Étude du profil immunitaire de sujets âgés hospitalisés en unité de court séjour gériatrique

Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status

Introduction:

Vitamin D (VD) deficiency is a major public health problem worldwide. In spite of its high prevalence, particularly among elderly people, VD deficiency is still underestimated by many physicians. Increasingly, VD deficiency is associated with several known geriatric syndromes.

Methods:

The study sample consisted of 125 patients, aged 75 years and older, admitted to the acute geriatric unit. The plausible association between the serum 25-hydroxyvitamin D [25(OH)D] level and patient age, sex, body mass index, renal function, cholecystectomy history, and the prescribed drugs had been investigated. The Fisher's exact test was used to conduct the statistical analysis of data.

Results:

Surprisingly, furosemide treatment was correlated with normal 25(OH)D levels and an increased incidence of secondary hyperparathyroidism. Unlike the other four parameters mentioned above, our data showed that only the patient sex exhibited a significant association with 25(OH)D level as elderly males suffered from a serious VD deficiency as compared to elderly females.

Conclusion:

Old age is an independent risk factor for VD deficiency. The supplementary dose of VD should be precisely defined to achieve the optimal serum 25(OH)D level in elderly people. The definition of the normal serum 25(OH)D threshold in elderly furosemide-treated patients is worth of further studies.

Telomere length is a prognostic biomarker in elderly advanced ovarian cancer patients: a multicenter GINECO study

Purpose

Age induces a progressive decline in functional reserve and impacts cancer treatments. Telomere attrition leads to tissue senescence. We tested the hypothesis that telomere length (TL) could predict patient vulnerability and outcome with cancer treatment.

Patients and methods

An ancillary study in the Elderly Women GINECO Trial 3 was performed to evaluate the impact of geriatric covariates on survival in elderly advanced ovarian cancer patients receiving six cycles of carboplatin. TL was estimated from peripheral blood at inclusion using standard procedures.

Results

TL (in base pairs) was estimated for 109/111 patients (median 6.1 kb; range [4.5-8.3 kb]). With a cut-off of 5.77 kb, TL discriminated two patient groups, long telomere (LT) and short telomeres (ST), with significantly different treatment completion rates of 0.80 (95%CI [0.71-0.89]) and 0.59 (95%CI [0.41-0.76]), respectively (odds ratio [OR]=2.8, p=0.02). ST patients were at higher risk of serious adverse events (SAE, OR=2.7; p=0.02) and had more unplanned hospital admissions (OR=2.1; p=0.08). After adjustment on FIGO stage, TL shorter than 6 kb was a risk factor of premature death (HR=1.57; p=0.06).

Conclusion

This exploratory study identifies TL as predictive factor of decreased treatment completion, SAE risk, unplanned hospital admissions and OS after adjustment on FIGO stage.

Lymphopenia as prognostic factor for mortality and hospital length of stay for elderly hospitalized patients

BACKGROUND

Lymphopenia is a common finding in elderly patients and its relevance is unknown.

AIMS

To evaluate the clinical prognostic value of lymphopenia on the admission of elderly hospitalized patients.

METHODS

From 2012 to 2013, all consecutive patients >75 hospitalized because of medical conditions were prospectively included in the study. Sociodemographic, clinical and laboratory data were collected. Lymphopenia was considered by a plasmatic lymphocyte count of <1100 × 10(9)/l. Hospital length of stay, in-hospital mortality and mortality after a 1-year follow-up were assessed.

RESULTS

The total sample consisted of 180 patients, 90 of whom were females (50 %). Mean age was 83.8 years (SD 5.4). Lymphopenia was present in 45 patients (25 %) upon admission. When compared, those patients with lymphopenia showed a longer hospital stay (19.9 vs. 15.7 days; p 0.002) and higher in-hospital mortality (26.7 vs 7.7 %; p 0.001). The odds ratio for in-hospital mortality in patients with lymphopenia was 3.9 (p 0.03) and the hazard ratio for 1-year mortality 1.9 (p 0.038). Both groups of elderly patients, with and without lymphopenia on admission, showed no differences related to sociodemographic, clinical, or other laboratory data. The study showed no difference in rate of infections between the groups.

CONCLUSION

A quarter of our elderly hospitalized patients had lymphopenia on admission. Furthermore, lymphopenia seemed to constitute as a predictor for bad outcome in terms of a longer hospital stay, in-hospital mortality and 1-year mortality after discharge.

