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P-045: Evolution of patients of 80 years and over after a stay in intensive care unit: a retrospective study
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
P-042 Providing clear structure and leadership to an assessment area can reduce patient length of stay (LoS) and enhance staff experience A. Watson1 , A. Ali2 , D. Aw1 1 Nottingham University Hospitals, Nottingham, England; 2 United Kingdom Background: In September 2014, the Geriatric department took over the management of a medical assessment ward at Nottingham University Hospitals. A large team of consultants provided daily senior cover. Staff morale was low, patient care disjointed and there was a lack of leadership and consistency in ward processes. Objective: To provide leadership and improve consistency of ward processes to reduce LoS and enhance staff experience. Methods: A clinician lead and dedicated project manager were appointed to provide leadership and engage the team in the process redesign. Consultant job plans were modified to ensure daily geriatric presence. A standardised operating procedure (SOP) including roles and responsibilities was developed with the team. Through a series of Plan Do Study Act (PDSA) cycles we introduced: • A 9am “huddle” for staff allocation and safety and process messages. • Morning and afternoon board rounds. • “One stop” ward rounds. • Prioritisation sheets (identifying patients medically unwell or ready for discharge). • Optimised IT resources. We ran focus weeks where aspects of the SOP were score boarded to embed the process and enhance accountability. Results: LoS reduced from 35 to 29 hours. Morning and afternoon board round consistency increased (from 18% to 80% and from 24% to 60% respectively). Prioritised ward rounds increased from 18% to 100%. Consultants reported being clearer about their role (37% to 76%). The ward team felt happier coming to work (29% to 65%) and felt valued (18% to 59%). Conclusions: Clear leadership structure and guidance on roles, responsibilities and processes reduced length of stay, improved flow and improved staff experience. P-043 Older fall patients in the acute medical department: A descriptive cohort study M.R. Wejse1 , A.-K. Giger2 , E. Pressel3 Dep. of Geriatric Medicine, Bispebjerg Hospital, University of Copenhagen, Denmark, Copenhagen NV, Denmark; 2 Denmark; 3 Bispebjerg Hospital, Copenhagen NV, Denmark
1
Objective: Fall upon admission in older patients is frequent and often due to underlying disease, but little is known about this patient group. The aim of this study was to describe the clinical characteristics, complexity and illness-severity of a cohort of older fall patients admitted to the acute medical ward. Methods: We included 21 patients (>65 years old) who were admitted to the acute medical ward in October 2013 with the ICD-10 diagnosis fall (R29.6/7) or as a direct consequence of falling. The cohort was studied retrospectively and data was collected from the hospitals electronic journal system. We registered the number of acute diseases diagnosed or treated within the first three days after admission, vital parameters (EWS), 30-days mortality rate and length of stay. Furthermore we registered 30-day re-admission rate, comorbidity and polypharmacy. Results: 33.3% of our patients had died 30 days after admission. 43.3% had been admitted to hospital 30 days before or after the study period. On average 3.9 acute diseases were diagnosed or treated during the first 3 days after admission. The mean EWS-score was 4.2 indicating
S43
a medium observation level. Our patients received on average 7.4 medications and had 6.0 comorbidities. Conclusions: Older fall patients in the acute medical ward are characterized by acute medical conditions, multi-morbidity and polypharmacy. Mortality and admission rates are surprisingly high, indicating that there should be focus on these patients in the acute clinical setting. Further studies need to be done in order to proof our results in larger cohorts. P-044 Rates and potential risk factors for hospital readmissions of older patients M. Wibert1 , B. Hamoir2 , M. De Saint Hubert3 , C. Swine2 , D. Schoevaerdts4 1 CHU Dinant-Godinne, Courcelles, Belgium; 2 CHU Dinant Godinne UCL Namur, Yvoir, Belgium; 3 CHU Dinant-Godinne, Yvoir, Belgium; 4 CHU Dinant-Godinne UCL Namur, Floreffe, Belgium Objectives: To determine potential risk factors and hospital readmission rates within 6 months following an index hospitalization and test the association with the LACE (LI) and SCHONBERG indexes (SI). Methods: Retrospective observational study in a tertiary care hospital, extracting clinical data from a computerized database. Were included 369 patients more than 75 years hospitalized from the emergency department (ED) during the first semester of 2014, and assessed by the geriatric liaison team. Results: The readmission rates was 34% (95% CI: 29–40) at 6 months from the index stay. Characteristics not significantly associated with readmissions where: ISAR score, polypharmacy, a previous fall in the past 6 months, living place, dementia and a low body mass index. Six months readmissions were however associated with: a previous ED visit (OR: 35.0; P < 0.001), male gender (OR: 2.7; P: 0.001), marital status (OR: 2.1; P: 0.003), assistance for ADL (OR: 1.6; P: 0.039) and iADL (OR:1.6; P: 0.042), a high Charlson Comorbidity Index (OR: 1.2; P < 0.001), younger age (OR: 1.1; P: 0.018), a high level of LI (OR: 1.1; P: 0.004) and a high level of SI (OR: 1.1; P < 0.001). Conclusion: In our cohort one third of the older patients where readmitted within the 6 months after discharge. A previous ED visit strongly predicted readmission, as other factors or scores as the LACE and SCHONBERG indexes. P-045 Evolution of patients of 80 years and over after a stay in intensive care unit: a retrospective study A.