Magnesium levels among critically ill elderly patients;mortality and morbidity correlation

Objectives: To evaluate the association between magnesium levels, morbidity and mortality in critically ill elderly patients admitted in ICU. Methods: A cross-sectional study was done on patients admitted to the intensive care unit (ICU) of the Geriatrics department at a University Hospital over 1.5 years period. Data collected included patients demographics and medical history, length of stay in the ICU. Lab tests included serum Magnesium on admission, serum sodium and potassium. In addition, the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Sequential Organ Failure Assessment (SOFA) score were determined at the day of admission. Results: A single center, cross sectional study was done on 100 patients who were admitted to the Geriatrics medical ICU at Ain Shams university Hospital in Cairo. At admission 23% of patients had low magnesium (Mg) level and 59% had normal magnesium level and 18% had high Mg level. The mean age of patients with hypomagnesaemia was 71.69 years old while those with normal magnesium level were 69.5 years old and that with hypermagnesaemia were 69.7 years old. The length of ICU stay was longer among patients with high Mg level (11.7 ± 14.4 days) and among those with normal magnesium level (7.6 ± 5.8 days) versus (7.5 ± 3.8 days) those with low Mg level, among the studied groups (55.6%) of patients with Hypermagnesaemia died versus (44.1%) of patients with normal Mg level. Among the studied groups, those with high Mg level were found to have higher APACHE II score (20.7 ± 7.4) and SOFA score (5.5 ± 3.6) than the other subjects. Significant positive correlation was found between mean Mg level and SOFA score. Conclusion: Development of hypermagnesaemia during an ICU stay is associated with bad prognosis. Monitoring of serum magnesium levels may have prognostic, and perhaps therapeutic, implications.

S100B and delirium in the geriatric acute care setting

Delirium and its relation to biochemical markers have been considered a study question in several research works. The relation between S100B levels and delirium is still a matter of discussion. Objective: To compare the serum level of S100B in patients with and without delirium and to detect the relation between S100B and delirium subtypes. Method: A case control study was conducted on 114 elderly (60 years and older) selected from the geriatric acute care unit at Ain Shams University Hospitals. They were classified into two groups;58 elderly cases who had delirium diagnosed by Confusion Assessment Method and 56 controls. Then delirium was reclassified according to the subtypes of delirium into Hyperactive: 46 patients, hypoactive: 2 patients, and Mixed: 10 patients. Serum S100B levels were determined by ELISA. Results: Cases were significantly older than controls (72.4 ± 9.4 versus 66.9 ± 5.3 years respectively) (P < 0.001). S100B levels were higher in cases (32.4 ± 9.8 pg/ml) than controls (30 ± 9.3 pg/ml) but the difference was not statistically significant (P = 0.19). There was no significant difference in S100B levels between the different subtypes of delirium. Conclusion: Delirious patients had higher S100B levels than controls but the difference was not statistically significant.

Geriatrics intensive care unit: Outcome and risk factors for in hospital mortality

OBJECTIVES: To evaluate outcome and risk factors, particularly the (APATCHE II) score in elderly patients after admission to a geriatrics intensive care unit (ICU). Methods: A cross sectional study of patients ≥ 60 years admitted to the intensive care unit (ICU) of the Geriatrics department at Ain Shams University Hospital over 2 years period. We recorded age, sex, previous medical history, primary diagnosis, date of admission and discharge or death and APACHE II score on admission. Results: 202 patients admitted to the ICU were studied. The mean ICU mortality rates for these patients were (32, 5%), the mean APATCHE II score was (19.07). 27.3% of patients who died had hypokalemia and 43.2% had hyponatremia. Conclusion: ICU mortality rate are higher in elderly patients particularly with long ICU stay and hyponatremia.

Nocturia: Impact on quality of life in an Egyptian adult population

OBJECTIVE: To estimate the effects of nocturia on quality of life (QoL) and to assess the associated effects of sleep problems. Background: Nocturnal urination (nocturia) is such a commonplace occurrence in the lives of many older adults that it is frequently overlooked as a potential cause of sleep disturbance. Methods: The current study was carried out to assess the prevalence of nocturia in elderly males and its impact on sleep quality and QoL. The study enrolled 200 elderly males aged 60 years old and above. All participants were recruited from geriatric clubs in Cairo. All participants in the study were subjected to: comprehensive geriatric assessment, American Urological Association (AUA) score used to measure the severity of nocturia ,assessment of sleep quality using Pittsburgh Sleep Quality Index (PSQI) and assessment of QoL using “SF-12 Short Form Health Survey”. Results: The study showed that the prevalence of nocturia in elderly males aged ≥60 years old was 68% with significant association between nocturia and diabetes mellitus, heart failure, stroke, prostatism, recurrent UTI and diuretic use. As regard sleep quality, the current study showed that the prevalence of poor sleep in the studied subjects is 70.5% with significant association between nocturia and poor sleep quality. Nocturia significantly affects sleep latency, sleep efficiency and daytime dysfunction, high significantly affecting sleep disturbance. Also diabetes mellitus, ischemic heart disease, heart failure, prostatism, recurrent UTI, osteoarthritis and diuretic use are significantly associated with poor sleep quality. As regard quality of life, the current study showed significant association between nocturia and physical and mental health components of HRQL in the univariate analysis. But after multivariate analysis, nocturia is not an independent risk factor for poor quality of life. Nocturia affects QoL through its effect on sleep quality which is an independent risk factor for poor physical and mental health components of QoL. Conclusion: Nocturia may lead to sleep insufficiency and consequently to a decrease in mental and physical health. Patients who consult a doctor for nocturia should thus be treated adequately. In addition, it is worthwhile for doctors to routinely check if patients’ who contact them for sleep problems also have nocturia.