, including Cox regression and Kaplan-Meier analysis, evaluated SHR’s impact on mortality. Mediation models explored the effects of neutrophil-lymphocyte ratio (NLR) and SHR. Results: The 28-day mortality rate was 21.67%. Deceased patients had higher age, Charlson Comorbidity Index, procalcitonin, NLR, glucose, and SHR levels compared to survivors (P < 0.05). Both SHR and NLR significantly increased mortality risk, particularly in non-diabetic patients. Combining NLR and SHR improved ROC AUC to 0.898, with 89.80% sensitivity and 81.10% specificity. Kaplan-Meier analysis showed higher cumulative survival for SHR < 1.14, regardless of diabetes status (P < 0.05). NLR mediated 13.02% of the SHR-survival relationship, while SHR mediated 14.06% of the NLR-survival relationship. Conclusion: Elevated SHR is a significant mortality risk factor in elderly SCAP patients, independent of diabetes status. Stringent glucose control and careful monitoring of SHR may improve outcomes in elderly patients with acute respiratory conditions.

To investigate the relationship between malnutrition and delirium and its effect on prognosis in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. A prospective observational study was conducted. Patients with severe pneumonia aged ≥ 60 years old who underwent invasive mechanical ventilation admitted to department of critical care medicine of the Second People's Hospital of Lianyungang from January 2021 to December 2022 were enrolled. The confusion assessment method (CAM) was used to evaluate the delirium of the patients in intensive care unit (ICU). The score of CAM ≥ 1 was defined as delirium. Mini nutritional assessment short-form (MNA-SF) was used to assess the nutritional status of patients, and MNA-SF score ≤ 7 was defined as malnutrition. Patients were divided into delirium group and non-delirium group according to whether delirium occurred. The differences in clinical indicators, length of ICU stay, duration of mechanical ventilation and wake-up time after drug withdrawal were compared between the two groups. After 28 days of short-term follow-up, the patients were divided into death group and survival group, and the differences in the incidence of delirium and malnutrition between the two groups were compared. Binary multivariate Logistic regression analysis was used to screen the risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. Kaplan-Meier survival curve was used to analyze the effect of delirium on prognosis. A total of 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation were enrolled, of whom 98 survived and 34 died within 28 days, with a mortality of 25.76%. The incidence of malnutrition and delirium in the death group was significantly higher than that in the survival group (61.76% vs. 37.76%, 64.71% vs. 26.53%, both P < 0.05), and the MNA-SF score was significantly lower than that in the survival group (6.32±1.80 vs. 8.72±2.23, P < 0.01). Procalcitonin (PCT), interleukin-6 (IL-6) and blood lactic acid (Lac) in the death group were significantly higher than those in the survival group [PCT (μg/L): 4.47 (2.69, 10.39) vs. 2.77 (1.28, 5.94), IL-6 (ng/L): 204.08 (126.12, 509.85) vs. 120.46 (60.67, 290.99), Lac (mmol/L): 5.14 (2.75, 8.60) vs. 3.13 (2.16, 4.30), all P < 0.05], and the wake-up time after drug withdrawal was significantly longer than that in the survival group (minutes: 33.94±8.51 vs. 28.92±7.03, P < 0.01). Among 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation, 48 patients had delirium during ICU stay, and 84 patients did not have delirium. The incidence of delirium was 36.36%. The 28-day mortality in the delirium group was significantly higher than that in the non-delirium group (45.83% vs. 14.29%, P < 0.01), and the MNA-SF score was significantly lower than that in the non-delirium group (6.46±1.77 vs. 9.05±2.15, P < 0.01), the length of ICU stay, duration of mechanical ventilation, and wake-up time after drug withdrawal were also significantly longer than those in the non-delirium group [length of ICU stay (days): 13.40±9.59 vs. 10.06±7.81, duration of mechanical ventilation (hours): 197.06±89.80 vs. 138.81±82.30, wake-up time after drug withdrawal (minutes): 35.85±7.01 vs. 26.99±6.12, all P < 0.05]. Binary multivariate Logistic regression analysis showed that malnutrition [odds ratio (OR) = 7.527, 95% confidence interval (95%CI) was 2.585-21.917], Lac (OR = 5.345, 95%CI was 1.733-16.483), wake-up time after drug withdrawal (OR = 6.653, 95%CI was 2.021-21.904) were independent risk factors for delirium during ICU stay in elderly patients with severe pneumonia undergoing invasive mechanical ventilation (all P < 0.01). Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate of patients in the delirium group was significantly lower than that in the non-delirium group (54.17% vs. 85.71%), and the difference was statistically significant (Log-Rank test: χ² = 16.780, P < 0.001). The risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation during ICU stay include malnutrition, Lac, and wake-up time after drug withdrawal. The occurrence of delirium is closely related to poor prognosis.