-A. Zulfiqar1 , V. Champenois1 , M. Drame´ 1 , L. Kanagaratnam2 , B. Marinthe3 , J.-L. Pennaforte1 , J.-L. Novella2 , A. Leon ´ 1 1 CHU Reims, Reims, France; 2 France; 3 St-Dizier Hospital, Saint-Dizier, France Objectives: Aging has led to an increase in the number of elderly patients admitted to intensive care. Methods: Retrospective study in Intensive Care Unit at Saint-Dizier Hospital including patients older than 80 years, during 1 year. Results: 69 patients were admitted, 34 were women. The mean age was 84.1 years (80–94). The majority of patients were from the Emergency (42 patients). 13 patients lived at home without help, while 35 patients lived at home with assistance and 19 were living in institutions. Charlson score means in our series was 7.1 (4–9). Cardiovascular history was the most represented (97.1%). Dementia “known” for 10 patients (14.5%). Principal reason for admission in Intensive Care remains acute respiratory failure (36 patients). The mean SAPS II score is valued at 46.8±24.2 (18–113). The average length of stay was 9±9.9 days (1–58 days). Therapeutic limitation decision was made to 35 patients. 27 patients died in the intensive care unit, which makes 39.13% of intra-ICU mortality. A total of
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 1
1
1
1
1
M. Richard , F. Truchon , C. Germain , L. Babe , A. Martin-Kleisch , J.-L. Novella2 , A.-A. Zulfiqar1 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 meticillinsensitive Staphylococcus aureus infection, which is complicated by an atrial fibrillation. Therapeutic approach combining oxacillinaminoglycosides 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. Zulfiqar1 , A. Sebaux1 , M. Drame´ 1 , E. Andres2 , J.-L. Novella3 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. Lescuyer1 , A.-A. Zulfiqar2 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 (22.9 mmol/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. Verhulst1 , C. Dalgard ˚ 2 , C. Labat3 , J.D. Kark4 , M. Kimura5 , 6 K. Christensen , S. Toupance7 , A. Aviv5 , K.O. Kyvik2 , A. Benetos7 1 University of Groningen, Groningen, Netherlands; 2 University of Southern Denmark, Odense, Denmark; 3 Inserm U 1116, Vandoeuvrel`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.
P-042 Providing clear structure and leadership to an assessment area can reduce patient length of stay (LoS) and enhance staff experience A. Watson1 , A. Ali2 , D. Aw1 1 Nottingham University Hospitals, Nottingham, England; 2 United Kingdom Background: In September 2014, the Geriatric department took over the management of a medical assessment ward at Nottingham University Hospitals. A large team of consultants provided daily senior cover. Staff morale was low, patient care disjointed and there was a lack of leadership and consistency in ward processes. Objective: To provide leadership and improve consistency of ward processes to reduce LoS and enhance staff experience. Methods: A clinician lead and dedicated project manager were appointed to provide leadership and engage the team in the process redesign. Consultant job plans were modified to ensure daily geriatric presence. A standardised operating procedure (SOP) including roles and responsibilities was developed with the team. Through a series of Plan Do Study Act (PDSA) cycles we introduced: • A 9am “huddle” for staff allocation and safety and process messages. • Morning and afternoon board rounds. • “One stop” ward rounds. • Prioritisation sheets (identifying patients medically unwell or ready for discharge). • Optimised IT resources. We ran focus weeks where aspects of the SOP were score boarded to embed the process and enhance accountability. Results: LoS reduced from 35 to 29 hours. Morning and afternoon board round consistency increased (from 18% to 80% and from 24% to 60% respectively). Prioritised ward rounds increased from 18% to 100%. Consultants reported being clearer about their role (37% to 76%). The ward team felt happier coming to work (29% to 65%) and felt valued (18% to 59%). Conclusions: Clear leadership structure and guidance on roles, responsibilities and processes reduced length of stay, improved flow and improved staff experience. P-043 Older fall patients in the acute medical department: A descriptive cohort study M.R. Wejse1 , A.-K. Giger2 , E. Pressel3 Dep. of Geriatric Medicine, Bispebjerg Hospital, University of Copenhagen, Denmark, Copenhagen NV, Denmark; 2 Denmark; 3 Bispebjerg Hospital, Copenhagen NV, Denmark
1
