The aim of this study was to determine whether sudden cardiac death from pulmonary embolism exhib... more The aim of this study was to determine whether sudden cardiac death from pulmonary embolism exhibits any chronobiological rhythm. Five hundred and seven consecutive subjects dying suddenly outside of hospital and brought into our Emergency Department from January 1983 to December 1989 were studied. The time and date of event were accurately recorded. All subjects underwent autopsy and 48 of them were found to have died of pulmonary embolism (23 males, mean age 73.9 +/- 8 years and 25 females, mean age 76 +/- 12 years). All data were analysed by means of single cosinor[19,20]. In the subjects with pulmonary emboli both a circadian and a circannual rhythmicity were found, with a significant acrophase respectively in the morning (h.min. 11.46, P = 0.003) and in winter (-19.3, P = 0.009).
Current knowledges about time-dependent variations in onset of several acute medical diseases are... more Current knowledges about time-dependent variations in onset of several acute medical diseases are briefly reviewed. Moreover, temporal variation in relative risk factors are also discussed. Any clue to the increased likelihood of a given event can heighten suspicion and shorten time of effective action. The predictability of a certain event, due to the periodicity of cyclic changes, can be of a practical interest in everyday medical practice.
The circadian patterns in the onset of symptoms of acute myocardial infarction were assessed in a... more The circadian patterns in the onset of symptoms of acute myocardial infarction were assessed in a prospective study involving 450 patients. Analysis of the data in the 424 patients in whom the time of onset was known did not show any statistically significant circadian rhythms, either for the group as a whole or for subgroups divided according to sex, age group (< 60, 60-69, 70-79 and > or = 80 years old), or the presence or absence of diabetes mellitus. The frequency of onset of symptoms was highest in the morning (06.01-12.00 h) for the group as a whole (29.2%). Patients aged < 70 and > or = 80 years old showed a peak in the morning, whereas patients aged 70-79 years old showed a peak in the afternoon (12.01-18.00 h).
This study was intended to determine whether there are circa-annual variations in the incidence o... more This study was intended to determine whether there are circa-annual variations in the incidence of fatal pulmonary embolism for hospitalized patients. Patients (152), admitted into both the medical and surgical departments of St. Anna Hospital of Ferrara, Italy, during an 8-year period (1983-1990) and who died in hospital as a result of pulmonary embolism, were considered. The day and month of death were registered, and analysed by inferential statistics (single cosinor). A circa-annual variation, with a statistically significant peak in late January (P = 0.002), was found for the total sample. After stratification by sex, this winter peak was confirmed only for women (P = 0.006).
Anatomo-physiopathological and chronobiological features of 59 diabetic subjects out of 610 non h... more Anatomo-physiopathological and chronobiological features of 59 diabetic subjects out of 610 non hospitalized individuals observed for sudden death (SD) in an Emergency Room, over an 8-year period, were studied. Mean age and anatomopathological causes of SD were not different between diabetic (DMs) and non-diabetic subjects (NDs). However the frequency of DMs was higher among subjects who died from circulatory failure death (CFD), rather than from arrhythmic death (AD). Diabetics presented a prevalent peak incidence of SD in the afternoon-late evening; whereas in NDs two peaks were present, respectively in the morning and in the afternoon. According to anatomo-physiopathological causes, DMs presented a higher incidence of acute myocardial infarction (AMI) and CFD between 21:01 and 24:00, whereas in NDs the prevalent peak of AMI was observed in the early afternoon (13:01 to 16:00). Moreover, in DMs SD from acute myocardial failure prevalently occurred in the early afternoon (13:01 to 16:00), whereas in NDs it was uniformly distributed throughout the day. The present study seems to indicate that different anatomo-physiopathological causes of SD may present specific temporal patterns in diabetics.
