European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

176 / 290

Introduction: Around 1/4 of the strokes is cryptogenic. 25% of the
strokes is related to atrial fibrillation (AF), which is often asymptomatic
and difficult to detect. Implantable Loop Recorder (ILR) proved to
be superior than conventional follow-up in detecting AF after a
cryptogenic stroke (1).
Methods: Between 2010 and 2016, 26 patients with cryptogenic stroke
underwent ILR implantation, aimed at detecting AF; 2 other patients
with a complex clinical scenario, have been implanted to better guide
the therapy.
Results: Mean age was 69 years. 67% of the patients was on
acetylsalicyclic acid, 10.7% on thienopyridines and 7.1% of the patients
was on double anti-platelet therapy. 2 patients with a complex clinical
scenario were on oral anticoagulant therapy.
After a mean follow-up of 10 ± 12 months, AF was detected in 7
patients, two of whom also experienced asystole. One patient with
AF, stroke and syncope showed an asystole lasting 20 seconds. One
patient with paroxysmal AF after an acute myocardial infarction,
showed recurrence of AF, that led to maintain oral anticoagulation. A
pacemaker was implanted in 3 patients, 4 patients started warfarin
and 2 patients new oral anticoagulant therapy.
Conclusions: The ILR is a useful device both in the diagnosis of
arrhythmias and in guiding the therapy in complex clinical scenarios.
Reference
1. Sanna T, Diener HC, Passman RS et al. Cryptogenic stroke and
underlying atrial fibrillation. N Engl J Med . 2014;370:2478 –86.
P-534
Should we use Cystatine C based equations to estimate GFR in
elderly patients 80 plus?
P. Weiler, B. Hölzl. Landesklinik St. Veit, Paracelsus Medical University,
Salzburg, Austria
Background: The incidence of chronic kidney disease (CKD), heart
failure (HF) and atrial fibrillation (AF) is increasing with age. Aim of
the study was to analyze the correlation between creatinine and/or
cystatine based estimated GFR equations and NT-proBNP or AF,
respectively.
Methods: 100 consecutive patients, mean age 86 (80–95), 81% females
were included. eGFR was calculated employing MDRD, CKD-Epi 2009
(creatinin based), CKD-Epi 2012 (creatinine/cystatine based) and
Grubb equation (cystatine/age) respectively. NT-proBNP was mea-
sured. Additionally the prevalence of AF was determined in the
study population. Anova, Spearman ’s and Pearson-Correlation-Test,
Mann-Whitney U Test, Chi squared Test, logistic regression test were
applied.
Results: NT-proBNP (median 3,617 pg/mL with 779 pg/mL without
AF) correlated highly significant (p 0,0001) with AF NT-proBNP higher
than 500 pg/mL showed lower eGFR (p 0,019) (Grubb Formula). Cut
off point was 900 pg/mL (p 0,054) for MDRD Equation. Patients
with AF showed lower eGFR (Grubb Formula: p 0,032); (CKD-Epi 2012:
p 0,042); (CDK-Epi 2009: p 0,05); (MDRD: p 0,07 ns).
Conclusion: Cystatine C based equations to estimate GFR in elderly
patients showed a higher association with cardiovascular risk factors
as HF and AF, than creatinine based formulas. Reliable risk stratification
may help to avoid over- or undertreatment, especially in the elderly.
Area: Infectious diseases and vaccines
P-535
Golden hours of sepsis for long term patients in Enaya Specialized
Care Center
I. Badarudeen, H. Alhamad, S. Osman, M. Malkawi, R. Attalla,
N. Alsalami, W. Alam. Hamad Medical Corporation, Doha, Qatar
Introduction: The Enaya Specialized Care Center is a support facility
that works with Hamad General Hospital and Rumailah Hospital and
provides 24-hour care to long-term patients. The center features 156
patient beds, is the only specialized facility of its kind in Qatar, and one
of the first in the Arab World. Sepsis is one of the most prevalent
diseases and one of the main causes of death among hospitalized
patients. The Severe Sepsis 3-Hour Bundle represents a distillation of
the recommendations found in the practice guidelines published by
the Surviving Sepsis Campaign.
In Enaya, there was low rate of compliance (52%) with 3 hours sepsis
bundle (blood cultures, intravenous fluids, lactate level, antibiotics) in
patients with sepsis which leads to increased morbidity and mortality.
A quality improvement project was carried out from September 2015
to December 2015.
Aim:To increase the compliance rate of 3 hour sepsis bundle from 50%
to 80% in patient with sepsis in ENAYA.
Methodology:
• Data collection and analysis
• Educational sessions and surveys
• Designed pocket cards on systemic inflammatory response
syndrome and sepsis for nurses and doctors
• Designed, piloted and implemented a compliance monitoring tool
for the monitoring compliance to sepsis bundle
Results: By the end of December 2015, the compliance to sepsis
bundle improved from52% to 100%. In themonths thereafter, the effect
of our project was sustained through January-March 2016, with
compliance rate average of 94%.
P-536
Clostridium difficile infection mortality prediction model in
geriatric patients
K. Bielakova, H.M. Kubešova. Department of Internal Medicine, Geriatrics
and General Practice, Faculty of Medicine, Masaryk University, Faculty
Hospital Brno, Czech Republic
Introduction: Clostridium difficile infection (CDI) is becoming a
serious problem predominantly in geriatric patients, who are a
significant risk group. The goal of this study was to evaluate the risk
factors for mortality in CDI patients and to construct a binary logistic
regression model which describes the probability of mortality in
geriatric patients suffering from CDI.
Methods: In this retrospective study the group of 235 patients over 65
years of age with confirmed diagnoses of CDI, hospitalised at the
Department of Internal Medicine, Geriatrics and General Practice,
Brno, from January 2008 to December 2013, were evaluated. The
examined group consisted of 148 women (63%) and 87 men (37%). For
the diagnosis of CDI, confirmation of A and B toxins in the patients’
stool or autopsy confirmation was crucial.
Results: The impact of antibiotic therapy in patients’ histories on the
increased incidence of CDI was clearly confirmed in our study group.
Other risk factors included cerebrovascular disease, dementia, the
presence of pressure ulcers and immobility. Our new model con-
sisted of a combination of the following parameters: the number of
antibiotics used from patients’ history, nutritional status (Mini
Nutritional Assessment short-form test), presence of pressure ulcers,
and occurrence of fever.
Conclusion: Our logistic regression model may predict mortality in
geriatric patients suffering from CDI. This could help improving the
therapeutic process.
P-537
Seroprevalence of hepatitis B and hepatitis C virus infections in
elderly residents in nursing homes in a metropolitan area of Sicily
D. Brischetto1, G. Caccamo2, S. Maimone2, P. Parisi3, G. Pettinato4,
A. Catalano1, A. Lasco1, G. Basile 1, G. Raimondo 2. 1Unit of Geriatrics,
University Hospital of Messina, 2Unit of Clinical and Molecular
Hepatology, University Hospital of Messina, 3Nursing Home “Opus”,
4Nursing Home “Giardino sui Laghi”, Messina, Italy
Introduction: The hepatitis B virus (HBV) and hepatitis C virus (HCV)
prevalence in Italy is reported to be significantly higher in elderly
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S170