Objective: Fall upon admission in older patients is frequent and often due to underlying disease, but little is known about this patient group. The aim of this study was to describe the clinical characteristics, complexity and illness-severity of a cohort of older fall patients admitted to the acute medical ward. Methods: We included 21 patients (>65 years old) who were admitted to the acute medical ward in October 2013 with the ICD-10 diagnosis fall (R29.6/7) or as a direct consequence of falling. The cohort was studied retrospectively and data was collected from the hospitals electronic journal system. We registered the number of acute diseases diagnosed or treated within the first three days after admission, vital parameters (EWS), 30-days mortality rate and length of stay. Furthermore we registered 30-day re-admission rate, comorbidity and polypharmacy. Results: 33.3% of our patients had died 30 days after admission. 43.3% had been admitted to hospital 30 days before or after the study period. On average 3.9 acute diseases were diagnosed or treated during the first 3 days after admission. The mean EWS-score was 4.2 indicating
S43
a medium observation level. Our patients received on average 7.4 medications and had 6.0 comorbidities. Conclusions: Older fall patients in the acute medical ward are characterized by acute medical conditions, multi-morbidity and polypharmacy. Mortality and admission rates are surprisingly high, indicating that there should be focus on these patients in the acute clinical setting. Further studies need to be done in order to proof our results in larger cohorts. P-044 Rates and potential risk factors for hospital readmissions of older patients M. Wibert1 , B. Hamoir2 , M. De Saint Hubert3 , C. Swine2 , D. Schoevaerdts4 1 CHU Dinant-Godinne, Courcelles, Belgium; 2 CHU Dinant Godinne UCL Namur, Yvoir, Belgium; 3 CHU Dinant-Godinne, Yvoir, Belgium; 4 CHU Dinant-Godinne UCL Namur, Floreffe, Belgium Objectives: To determine potential risk factors and hospital readmission rates within 6 months following an index hospitalization and test the association with the LACE (LI) and SCHONBERG indexes (SI). Methods: Retrospective observational study in a tertiary care hospital, extracting clinical data from a computerized database. Were included 369 patients more than 75 years hospitalized from the emergency department (ED) during the first semester of 2014, and assessed by the geriatric liaison team. Results: The readmission rates was 34% (95% CI: 29–40) at 6 months from the index stay. Characteristics not significantly associated with readmissions where: ISAR score, polypharmacy, a previous fall in the past 6 months, living place, dementia and a low body mass index. Six months readmissions were however associated with: a previous ED visit (OR: 35.0; P < 0.001), male gender (OR: 2.7; P: 0.001), marital status (OR: 2.1; P: 0.003), assistance for ADL (OR: 1.6; P: 0.039) and iADL (OR:1.6; P: 0.042), a high Charlson Comorbidity Index (OR: 1.2; P < 0.001), younger age (OR: 1.1; P: 0.018), a high level of LI (OR: 1.1; P: 0.004) and a high level of SI (OR: 1.1; P < 0.001). Conclusion: In our cohort one third of the older patients where readmitted within the 6 months after discharge. A previous ED visit strongly predicted readmission, as other factors or scores as the LACE and SCHONBERG indexes. P-045 Evolution of patients of 80 years and over after a stay in intensive care unit: a retrospective study A.-A. Zulfiqar1 , V. Champenois1 , M. Drame´ 1 , L. Kanagaratnam2 , B. Marinthe3 , J.-L. Pennaforte1 , J.-L. Novella2 , A. Leon ´ 1 1 CHU Reims, Reims, France; 2 France; 3 St-Dizier Hospital, Saint-Dizier, France Objectives: Aging has led to an increase in the number of elderly patients admitted to intensive care. Methods: Retrospective study in Intensive Care Unit at Saint-Dizier Hospital including patients older than 80 years, during 1 year. Results: 69 patients were admitted, 34 were women. The mean age was 84.1 years (80–94). The majority of patients were from the Emergency (42 patients). 13 patients lived at home without help, while 35 patients lived at home with assistance and 19 were living in institutions. Charlson score means in our series was 7.1 (4–9). Cardiovascular history was the most represented (97.1%). Dementia “known” for 10 patients (14.5%). Principal reason for admission in Intensive Care remains acute respiratory failure (36 patients). The mean SAPS II score is valued at 46.8±24.2 (18–113). The average length of stay was 9±9.9 days (1–58 days). Therapeutic limitation decision was made to 35 patients. 27 patients died in the intensive care unit, which makes 39.13% of intra-ICU mortality. A total of
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 1
1
1
1
1
M. Richard , F. Truchon , C. Germain , L. Babe , A. Martin-Kleisch , J.-L. Novella2 , A.-A. Zulfiqar1 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 meticillinsensitive Staphylococcus aureus infection, which is complicated by an atrial fibrillation. Therapeutic approach combining oxacillinaminoglycosides 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. Zulfiqar1 , A. Sebaux1 , M. Drame´ 1 , E. Andres2 , J.-L. Novella3 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. Lescuyer1 , A.-A. Zulfiqar2 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 (22.9 mmol/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. Verhulst1 , C. Dalgard ˚ 2 , C. Labat3 , J.D. Kark4 , M. Kimura5 , 6 K. Christensen , S. Toupance7 , A. Aviv5 , K.O. Kyvik2 , A. Benetos7 1 University of Groningen, Groningen, Netherlands; 2 University of Southern Denmark, Odense, Denmark; 3 Inserm U 1116, Vandoeuvrel`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.