Anatomoclinical and chronobiological aspects of sudden death (SD) of 671 subjects observed at the... more Anatomoclinical and chronobiological aspects of sudden death (SD) of 671 subjects observed at the Emergency Room of Ferrara Hospital from January 1983 to December 1991 were prospectively investigated. 3 groups stratified by age were considered: group A with age < 65 years (no. = 251, 37.4%), group B with age between 65 and 74 years (no. = 210, 31.3%), and group C with age > or = 75 years (no. = 210, 31.3%). SD was classified on the basis of either anatomopathological (i.e.: acute myocardial infarction, acute myocardial failure, intracerebral hemorrhage, rupture of aortic aneurysm, pulmonary embolism), and clinical findings (i.e.: arrhythmic death and circulatory failure death). Patients were grouped into six 4-hour periods according to the time of onset of symptoms, and circadian distribution was tested for uniformity by a chi 2 test for goodness of fit. The analysis found in group C an increased frequency of SD due to pulmonary embolism and rupture of aortic aneurysm, and an increment of males/females ratio in deaths from cardiac causes. In group C the mean age of SD, in particular from acute myocardial infarction, pulmonary embolism or arrhythmic death proved higher in females compared to males. Only for group B was a significant circadian periodicity found for SD from acute myocardial infarction and arrhythmic death, with a peak in the morning.
Rivista europea per le scienze mediche e farmacologiche = European review for medical and pharmacological sciences = Revue européenne pour les sciences médicales et pharmacologiques
An epidemiologic retrospective study was conducted from January 1984 to December 1988 on subjects... more An epidemiologic retrospective study was conducted from January 1984 to December 1988 on subjects admitted into the Institute of Semeiotica Medica of the University of Ferrara (as a general medicine, unselective department) and presenting a stroke. Year, month and hour of onset of symptoms in 141 patients (all resident in Ferrara, mean age 74.3 +/- 8.3 years) were carefully recorded. The definition of precise clock hour was reached only in 108 cases. The data were then analyzed by means of Halberg's single cosinor. Time series analysis showed a seasonal pattern of disease onset, characterized by a circannual rhythm with acrophase in late winter - early spring (-83.9 degrees). A significant circadian rhythm was found too, with acrophase at afternoon (-242.8 degrees).
It is known that many physiological variables show a rhythmic variability along a time span, e.g.... more It is known that many physiological variables show a rhythmic variability along a time span, e.g.: day, week, month or year. It is possible that the temporal overlapping of a constellation of factors may act as favouring and/or triggering factors for the onset of several acute diseases. Among these, epistaxis shows a circadian variability too. Such pattern, characterised by a prevalent peak in the morning and a secondary one in the evening, strictly resembles that of arterial blood pressure. The lack of differences between the temporal pattern of hypertensive and normotensive subjects suggests that the physiological pattern of blood pressure, and not strictly a condition of hypertension, may play a favouring role in certain hours of the day, probably together other local factors.
Medical science monitor: international medical journal of experimental and clinical research
The occurrence of several adverse cardiovascular events, eg, myocardial infarction and stroke, is... more The occurrence of several adverse cardiovascular events, eg, myocardial infarction and stroke, is not randomly distributed over time, but shows definite seasonal patterns. The temporal pattern for pulmonary embolism (PE) is known, whereas the data concerning deep vein thrombosis (DVT) are not conclusive. The aim of our study was to investigate whether a seasonal variation exists also for DVT, together with the possible influence of different comorbid risk factors. We observed 1164 consecutive cases of DVT at the General Hospital of Ferrara, Italy, from 1998 to 2002. The total sample was divided into subgroups by gender, and by the most common comorbid conditions. For statistical analysis, the distribution of symptom onset was tested for uniformity by the chi 2 test for goodness of fit, and partial Fourier series were used to assess rhythmicity. Seasonal analysis showed a significantly reduced frequency of DVT events in summer and increased in winter, for the total population (p<0.0001), men (p=0.003), women (p=0.007), subjects with PE (p=0.001), and hypertension (p=0.001). Similarly, chronobiological analysis yielded a significant seasonal variation, with a peak in December for the total population (p<0.001), men and women (p<0.001 and p=0.02, respectively), PE (p=0.006), and hypertension (p=0.028). This study shows the existence of a highly significant seasonal pattern in the occurrence of DVT, characterized by a winter peak. Thus, colder months and relative hypercoagulability could be considered a supplementary high risk condition when prescribing an anticoagulant regimen.
