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Roberts JA, Basu-Roy S, Shin J, Varma VR, Williamson A, Blackshear C, Griswold ME, Candia J, Elango P, Karikkineth AC, Tanaka T, Ferrucci L, Thambisetty M. Serum Proteomic Signatures of Common Health Outcomes among Older Adults. Gerontology 2024; 70:269-278. [PMID: 38219723 DOI: 10.1159/000534753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/09/2023] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION In aging populations, the coexistence of multiple health comorbidities represents a significant challenge for clinicians and researchers. Leveraging advances in omics techniques to characterize these health conditions may provide insight into disease pathogenesis as well as reveal biomarkers for monitoring, prognostication, and diagnosis. Researchers have previously established the utility of big data approaches with respect to comprehensive health outcome measurements in younger populations, identifying protein markers that may provide significant health information with a single blood sample. METHODS Here, we employed a similar approach in two cohorts of older adults, the Baltimore Longitudinal Study of Aging (mean age = 76.12 years) and InCHIANTI Study (mean age = 66.05 years), examining the relationship between levels of serum proteins and 5 key health outcomes: kidney function, fasting glucose, physical activity, lean body mass, and percent body fat. RESULTS Correlations between proteins and health outcomes were primarily shared across both older adult cohorts. We further identified that most proteins associated with health outcomes in the older adult cohorts were not associated with the same outcomes in a prior study of a younger population. A subset of proteins, adiponectin, MIC-1, and NCAM-120, were associated with at least three health outcomes in both older adult cohorts but not in the previously published younger cohort, suggesting that they may represent plausible markers of general health in older adult populations. CONCLUSION Taken together, these findings suggest that comprehensive protein health markers have utility in aging populations and are distinct from those identified in younger adults, indicating unique mechanisms of disease with aging.
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Affiliation(s)
- Jackson A Roberts
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA,
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA,
| | - Sayantani Basu-Roy
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Jong Shin
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Vijay R Varma
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Andrew Williamson
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Chad Blackshear
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Julián Candia
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Palchamy Elango
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Ajoy C Karikkineth
- Clinical Research Core, National Institute on Aging, National Institutes of Health Intramural Research Program, Baltimore, Maryland, USA
| | - Toshiko Tanaka
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Madhav Thambisetty
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
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Ticinesi A, Nouvenne A, Cerundolo N, Prati B, Parise A, Tana C, Rendo M, Guerra A, Meschi T. Accounting for frailty and multimorbidity when interpreting high-sensitivity troponin I tests in oldest old. J Am Geriatr Soc 2021; 70:549-559. [PMID: 34792185 PMCID: PMC9299120 DOI: 10.1111/jgs.17566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/17/2022]
Abstract
Background Older patients evaluated in Emergency Departments (ED) for suspect Myocardial Infarction (MI) frequently exhibit unspecific elevations of serum high‐sensitivity troponin I (hs‐TnI), making interpretation particularly challenging for emergency physicians. The aim of this longitudinal study was to identify the interaction of multimorbidity and frailty with hs‐TnI levels in older patients seeking emergency care. Methods A group of patients aged≥75 with suspected MI was enrolled in our acute geriatric ward immediately after ED visit. Multimorbidity and frailty were measured with Cumulative Illness Rating Scale (CIRS) and Clinical Frailty Scale (CFS), respectively. The association of hs‐TnI with MI (main endpoint) was assessed by calculation of the Area Under the Receiver‐Operating Characteristic Curve (AUROC), deriving population‐specific cut‐offs with Youden test. The factors associated with hs‐TnI categories, including MI, CFS and CIRS, were determined with stepwise multinomial logistic regression. The association of hs‐TnI with 3‐month mortality (secondary endpoint) was also investigated with stepwise logistic regression. Results Among 268 participants (147 F, median age 85, IQR 80–89), hs‐TnI elevation was found in 191 cases (71%, median 23 ng/L, IQR 11–65), but MI was present in only 12 cases (4.5%). hs‐TnI was significantly associated with MI (AUROC 0.751, 95% CI 0.580–0.922, p = 0.003), with an optimal cut‐off of 141 ng/L. hs‐TnI levels ≥141 ng/L were significantly associated with CFS (OR 1.58, 95% CI 1.15–2.18, p = 0.005), while levels <141 ng/L were associated with the cardiac subscore of CIRS (OR 1.36, 95% CI 1.07–1.71, p = 0.011). CFS, but not hs‐TnI levels, predicted 3‐month mortality. Conclusions In geriatric patients with suspected MI, frailty and cardiovascular multimorbidity should be carefully considered when interpreting emergency hs‐TnI testing.
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Affiliation(s)
- Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Claudio Tana
- Internal Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital, Chieti, Italy
| | - Martina Rendo
- Primary Care Department, Parma District, Azienda Unità Sanitaria Locale di Parma, Parma, Italy
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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Samara I, Tsiara S, Papafaklis MI, Pappas K, Kolios G, Vryzas N, Michalis LK, Bairaktari ET, Katsouras CS. Elderly patients with non-cardiac admissions and elevated high-sensitivity troponin: the prognostic value of renal function. World J Cardiol 2021; 13:566-573. [PMID: 34754401 PMCID: PMC8554362 DOI: 10.4330/wjc.v13.i10.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/30/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-sensitivity cardiac troponin (hs-cTn) levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events. However, most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.
AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.
METHODS In this retrospective study, we selected patients who were aged ≥ 65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons. Eligible patients were those who had hs-cTnI concentrations ≥ 100 ng/L. We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.
RESULTS One hundred and forty-six patients (59% female) were selected with an age range from 65 to 100 (mean ± SD: 85.4 ± 7.61) years. The median hs-cTnI value was 284.2 ng/L. For 72 (49%) patients the diagnosis of hospitalization was an infectious disease. The overall in-hospital mortality was 32% (47 patients). Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive (median: 314.8 vs 282.5 ng/L; P = 0.565). There was no difference in mortality in patients with infectious vs non-infectious disease (29% vs 35%). Multivariable analysis showed that age (OR 1.062 per 1 year increase, 95%CI: 1.000-1.127; P = 0.048) and creatinine levels (OR 2.065 per 1 mg/dL increase, 95%CI: 1.383-3.085; P < 0.001) were the only independent predictors of death. Mortality was 49% in patients with eGFR < 30 mL/min/1.73 m2.
CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons. The presence of severe renal impairment is a marker of extremely high in-hospital mortality.
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Affiliation(s)
- Ioanna Samara
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Stavroula Tsiara
- Second Department of Internal Medicine, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Michail I Papafaklis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Konstantinos Pappas
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Georgios Kolios
- Laboratory of Biochemistry, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Nikolaos Vryzas
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Eleni T Bairaktari
- Laboratory of Clinical Chemistry, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece
| | - Christos S Katsouras
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
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