Changes In Biochemical Indexes Before The Death Of The Very Elderly

Objective: By comparing the changes of biochemical and hematological parameters between the 15 days and 30 days before the death of the very elderly and the healthy control group,the effects of blood lipid-related indicators,non-specific inflammatory factors,nutrition-related indicators and electrolyte changes on the death of the very elderly were explored.Methods: A retrospective analysis was performed on 287 patients who died from February 2012 to October 2017 at the Department of Internal Medicine of the First Affiliated Hospital of Soochow University(mainly in gerontology and emergency ICU).The age and gender of the patients were collected.There were 266 healthy subjects that match age and gender in the same period.A total of 553 subjects were 75 years of age or older.Each subject collected complete clinical data,diagnostic information,blood biochemistry,and blood routine tests: All respondents before the investigation One night after dinner,fasting for 12 hours,collecting fasting venous blood 5ml,5ml,anticoagulated with heparin,separated plasma,stored at low temperature-20 �C,completed at the First Affiliated Hospital of Soochow University Test Center:fasting blood glucose(FBG),albumin(ALB),prealbumin(PAB),totalprotein(TP),hemoglobin(HGB),hypersensitive C-reactive protein(hs-CRP),cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),serum potassium(K),blood sodium(Na),blood chloride(Cl),blood calcium(Ca)etc..According to ICD-10,the cause of the death was classified and the composition ratio was calculated.Statistical analysis was performed using SPSS18.0.The main statistical indicators were all tested for normality.Measured data for normal distribution were expressed as mean �standard deviation(x �s);independent t test were used for comparison between groups.;comparison in groups were used a paired sample t test;count data using chi-square test.Pearson's linear correlation analysis is used to analyze the correlation between TC and ALB,PAB,TP and HGB;The risk of death for the very elderly is analyzed by multi-factor unconditional logistic regression analysis.The difference was statistically significant at P<0.05,and P<0.01 indicates that the difference was very statistically significant.Result:1.Among 287 the cause of the death of the very elderly,147(51.2%)were infectious diseases,followed by 44 cases(15.3%)caused by tumor infections,35 cases(12.2%)of tumors,and 33 cases(11.5%)of cardiovascular accidents.%);24 cases(8.4%)of cerebrovascular accident;the top three causes of death for the very elderly are infectious diseases,tumors with infections,and tumors.2.15 days and 30 days before the death of the very elderly was compared with that : 1)Blood lipids and hs-CRP: The former had significantly decreased TC,LDL-C and HDL-C,and hs-CRP increased,the difference was statistically significant(P< 0.01),here was no significant difference between the former and the latter TG(P>0.05);2)nutrition-related indicators: the former ALB,PAB,TP,HGB significantly less than the latter,the difference was statistically significant(P < 0.01),Here was no significant difference between the former and the latter FBG(P>0.05);3)Blood electrolytes: here was no significant difference between the former and the latter K,Cl(P>0.05),but the former Na was a higher than the latter,the difference was statistically significant(P<0.01);Ca was lower than the latter,and the difference was statistically significant(P<0.05).3.15 days before the death of the very elderly was compared with the healthy control group : 1)Blood lipids and hs-CRP: The former TC,LDL-C and HDL-C less than the latter,and the hs-CRP increased,the difference was statistically significant(P<0.01).),here was no significant difference between the former and the latter TG(P>0.05);2)nutrition-related indicators: the former ALB,PAB,TP,HGB significantly less than the latter,the difference was statistically significant(P <0.01),The former FBG increased,the difference was statistically significant(P <0.01);3)blood electrolytes: here was no significant difference between the former and the latter K,Cl(P>0.05),but the former Na was higher than the latter,the difference was statistically significant(P<0.01);Ca was significantly lower and the difference was statistically significant(P<0.01).4.The correlation analysis of TC and various nutrition-related indicators within 15 days before the death of the very elderly showed that: TC was positively correlated with ALB,PAB,TP,and HGB(P<0.05).The correlation coefficients were 0.342,0.336,0.385,and 0.228,respectively.5.Multivariate logistic regression analysis was conducted.The study found that FBG(P = 0.04,OR = 1.263,95% CI: 1.075-1.483),hs-CRP(P <0.001,OR = 1.274,95% CI: 1.185-1.369)increasing is the important risk factors for the death of the very elderly;ALB(P=0.028,OR=0.903,95%CI: 0.824-0.989),HGB(P=0.021,OR=0.982,95%CI: 0.967-0.997),TP(P=0.001,OR=0.915,95%CI:0.867-0.966)decreasing is the important risk factors for the death of the very elderly.Conclusion:1.The levels of TC,LDL-C,and HDL-C in the 15 days before the death of the very elderly changed and decreased that was compared with the other two groups.The level of serum sodium was higher than that of the two groups,and the serum calcium level was lower than the 30 days of the death group and the control group.The nutritional indicators ALB,TP,HGB,and PAB were also lower than the 30-day death group and control group.The above indicators can be used as an auxiliary index to judge and evaluate disease changes.2.There was a correlation between TC and nutrition-related indicators ALB,TP,HGB and PAB in the 15 days before the death of the very elderly,and there was a positive correlation.With the worsening of the disease in the very elderly,ALB,TP,HGB and PAB decreased,and TC also decreased significantly.3.The very elderly generally have varying degrees of malnutrition,and the reduction of ALB,TP,and HGB is the important risk factor for the death of the very elderly.The increase of FBG and hs-CRP is the important risk factor for the death of the very elderly.It can be used as an auxiliary basis to assess the risk of the death in the very elderly patients.