A circannual variation in the onset of several acute diseases, mostly dealing with cardiovascular... more A circannual variation in the onset of several acute diseases, mostly dealing with cardiovascular system, has been reported. The present study was to verify the possible existence of a seasonal variability in the onset of acute pancreatitis. All patients consecutively admitted to the Hospital of Ferrara, Italy, between January 1998 to December 2002, whose discharge diagnosis was acute pancreatitis, were considered. According to the time of admission, cases were categorized into twelve 1-mo intervals and in four periods by season. chi (2) test for goodness of fit and partial Fourier series were used for statistical analysis. During the study period, 549 cases of acute pancreatitis were observed. A significant peak of higher incidence was found in March-May, both for total population, males and subgroups with and without cholelithiasis or alcoholism. Fourier analysis showed the existence of a circannual rhythmic pattern with its main peak in March (95% C.L.: February-April, P = 0.005), and a secondary one in September. Death occurred more frequently in December-February, compared to the other periods (P = 0.029), and chronobiologic analysis yielded a seasonal peak in November-December (P<0.001). This study shows the existence of a circannual variation in the onset of acute pancreatitis, with a significantly higher frequency of events in the spring, especially for patients with cholelithiasis or alcoholism. Moreover, events occurring during the colder months seem to be characterized by a higher mortality rate.
Chronobiology is a branch of biomedical sciences devoted to the study of biological rhythms. Biol... more Chronobiology is a branch of biomedical sciences devoted to the study of biological rhythms. Biological rhythms exist at any level of living organisms and, according to their cycle length, may be divided into: a) circadian rhythms (period of approximately 24 hours), b) ultradian rhythms (period shorter than 24 hours), c) infradian rhythms (period longer than 24 hours). The cardiovascular system is organized according to an oscillatory pattern, and most cardiovascular functions exhibit circadian changes. Most evidence suggests that occurrence of cardiovascular events is not evenly distributed in time, but shows peculiar temporal patterns varying with time of the day, day of the week, and month of the year. These patterns coincide with the temporal variation in the (a) pathophysiological mechanisms that trigger cardiovascular events, and (b) physiological changes in the body rhythms. We will here briefly review the temporal aspects in occurrence of myocardial ischemia and infarction, as well as underlying triggering factors and possible applications in therapy.
European review for medical and pharmacological sciences
We report the case of a 84-year-old man, with history of rheumatoid arthritis, admitted the Hospi... more We report the case of a 84-year-old man, with history of rheumatoid arthritis, admitted the Hospital for a fall and complaining of dysaesthesia and pain located to the cervical spine and arms. Within a few hours after admission, fever and acute, progressive, ascendant quadriplegia became evident. Magnetic resonance imaging (MRI) of cervical spine showed spinal canal stenosis between C4-C6 with spinal cord compression. Hemocultures resulted positive for Staphylococcus aureus. The clinical picture rapidly evolved to sepsis with a fatal multi-organ failure. An autopsy found a osteosclerosis narrowing the neurocanal at the level of C3-C6, and recent cervical medulla infarction. A histological exam revealed the presence of a suppurative pachymeningitis with local phenomenas of periradiculitis, vasculitis and thrombosis of the anterior medullar artery, associated with coagulative necrosis of the neural tissue.
