Warren Raymond

Effect of frailty on functional gain, resource utilisation, and discharge destination: An observational prospective study in a GEM ward

Background. A geriatric evaluation and management unit (GEM) manages elderly inpatients with functional impairments. There is a paucity of literature on frailty and whether this impacts on rehabilitation outcomes. Objectives. To examine frailty score (FS) as a predictor of functional gain, resource utilisation, and destinations for GEM patients. Methods. A single centre prospective case study design. Participants (n = 136) were ≥65 years old and admitted to a tertiary hospital GEM. Five patients were excluded by the preset exclusion criteria, that is, medically unstable, severe dementia or communication difficulties after stroke. Core data included demographics, frailty score (FS), and functional independence. Results. The mean functional improvement (FIM) from admission to discharge was 11.26 (95% CI 8.87, 13.66; P < 0.001). Discharge FIM was positively correlated with admission FIM (β = 0.748; P < 0.001) and negatively correlated with frailty score (β = −1.151; P = 0.014). The majority of the patients were in the “frail” group. “Frail” and “severely frail” subgroups improved more on mean FIM scores at discharge, relative to that experienced by the “pre-frail” group. Conclusion. All patients experienced functional improvement. Frailer patients improved more on their FIM and improved relatively more than their prefrail counterparts. Higher frailty correlated with reduced independence and greater resource utilisation. This study demonstrates that FS could be a prognostic indicator of physical independence and resource utilisation.

IL-17A levels in systemic lupus erythematosus associated with inflammatory markers and lower rates of malignancy and heart damage: Evidence for a dual role

OBJECTIVE The interleukin 17 (IL-17) cytokine family is involved in a number of chronic inflammatory diseases. In spite of contradictory findings and a lack of causality in clinical studies, IL-17 inhibition for systemic lupus erythematosus (SLE) has regained attention as a potential therapeutic pathway, after demonstrating disease-modifying capabilities in ankylosing spondylitis. We investigated the clinical associations of interleukin 17 A (IL-17A) in patients with SLE. MATERIAL AND METHODS A cross-sectional study was performed involving SLE patients (n=102; age: 49 years; 86% female) recruited from a regional registry. IL-17A levels were determined by immunoassay, disease activity by Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K), and cumulative damage by Systemic Lupus International Collaborative Clinics Damage Index (SDI) scores. Non-parametric techniques were used to examine the association between IL-17A and disease activity and autoantibody profiles were compared with healthy controls (n=31): principal component analysis (PCA) was used to determine the interplay of immune cells across disease states and damage development in SLE patients. RESULTS SLE patients had higher IgG levels, lower T-cell and B-cell counts, but median IL-17A levels did not differ from the controls (28.4 vs. 28.4 pg/mL, p=0.9). In SLE patients, IL-17A did not correlate with SLEDAI-2K or SDI, but was inversely related with age (correlation coefficients, Rs.=-0.29, p<0.05), systolic blood pressure (Rs.=-0.31, p<0.05), years of smoking (Rs.=-0.43, p<0.05), cumulative heart (Rs.=-0.22, p<0.05), and malignancy damage (Rs.=-0.18, p<0.05). Serological correlations for IL-17A existed with immunoglobulin G (IgG) levels (Rs.=0.21, p<0.05), high sensitivity C-reactive protein (hs-CRP) levels (Rs.=0.28, p<0.05), proteinuria (Rs.=0.64, p<0.05), and pre-albumin (Rs.=-0.22, p<0.05). Longitudinal data showed only modest fluctuation in IL-17A levels, independent of SLEDAI-2K. CONCLUSION These results suggest that IL-17A, while participating in inflammation, may also serve a protective purpose in SLE patients.

