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Cremona, Italy

Morandi A.,Ancelle Hospital | Morandi A.,Geriatric Research Group | Morandi A.,Center for Quality Aging | Barnett N.,Vanderbilt University | And 12 more authors.
Journal of Critical Care | Year: 2013

Purpose: The pathophysiology of delirium in critical illness is unclear. 25-OH vitamin D (25-OHD) has neuroprotective properties but a relationship between serum 25-OHD and delirium has not been examined. We tested the hypothesis that low serum 25-OHD is associated with delirium during critical illness. Materials and Methods: In a prospective cohort of 120 medical intensive care unit (ICU) patients, blood was collected within 24 hours of ICU admission for measurement of 25-OHD. Delirium was identified once daily using the Confusion Assessment Method for the ICU. Multivariable logistic regression was used to analyze the association between 25-OHD and delirium assessed the same day and the subsequent day after25-OHD measurement, with adjustments for age and severity of illness. Results: Median age was 52 years (interquartile range, 40-62), and Acute Physiology and Chronic Health Evaluation II was 23 (interquartile range, 17-30). Thirty-seven patients (41%) were delirious on the day of 25-OHD measurement. 25-OHD levels were not associated with delirium on the day of 25-OHD measurement (odds ratio, 1.01; 95% confidence interval, 0.98-1.02) or on the day after measurement (odds ratio, 1.01; 95% confidence interval, 0.99-1.03). Conclusions: This pilot study suggests that 25-OHD levels measured early during critical illness are not important determinants of delirium risk. Since 25-OHD levels can fluctuate during critical illness, a study of daily serial measurements of 25-OHD levels and their relationship to delirium during the duration of critical illness may yield different results. © 2013 Elsevier Inc. Source


Morandi A.,Ancelle Hospital | Morandi A.,Geriatric Research Group | Girard T.D.,Vanderbilt University | Girard T.D.,Geriatric Research | And 13 more authors.
Rejuvenation Research | Year: 2014

The effect of statins on functional status in older patients is unclear. Statins might carry a deleterious effect on muscle function leading to myopathy and therefore affecting functional recovery. We evaluated the relationship between statin exposure at in-hospital rehabilitation admission and functional outcome at discharge. This was a retrospective cohort study of older patients 70 years and older consecutively admitted to an in-hospital rehabilitation after an acute hospitalization. Statin exposure was measured at the time of rehabilitation admission. Functional status was defined with the Barthel Index (BI) score at the time of discharge. A multi-variable linear regression model was used to evaluate the association between statin exposure and functional status at discharge adjusting for potential confounders through a propensity score for statin exposure. A total of 2435 patients were included. The cohort had a mean age of 81.1 years. Of these 9% (n=220) were on statins at the time of admission. In the multi-variable analysis, the use of statins at the time of admission was independently associated with an improved functional status at discharge (point estimate 5.2; 95% confidence interval 1.5-8.9; p<0.01) after adjusting for relevant confounders. Patients who were receiving statins at the time of admission had a BI score 5 points higher compared to those who were not receiving statins. The use of statins was overall safe in a group of co-morbid older patients undergoing rehabilitation training after an acute hospitalization. Additionally, a possible benefit was found given the positive association between statin use and higher functional status at discharge. © 2014, Mary Ann Liebert, Inc. Source

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