Urinary tract infections (UTIs) are common bacterial diseases. We related diagnosis of UTIs based... more Urinary tract infections (UTIs) are common bacterial diseases. We related diagnosis of UTIs based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and in-hospital mortality (IHM) in a cohort of hospitalized elderly subjects. All patients admitted between 2000 and 2013 to the general hospital of Ferrara, in northeast Italy, with ICD-9-CM code of UTIs were included. IHM was the main outcome, and age, sex, type of microorganism, sepsis, and Charlson comorbidity index (CCI) based on ICD-9-CM, were also analyzed. The total sample included 2,266 patients (1,670 women, 73.7%) with UTIs and identification of a cultural organism. Mean age was 81.7±7.5 years (range, 65-103). One hundred and sixteen (5.1%, of whom 34.5% were male and 65.5% were female) cases developed sepsis, and 84 (3.7%, of whom 45.2% were male, 54.8% were female) had a fatal outcome. Nonsurvivors had lower prevalence of IVUs due to Escherichia coli (53.6 vs. 71.7%, p<0.001) and higher prevalence of UTIs due to Pseudomonas aeruginosa (19 vs 7.1%, p<0.001). Moreover, non-survivors developed more frequently sepsis (31% vs. 4.1%, p<0.001), and had higher CCI (2.81±2.43 vs. 2.21±2.04, p=0.011). IHM was independently associated, in decreasing order of odds ratios (ORs), with sepsis (OR 10.3; 95% confidence interval [95%CI] 6.113-17.460, p<0.001), P. aeruginosa infection (OR 2.541; 95%CI 1.422-4.543, p=0.002), female gender (OR 2.324; 95%CI 1.480-3.650, p<0.001), CCI (OR 1.103; 95%CI 1.005-1.210, p=0.038), age (OR 1.034; 95%CI 1.002-1.066, p=0.036), and E. coli infection (OR 0.5; 95%CI 0.320-0.780, p=0.002). In a large sample of elderly patients hospitalized for UTIs in a single center in northeastern Italy, apart the development of sepsis, IHM was much more dependent on pathogen and female gender than comorbidity index and age.
The aim of this study was to determine whether sudden cardiac death from pulmonary embolism exhib... more The aim of this study was to determine whether sudden cardiac death from pulmonary embolism exhibits any chronobiological rhythm. Five hundred and seven consecutive subjects dying suddenly outside of hospital and brought into our Emergency Department from January 1983 to December 1989 were studied. The time and date of event were accurately recorded. All subjects underwent autopsy and 48 of them were found to have died of pulmonary embolism (23 males, mean age 73.9 +/- 8 years and 25 females, mean age 76 +/- 12 years). All data were analysed by means of single cosinor[19,20]. In the subjects with pulmonary emboli both a circadian and a circannual rhythmicity were found, with a significant acrophase respectively in the morning (h.min. 11.46, P = 0.003) and in winter (-19.3, P = 0.009).
Current knowledges about time-dependent variations in onset of several acute medical diseases are... more Current knowledges about time-dependent variations in onset of several acute medical diseases are briefly reviewed. Moreover, temporal variation in relative risk factors are also discussed. Any clue to the increased likelihood of a given event can heighten suspicion and shorten time of effective action. The predictability of a certain event, due to the periodicity of cyclic changes, can be of a practical interest in everyday medical practice.
The circadian patterns in the onset of symptoms of acute myocardial infarction were assessed in a... more The circadian patterns in the onset of symptoms of acute myocardial infarction were assessed in a prospective study involving 450 patients. Analysis of the data in the 424 patients in whom the time of onset was known did not show any statistically significant circadian rhythms, either for the group as a whole or for subgroups divided according to sex, age group (< 60, 60-69, 70-79 and > or = 80 years old), or the presence or absence of diabetes mellitus. The frequency of onset of symptoms was highest in the morning (06.01-12.00 h) for the group as a whole (29.2%). Patients aged < 70 and > or = 80 years old showed a peak in the morning, whereas patients aged 70-79 years old showed a peak in the afternoon (12.01-18.00 h).