Increased von Willebrand factor levels in patients with systemic lupus erythematosus reflect inflammation rather than increased propensity for platelet activation

Background von Willebrand factor (VWF) is involved in platelet plug formation and protein transport. Increased VWF levels in systemic lupus erythematous (SLE) are considered risk factors for vascular events. VWF protein levels, however, do not accurately reflect its platelet-aggregating function, which has not been examined in SLE. Methods Cross-sectional study with clinical and laboratory data obtained in patients with SLE (n=92) from a regional lupus registry. VWF function was determined by ristocetin-induced platelet aggregation (VWF ristocetin cofactor, VWF:RCo) and VWF levels by turbidimetric assay (VWF antigen, VWF:Ag). The platelet-aggregating activity per VWF unit was estimated by the VWF RCo/Ag ratio. Healthy controls served as comparators and associations were evaluated by non-parametric methods. Results VWF:Ag (142% vs 107%, p=0.001) and VWF:RCo levels (123% vs 78%, p<0.041) were increased in patients with SLE, but VWF RCo/Ag ratio was similar as in controls (0.83 vs 0.82, p=0.8). VWF:Ag levels were higher in patients experiencing serositis but unrelated to other manifestations, thrombotic disease, Systemic Lupus Erythematous Disease Activity Index 2000 or Systemic Lupus International Collaborative Clinics-Damage Index. VWF:Ag levels correlated significantly with VWF:RCo levels (Rs 0.8, p<0.001), erythrocyte sedimentation rate (ESR) (Rs 0.32, p<0.01), anti-dsDNA Ab (Rs 0.27, p<0.01), total IgG (Rs 0.33 p<0.01), fibrinogen (Rs 0.28, p<0.01) and ceruloplasmin (Rs 0.367, p<0.01) levels. VWF:RCo levels were not related to clinical findings but were correlated with ESR, anti-dsDNA and transferrin levels. No serological associations existed for VWF RCo/Ag ratio (all p>0.2). Conclusions In this SLE cohort, VWF:Ag behaved similarly to acute-phase reactants, but VWF:Ag increases were not matched by increases in functional activity per unit of VWF. Thus, more VWF did not increase the propensity for platelet aggregation in SLE.

Higher Charlson Comorbidity Index scores do not influence Functional Independence Measure score gains in older rehabilitation patients

To assess the effect of age‐adjusted Charlson Comorbidity Index (CCI) score on Functional Independence Measure (FIM) score gain in older rehabilitation patients.

THU0465 Fracture Liaison Service Reduces Re-Fracture Rate, Cost-Effective and Cost Saving in Western Australia

Background Osteoporotic fractures impose significant morbidity, mortality and economic burden (1). Earlier research showed low rates of secondary prevention for patients discharged from Emergency Department (ED) with a fracture (2). The Fracture Liaison Service (FLS) aimed to identify, review and then manage these patients following their discharge from the ED. Objectives Determine the economic benefits of a FLS in a Western Australian hospital. Methods Patients aged >50yrs whom presented to the Emergency Department at Sir Charles Gairdner Hospital (SCGH) after a fracture were invited to the FLS. A retrospective control group from SCGH and a prospective control group from Fremantle Hospital were the comparators. A health economic analysis from the Payers Perspective (WA Health) examined recurrent fracture rates and quality of life (EQ-5D). Bottom-up costing included medications, investigations, GP visits and the cost of fracture determined by the literature or the AR-DRG 2013/14 prices for hospital presentation and admission. The mean incremental cost effectiveness ratios were bootstrapped (5000 iterations). Cost-effectiveness acceptability curves were generated and the willingness-to-pay was

The current role for clinical and renal histological findings as predictor for outcome in Australian patients with lupus nephritis

50,000AUD. Results This FLS reduced the rate of re-fracture compared to the retrospective cohort and other tertiary centre by 9.2 - 10.2%, equating to cost savings of approximately

Insulin-like growth factor-1 (IGF1) in systemic lupus erythematosus: relation to disease activity, organ damage and immunological findings:

750,168 -

Case finding for the primary prevention of fragility fractures with FRAX (without BMD) in those over 70 years: Reducing the reliance on BMD as the primary tool

810,400/1,000 patient-years in the first year compared to control cohorts. There was no difference in the QALYs gained across groups over 12 months. The FLS compared to SCGH retrospective cohort had a mean incremental cost of

Hospitalisation rates and characteristics for adult and childhood IgA vasculitis in Western Australia: IgA vasculitis in WA

6,168 (95CI

420 Hospitalisation for comorbid conditions in patients with systemic lupus erythematosus is more frequently due to cardiovascular and renal complications, subsequently increasing the risk of death

133,