52 / 210
S44
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
30 patients died in the hospital. At 6 months, 33 patients died,
with an average survival of 40.2 days. The SAPS 2 seems to be a
major prognostic factor in the mortality of patients aged over 80
years (p
<
0.0001). The SAPS II and hospitalization in intensive care
were significant prognostic markers. It was difficult to assess the
previous autonomy of patients included.
Conclusions:
A future prospective study will provide a detailed
analysis of the autonomy of patients aged over 80 years.
P-046
Geriatric care: how the Bouchon’s 1, 2, 3 model in geriatrics
become important, about a case
M. Richard
1
, F. Truchon
1
, C. Germain
1
, L. Babe
1
, A. Martin-Kleisch
1
,
J.-L. Novella
2
, A.-A. Zulfiqar
1
1
CHU Reims, Reims, France;
2
France
Objectives:
In Geriatrics, issues in the care of frail elderly are
crucial and the cascade of events can be faster, despite appropriate
therapeutic approach.
Methods:
We illustrate this problem by a clinical case.
Results:
A 83-year-old patient is admitted for fall, without loss of
consciousness, with biological rhabdomyolysis. He is followed for a
treated ischemic heart disease, hypertension treated. Discovery of a
meticillin-sensitive
Staphylococcus aureus
prostatitis which needed
antibiotics treatment. During his hospitalization, finding a right
knee edematous, hot and painful. The knee joint puncture finds
a turbid liquid with a bacteriological culture, finding a meticillin-
sensitive
Staphylococcus aureus
infection, which is complicated by
an atrial fibrillation. Therapeutic approach combining oxacillin-
aminoglycosides is prescribed. No prescription of anticoagulants
because of a discovery of a rectal bleeding (investigations for
melena may be realized after the decrease of septic context).
No endocarditis is discovered. At 10 days, sudden onset of right
lower limb with pulselessness. The CT angiography revealed acute
ischemia of the right leg, which led to a thrombectomy. Medically,
prescription of anticoagulants is realized but causing acute blood
loss by the increase of melena. Despite support transfusion, the
patient died a few days later.
Conclusions:
The occurrence of acute ischemia, urgent medical
and surgical pathology can combine fibrinoid and septic events.
In addition, the cascade of medical events in a frail elderly is a
source of high morbidity and mortality. This shows the temporal
dimension of the model of the frailty and importance of its early
detection in the elderly.
P-047
Hypervitaminia B12: Cross study in an acute geriatric unit
over a period of three months
A.-A. Zulfiqar
1
, A. Sebaux
1
, M. Dram´e
1
, E. Andres
2
, J.-L. Novella
3
1
CHU Reims, Reims, France;
2
CHRU Strasbourg, Strasbourg, France;
3
France
Objectives:
No consensus to date defines what to do in front of the
discovery of a hypervitaminia B12, especially in the elderly.
Methods:
Prospective study in an acute geriatric unit between
March 26 and June 30 2014 collecting all patients over 65 years
with hypervitaminia B12, as defined by the biochemistry laboratory
of the University Hospital of Reims (
>
663 pg/ml).
Results:
190 patients were hospitalized, 48 had a hypervitaminia
B12 (25.3%). 10 patients had vitamin B12 deficiency (5.3%). The
sex ratio of the population having increased vitamin B12 was
0.5. The average rate was 1085 pg / ml The average Charlson
score was at 7 (
±
2.4). In univariate analysis, the significant
related factors for hypervitaminia B12 were: acute renal failure
(p = 0.0002); liver disease (acute or chronic (p
<
0.0001); acute liver
disease (p
<
0.0001), chronic liver disease (p = 0.029). solid neoplasm
(p = 0.0030) Hepatic metastases were at the limit of significance
(p = 0.0622). No significant difference for chronic renal failure,
malnutrition, the red cell folate, or level of comorbidity (Charlson
score). In multivariate analysis, the variables independently related
to hypervitaminia B12 were: acute renal failure (odds ratio =
6.3; p
<
0.0001); liver disease (odds ratio = 5.4; p
<
0.0001);
hematological diseases (odds ratio = 5.7; p = 0.0017).
Conclusion:
Hypervitaminia B12 is associated mainly to solid
neoplasms and liver diseases. Hypervitaminia B12 could be a real
marker in the diagnosis and prognosis orientation of these disorders
in the elderly.
P-048
Hyperuremia in the elderly: Think about upper gastrointestinal
bleeding
S. Lescuyer
1
, A.-A. Zulfiqar
2
1
CHRU Strasbourg, Strasbourg, France;
2
CHU Reims, Reims, France
Objectives:
Hyperuremia in the upper gastrointestinal bleeding is
unknown, despite a pathophysiology explained.
Methods:
We report the case of a patient of 83 years illustrating
this problem.
Results:
The patient is sent to Emergency for hypotension and
delirium. The diagnosis of acute aplastic anemia is made with
hemoglobin 7.6 g/dl, in the context of cardiovascular collapse.
His treatment was two gastrotoxic: aspirin and celecoxib. The
review find no externalized bleeding, only epigastric tenderness.
Biology shows no inflammatory syndrome, normal creatinine (63
micromol/l) and increased urea (22.9mmol/l). Fluid resuscitation
and transfusion of packed red blood cells are both begun. A peptic
ulcer is suggested by taking two major gastrotoxic and elevated urea
with normal creatinine. An inhibitor of proton pump treatment
is introduced. A gastroesophageal gastroduodenal endoscopy is
recommended in emergency but refused by gastroenterologists
because of lack of stronger arguments. Unfortunately, he was
admitted to the ICU for hemorrhagic shock secondary to a
gastroduodenal ulcer perforation and ischemic colitis. He died
because of infectious complications.
Conclusions:
Blood protein digestion produces amino acids which
are reabsorbed in the proximal gastrointestinal tract, causing
increased blood urea (urea is used in the Glasgow-Blatchford score).
Studies should be conducted to examine the intrinsic and extrinsic
values hyperuremia for unexplained acute anemia. This biological
sign must attract attention, especially if there are other risk factors
for peptic ulcer, and could serve as an orientation particularly in
the elderly. It should not be directly linked on an extra-cellular
dehydration, while renal function is preserved.
Biogerontology and genetics
P-049
A short leukocyte telomere length predicts insulin resistance
S. Verhulst
1
, C. Dalg ˚ard
2
, C. Labat
3
, J.D. Kark
4
, M. Kimura
5
,
K. Christensen
6
, S. Toupance
7
, A. Aviv
5
, K.O. Kyvik
2
, A. Benetos
7
1
University of Groningen, Groningen, Netherlands;
2
University of
Southern Denmark, Odense, Denmark;
3
Inserm U 1116, Vandoeuvre-
l`es-Nancy, France;
4
Hebrew University-Hadassah School of Public
Health and Community Medicine, Jerusalem, Israel;
5
The State
University of New Jersey, New Jersey, United States of America;
6
University of Southern Denmark, Odense C, Denmark;
7
France
A number of studies have shown leukocyte telomere length (LTL)
to be inversely associated with insulin resistance and shorter in
type 2 diabetes mellitus. The aim of the present longitudinal study,
utilizing a twin design, was to assess whether shorter LTL predicts
insulin resistance or is a consequence thereof.