This study was intended to determine whether there are circa-annual variations in the incidence o... more This study was intended to determine whether there are circa-annual variations in the incidence of fatal pulmonary embolism for hospitalized patients. Patients (152), admitted into both the medical and surgical departments of St. Anna Hospital of Ferrara, Italy, during an 8-year period (1983-1990) and who died in hospital as a result of pulmonary embolism, were considered. The day and month of death were registered, and analysed by inferential statistics (single cosinor). A circa-annual variation, with a statistically significant peak in late January (P = 0.002), was found for the total sample. After stratification by sex, this winter peak was confirmed only for women (P = 0.006).
Anatomo-physiopathological and chronobiological features of 59 diabetic subjects out of 610 non h... more Anatomo-physiopathological and chronobiological features of 59 diabetic subjects out of 610 non hospitalized individuals observed for sudden death (SD) in an Emergency Room, over an 8-year period, were studied. Mean age and anatomopathological causes of SD were not different between diabetic (DMs) and non-diabetic subjects (NDs). However the frequency of DMs was higher among subjects who died from circulatory failure death (CFD), rather than from arrhythmic death (AD). Diabetics presented a prevalent peak incidence of SD in the afternoon-late evening; whereas in NDs two peaks were present, respectively in the morning and in the afternoon. According to anatomo-physiopathological causes, DMs presented a higher incidence of acute myocardial infarction (AMI) and CFD between 21:01 and 24:00, whereas in NDs the prevalent peak of AMI was observed in the early afternoon (13:01 to 16:00). Moreover, in DMs SD from acute myocardial failure prevalently occurred in the early afternoon (13:01 to 16:00), whereas in NDs it was uniformly distributed throughout the day. The present study seems to indicate that different anatomo-physiopathological causes of SD may present specific temporal patterns in diabetics.
Anatomoclinical and chronobiological aspects of sudden death (SD) of 671 subjects observed at the... more Anatomoclinical and chronobiological aspects of sudden death (SD) of 671 subjects observed at the Emergency Room of Ferrara Hospital from January 1983 to December 1991 were prospectively investigated. 3 groups stratified by age were considered: group A with age < 65 years (no. = 251, 37.4%), group B with age between 65 and 74 years (no. = 210, 31.3%), and group C with age > or = 75 years (no. = 210, 31.3%). SD was classified on the basis of either anatomopathological (i.e.: acute myocardial infarction, acute myocardial failure, intracerebral hemorrhage, rupture of aortic aneurysm, pulmonary embolism), and clinical findings (i.e.: arrhythmic death and circulatory failure death). Patients were grouped into six 4-hour periods according to the time of onset of symptoms, and circadian distribution was tested for uniformity by a chi 2 test for goodness of fit. The analysis found in group C an increased frequency of SD due to pulmonary embolism and rupture of aortic aneurysm, and an increment of males/females ratio in deaths from cardiac causes. In group C the mean age of SD, in particular from acute myocardial infarction, pulmonary embolism or arrhythmic death proved higher in females compared to males. Only for group B was a significant circadian periodicity found for SD from acute myocardial infarction and arrhythmic death, with a peak in the morning.
Rivista europea per le scienze mediche e farmacologiche = European review for medical and pharmacological sciences = Revue européenne pour les sciences médicales et pharmacologiques
An epidemiologic retrospective study was conducted from January 1984 to December 1988 on subjects... more An epidemiologic retrospective study was conducted from January 1984 to December 1988 on subjects admitted into the Institute of Semeiotica Medica of the University of Ferrara (as a general medicine, unselective department) and presenting a stroke. Year, month and hour of onset of symptoms in 141 patients (all resident in Ferrara, mean age 74.3 +/- 8.3 years) were carefully recorded. The definition of precise clock hour was reached only in 108 cases. The data were then analyzed by means of Halberg's single cosinor. Time series analysis showed a seasonal pattern of disease onset, characterized by a circannual rhythm with acrophase in late winter - early spring (-83.9 degrees). A significant circadian rhythm was found too, with acrophase at afternoon (-242.8 degrees).
