title: Prognosis in the hospitalized very elderly: the PROTEGER study.
abstract: BACKGROUND
  It was reported that many recognized cardiovascular risk factors were no longer valid in the very elderly and, sometimes, even act in the opposite direction. It remains unclear which cardiovascular risk factors are still vital for death prediction in the oldest-old population.
  
  
  METHODS
  We assessed cardiac abnormalities and dysfunction by ultrasonography and electrocardiography, blood pressure and arterial stiffness by BP monitor and tonometry, and biochemical parameters by routine laboratory assay, and investigated their associations with all-cause mortality in 331 hospitalized elderly patients (mean age ± standard deviation: 87 ± 7 years). After a mean follow-up of 378 days, 110 deaths occurred.
  
  
  RESULTS
  As compared with survivals, patients with all-cause mortality had significantly lower left ventricular ejection fraction (LVEF) (57.5 ± 13.8% vs 62.4 ± 11.2%, P = 0.002), low-density lipoprotein (LDL) (3.13 ± 0.98 vs 3.56 ± 0.98 mmol/L, P<0.001) and high-density lipoprotein (HDL) cholesterol (1.06 ± 0.30 vs 1.14 ± 0.32 mmol/L, P = 0.04), albumin (33.1 ± 5.4 vs 35.1 ± 4.5 g, P = 0.002), and creatinine clearance rate (Ccr) (42.4 ± 19.4 vs 55.8 ± 28.2 mL/min, P<0.001), and higher incidence of atrial fibrillation (26.4% vs 12.7%, P = 0.002). In multivariate Cox regression model, LVEF, atrial fibrillation, LDL cholesterol, albumin and Ccr were significant and independent death predictors with hazard ratios of 0.82 (0.70, 0.97), 1.74 (1.11, 2.74), 0.70 (0.57, 0.87), 0.66 (0.54, 0.82) and 0.57 (0.44, 0.75), respectively.
  
  
  CONCLUSIONS
  In the last stage of lifespan, cardiac systolic dysfunction and atrial fibrillation, as well as malnutrition and renal insufficiency, are crucial risk factors, which should be fully considered in the risk assessment strategy of the hospitalized elderly with cardiovascular diseases.
authors.affiliation: Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Athanase D
authors.initials: AD
authors.lastname: Protogerou
authors.forename: Pierre
authors.initials: P
authors.lastname: Iaria
authors.forename: Michel E
authors.initials: ME
authors.lastname: Safar
authors.forename: Yawei
authors.initials: Y
authors.lastname: Xu
authors.forename: Jacques
authors.initials: J
authors.lastname: Blacher
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Blood pressure; Elderly; Left ventricular ejection fraction; Mortality; Pulse wave velocity