The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are simple markers of systemic inflammatory responses. It has been previously suggested that they can predict COVID-19 severity. Age and frailty may also influence their values. This study aimed to evaluate the impact of COVID-19 severity versus age and frailty on NLR and PLR values. This was a retrospective, observational two cohorts’ comparative study. The first cohort is comprised of patents positive for SARS-CoV-2, with mild or asymptomatic disease, admitted to designated COVID-19 departments in a large geriatric medical center (GMC). The second included patients with COVID-19 admitted to designated COVID-19 departments in a large general hospital for symptomatic disease from March 2020 to March 2021. We compared baseline characteristics including comorbidities and chronic medications, disease symptoms, laboratory tests and compared the NLR and PLR between the two groups. The 177 patients admitted to the COVID-designated department in the GMC were over three decades older than the 289 COVID-19 patients admitted to the general hospital care (HC). They had substantially more comorbidities and chronic medications. All common disease symptoms were significantly more common in the HC group. Almost two thirds of the GMC patients remained asymptomatic compared to 2.1% in the HC group. Inflammatory markers, such as CRP and LDH, were significantly higher in the HC group. The NLR and PLR were both significantly higher in the GMC cohort comprised of older frailer patients with milder disease. NLR and PLR seem to be affected more by age and frailty than COVID-19 severity.

Background: Systemic inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with severe COVID-19, but their role in mild disease among frail older adults remains unclear. Early Israeli admission policies enabled hematologic profiling of asymptomatic and mild cases. Methods: Retrospective cohort of adults ≥65 years admitted to a geriatric center (March 2020–March 2021). Patients with Mild/asymptomatic COVID-19 cases were compared with patients hospitalized for other infections (pneumonia, urinary tract infection, cellulitis). Admission indices such as NLR, derived neutrophil-to-lymphocyte ratio (dNLR), PLR, hemoglobin-to-lymphocyte ratio (HLR), red cell distribution width (RDW), and C-reactive protein (CRP) were analyzed using receiver operating characteristic (ROC) curves. Sensitivity analyses compared COVID-19 with bacterial pneumonia and assessed one-week changes. Results: Among 450 patients (177 COVID-19 and 273 non-COVID; median age 85–86), COVID-19 cases showed lower white blood cell counts (WBC), neutrophils, and CRP but more marked lymphopenia. The most discriminative indices were dNLR, PLR, HLR, and RDW, which differed most (all p < 0.001), while NLR and systemic immune-inflammation index (SII) showed limited discrimination. The best AUC was 0.69. dNLR, PLR, and HLR remained elevated after one week. Conclusions: In frail older adults with early or mild COVID-19, modest but consistent hematologic patterns, including lymphopenia with elevated dNLR, PLR, and HLR, and lower RDW, were distinguished COVID-19 from other infections, although single-marker accuracy was limited. These routine indices may assist early differentiation when virologic testing is delayed or unavailable.

Background: Nursing care residents have high hospitalization rates. To address this, we established a unique virtual geriatric unit that has developed a program aimed at providing support to nursing homes.Aims: We aimed to evaluate effectiveness of in-house intravenous antibiotic treatment in nursing hospitals after the implementation of the specially designed training program.Methods: A cohort study of nursing home residents to evaluate a training program for providers, designed to increase awareness and give practical tools for in-house treatment of acute infections. Data obtained included types of infections, antibiotics used, hospital transfer, and length of treatment. Primary outcomes were in-house recovery, hospitalization and mortality. Univariate analysis and multivariable logistic regression analysis to assess association between different factors and recovery.Results: A total of 890 cases of acute infections were treated with intravenous antibiotics across 10 nursing homes over a total of 4,436 days. Of these cases, 34.8% were aged 90 years or older. Acute pneumonia was the most prevalent infection accounted for 354 cases (40.6%), followed by urinary tract infections (35.7%), and fever of presumed bacterial infection (17.1%). The mean duration of intravenous antibiotic treatment was 5.09 ± 3.86 days. Of the total cases, 800 (91.8%) recovered, 62 (7.1%) required hospitalization and nine (1.0%) resulted in mortality. There was no significant difference observed in recovery rates across different types of infections.Discussion: Appling a simple yet unique intervention program has led to more “in-house” residents receiving treatment, with positive clinical results.Conclusion: Treating in-house nursing home residents with acute infections resulted in high recovery rates. Special education programs and collaboration between healthcare organizations can improve treatment outcomes and decrease the burden on the healthcare system.

Several studies described neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) as markers of COVID-19 severity. In a recently published study, age and frailty affected NLR and PLR more than disease severity. The study compared two distinct cohorts. The first comprised older frailer patients positive for SARS-CoV-2, with mild or asymptomatic disease, admitted to designated COVID-19 departments in a large geriatric medical center (GMC). The second cohort comprised COVID-19 patients admitted to a large general hospital (GH) for symptomatic disease. This was a follow-up study comparing a subgroup of patients who had NLR and PLR values measured a week after admission. Only 100 of 177 patients in the original GMC cohort had a second NLR test compared to almost all (287 of 289) patients in the general hospital (GH) cohort. The subgroup baseline characteristics did not change significantly from that of the original cohort. Disease symptoms were more prevalent in the GH cohort. In the GMC group, the median second NLR rose from 3.9 to 4.6, while in the GH cohort, the NLR value dropped from 3.5 to 2.8, enhancing the NLR differences between the groups. Smaller changes were observed in the second PLR. These results strengthen the prior results that age and frailty seem to have a stronger impact on NLR and PLR than disease severity.

Background: Chest pain is one of the most common reasons for emergency department (ED) visits. Patients presenting with inconclusive symptoms complicate the diagnostic process and add to the burden upon the ED. This study aimed to determine factors possibly influencing ED decisions on hospitalization versus discharge for patients with the diagnosis of chest pain. Methods: In the cohort study including 400 patients admitted to the emergency unit with a working diagnosis of chest pain, data on demographics, medical history, symptoms, lab results, and risk scores were collected from the medical records of patients admitted to the ED with a working diagnosis of chest pain. To reduce potential bias, the analysis was restricted to 330 patients who were referred to the ED by a primary care provider or clinic for chest pain. Results: Of 330 patients admitted to the ED, 58.5% were discharged, and 41.5% were hospitalized. Hospitalized patients were significantly older, with a median age of 70 versus 57 years for those discharged (p < 0.001). A higher proportion of hospitalizations occurred during the late-night shift. Significant predictors of hospitalization included hyperlipidemia (OR 3.246), diaphoresis (OR 8.525), dyspnea (OR 2.897), and hypertension (OR 1.959). Nursing home residents had a lower risk of hospitalization (OR 0.381). The area under the ROC curve for this model was 0.801 (95% CI: 0.753–0.848), indicating the predictive accuracy of the model in estimating the probability of admission. The HEART (history, ECG, age, risk factors, and troponin level) score was more effective than the TIMI (Thrombolysis in Myocardial Infarction) score in predicting the need for hospitalization, with an area under the curve (AUC) of 0.807 compared to 0.742 for TIMI. Conclusions: The HEART score in comparison with TIMI score proved especially valuable for quick risk assessment for hospitalization. The model that included hyperlipidemia, diaphoresis, dyspnea, and hypertension was the most predictive for the risk of hospitalization. Further research with larger populations is needed to validate these findings.

Urinary tract infections (UTIs) are common among hospitalized older adults and are closely linked to antibiotic exposure and antimicrobial resistance. Loop