It is known that many physiological variables show a rhythmic variability along a time span, e.g.... more It is known that many physiological variables show a rhythmic variability along a time span, e.g.: day, week, month or year. It is possible that the temporal overlapping of a constellation of factors may act as favouring and/or triggering factors for the onset of several acute diseases. Among these, epistaxis shows a circadian variability too. Such pattern, characterised by a prevalent peak in the morning and a secondary one in the evening, strictly resembles that of arterial blood pressure. The lack of differences between the temporal pattern of hypertensive and normotensive subjects suggests that the physiological pattern of blood pressure, and not strictly a condition of hypertension, may play a favouring role in certain hours of the day, probably together other local factors.
Medical science monitor: international medical journal of experimental and clinical research
The occurrence of several adverse cardiovascular events, eg, myocardial infarction and stroke, is... more The occurrence of several adverse cardiovascular events, eg, myocardial infarction and stroke, is not randomly distributed over time, but shows definite seasonal patterns. The temporal pattern for pulmonary embolism (PE) is known, whereas the data concerning deep vein thrombosis (DVT) are not conclusive. The aim of our study was to investigate whether a seasonal variation exists also for DVT, together with the possible influence of different comorbid risk factors. We observed 1164 consecutive cases of DVT at the General Hospital of Ferrara, Italy, from 1998 to 2002. The total sample was divided into subgroups by gender, and by the most common comorbid conditions. For statistical analysis, the distribution of symptom onset was tested for uniformity by the chi 2 test for goodness of fit, and partial Fourier series were used to assess rhythmicity. Seasonal analysis showed a significantly reduced frequency of DVT events in summer and increased in winter, for the total population (p<0.0001), men (p=0.003), women (p=0.007), subjects with PE (p=0.001), and hypertension (p=0.001). Similarly, chronobiological analysis yielded a significant seasonal variation, with a peak in December for the total population (p<0.001), men and women (p<0.001 and p=0.02, respectively), PE (p=0.006), and hypertension (p=0.028). This study shows the existence of a highly significant seasonal pattern in the occurrence of DVT, characterized by a winter peak. Thus, colder months and relative hypercoagulability could be considered a supplementary high risk condition when prescribing an anticoagulant regimen.
A circannual variation in the onset of several acute diseases, mostly dealing with cardiovascular... more A circannual variation in the onset of several acute diseases, mostly dealing with cardiovascular system, has been reported. The present study was to verify the possible existence of a seasonal variability in the onset of acute pancreatitis. All patients consecutively admitted to the Hospital of Ferrara, Italy, between January 1998 to December 2002, whose discharge diagnosis was acute pancreatitis, were considered. According to the time of admission, cases were categorized into twelve 1-mo intervals and in four periods by season. chi (2) test for goodness of fit and partial Fourier series were used for statistical analysis. During the study period, 549 cases of acute pancreatitis were observed. A significant peak of higher incidence was found in March-May, both for total population, males and subgroups with and without cholelithiasis or alcoholism. Fourier analysis showed the existence of a circannual rhythmic pattern with its main peak in March (95% C.L.: February-April, P = 0.005), and a secondary one in September. Death occurred more frequently in December-February, compared to the other periods (P = 0.029), and chronobiologic analysis yielded a seasonal peak in November-December (P<0.001). This study shows the existence of a circannual variation in the onset of acute pancreatitis, with a significantly higher frequency of events in the spring, especially for patients with cholelithiasis or alcoholism. Moreover, events occurring during the colder months seem to be characterized by a higher mortality rate.
Chronobiology is a branch of biomedical sciences devoted to the study of biological rhythms. Biol... more Chronobiology is a branch of biomedical sciences devoted to the study of biological rhythms. Biological rhythms exist at any level of living organisms and, according to their cycle length, may be divided into: a) circadian rhythms (period of approximately 24 hours), b) ultradian rhythms (period shorter than 24 hours), c) infradian rhythms (period longer than 24 hours). The cardiovascular system is organized according to an oscillatory pattern, and most cardiovascular functions exhibit circadian changes. Most evidence suggests that occurrence of cardiovascular events is not evenly distributed in time, but shows peculiar temporal patterns varying with time of the day, day of the week, and month of the year. These patterns coincide with the temporal variation in the (a) pathophysiological mechanisms that trigger cardiovascular events, and (b) physiological changes in the body rhythms. We will here briefly review the temporal aspects in occurrence of myocardial ischemia and infarction, as well as underlying triggering factors and possible applications in therapy.
European review for medical and pharmacological sciences
We report the case of a 84-year-old man, with history of rheumatoid arthritis, admitted the Hospi... more We report the case of a 84-year-old man, with history of rheumatoid arthritis, admitted the Hospital for a fall and complaining of dysaesthesia and pain located to the cervical spine and arms. Within a few hours after admission, fever and acute, progressive, ascendant quadriplegia became evident. Magnetic resonance imaging (MRI) of cervical spine showed spinal canal stenosis between C4-C6 with spinal cord compression. Hemocultures resulted positive for Staphylococcus aureus. The clinical picture rapidly evolved to sepsis with a fatal multi-organ failure. An autopsy found a osteosclerosis narrowing the neurocanal at the level of C3-C6, and recent cervical medulla infarction. A histological exam revealed the presence of a suppurative pachymeningitis with local phenomenas of periradiculitis, vasculitis and thrombosis of the anterior medullar artery, associated with coagulative necrosis of the neural tissue.
Urinary tract infections (UTIs) are common bacterial diseases. We related diagnosis of UTIs based... more Urinary tract infections (UTIs) are common bacterial diseases. We related diagnosis of UTIs based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and in-hospital mortality (IHM) in a cohort of hospitalized elderly subjects. All patients admitted between 2000 and 2013 to the general hospital of Ferrara, in northeast Italy, with ICD-9-CM code of UTIs were included. IHM was the main outcome, and age, sex, type of microorganism, sepsis, and Charlson comorbidity index (CCI) based on ICD-9-CM, were also analyzed. The total sample included 2,266 patients (1,670 women, 73.7%) with UTIs and identification of a cultural organism. Mean age was 81.7±7.5 years (range, 65-103). One hundred and sixteen (5.1%, of whom 34.5% were male and 65.5% were female) cases developed sepsis, and 84 (3.7%, of whom 45.2% were male, 54.8% were female) had a fatal outcome. Nonsurvivors had lower prevalence of IVUs due to Escherichia coli (53.6 vs. 71.7%, p<0.001) and higher prevalence of UTIs due to Pseudomonas aeruginosa (19 vs 7.1%, p<0.001). Moreover, non-survivors developed more frequently sepsis (31% vs. 4.1%, p<0.001), and had higher CCI (2.81±2.43 vs. 2.21±2.04, p=0.011). IHM was independently associated, in decreasing order of odds ratios (ORs), with sepsis (OR 10.3; 95% confidence interval [95%CI] 6.113-17.460, p<0.001), P. aeruginosa infection (OR 2.541; 95%CI 1.422-4.543, p=0.002), female gender (OR 2.324; 95%CI 1.480-3.650, p<0.001), CCI (OR 1.103; 95%CI 1.005-1.210, p=0.038), age (OR 1.034; 95%CI 1.002-1.066, p=0.036), and E. coli infection (OR 0.5; 95%CI 0.320-0.780, p=0.002). In a large sample of elderly patients hospitalized for UTIs in a single center in northeastern Italy, apart the development of sepsis, IHM was much more dependent on pathogen and female gender than comorbidity index and age.
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