The impact of chemotherapy-associated neutrophil/ lymphocyte counts on prognosis of adjuvant chemotherapy in colorectal cancer

Background

Leukocytes play an important role in cancer development. However, the impact of chemotherapy-associated neutropenia/lymphopenia on the prognosis of adjuvant chemotherapy is unknown. Here, we aimed to explore the impact of chemotherapy-associated neutrophil/lymphocyte counts on prognosis of adjuvant chemotherapy in colorectal cancer (CRC) and the risk factors for developing neutropenia/lymphopenia which showed impact on the prognosis of CRC receiving adjuvant chemotherapy.

Methods

From February 2003 to January 2011, 243 stage II and III CRC patients receiving adjuvant chemotherapy were enrolled in this retrospective study. The associations between neutrophil/ lymphocyte counts and disease free survival (DFS)/overall survival (OS) of CRC, and the risk factors for neutropenia/lymphopenia were investigated.

Results

No association of chemotherapy-associated neutrophil counts and CRC recurrence (AUC = 0.474, P = 0.534), death (AUC = 0.449, P = 0.249) was found by ROC analysis. However, the chemotherapy-associated lymphocyte counts could significantly affect CRC recurrence (AUC = 0.634, P = 0.001), or death(AUC = 0.607, P = 0.015), with a optimized cut-off of 0.66 × 10⁹/L for recurrence, and 0.91 × 10⁹/L for death, respectively. Kaplan–Meier method showed chemotherapy-associated lymphopenia <0.66 × 10⁹/L was associated with shorter DFS (P < 0.0001), and chemotherapy-associated lymphopenia <0.91 × 10⁹/L was associated with shorter OS (P = 0.003). Cox regression model showed chemotherapy-associated lymphopenia <0.66 × 10⁹/L was the independent prognostic factor for DFS (HR, 3.521; 95%CI = 1.703-7.282), and chemotherapy-associated lymphopenia <0.91 × 10⁹/L was the independent prognostic factor for OS (HR, 2.083; 95% CI = 1.103-3.936). Multivariate logistic regression showed the risk of developing chemotherapy-associated lymphopenia <0.66 × 10⁹/L was found in those with pretreatment CEA ≥10 ng ml^-1 (OR, 3.338; 95% CI = 1.523-7.315), and the risk of developing chemotherapy-associated lymphopenia <0.91 × 10⁹/L was found in those with age >60 years (OR, 2.872; 95% CI = 1.344-6.136).

Conclusions

Chemotherapy-associated lymphopenia <0.66 × 10⁹/L /0.91 × 10⁹/L has a significant impact on the prognosis of CRC receiving adjuvant chemotherapy. Pretreatment CEA ≥10 ng ml^-1 is the independent risk factor for developing lymphopenia <0.66 × 10⁹/L, and age >60 years is the independent risk factor for developing lymphopenia <0.91 × 10⁹/L during adjuvant chemotherapy of CRC.

Ageing-associated changes in cellular immunity based on the SENIEUR protocol

To investigate ageing-associated changes in cellular immunity, we recruited three groups of healthy subjects based on SENIEUR protocol criteria. In addition, 10 subjects were randomly selected from each group to isolate their T cells from peripheral blood mononuclear cells; T cell proliferation after phytohemagglutinin (PHA) stimulation was determined by methyl thiazolyl tetrazolium assays. There were no marked differences in the absolute numbers of peripheral blood T cells, NK cells or B cells among the three groups (P > 0.05). Also, no significant differences were noted in the numbers of CD4+ cells, CD8+ cells, or the CD4+/CD8+ ratios (P > 0.05). After PHA stimulation, T cell proliferation was markedly increased, with the highest level in group C and the lowest level in group A (P < 0.05). Cytokine-induced killer tumouricidal activities were also dramatically increased, with the highest activity in group C and the lowest activity in group A (P < 0.05). Our findings suggest that the number of immune cells remains unchanged with advanced age. However, there is a trend for decreased cellular immunity with an increase in age.

[Cytomegalovirus ileitis in a non-immunocompromised old patient: a case report]

INTRODUCTION

Cytomegalovirus ileitis occurs rarely in immunocompetent subjects.

CASE REPORT

An 88-year-old woman presented with severe pain located in right iliac fossa. Biological tests showed an increase in C-reactive protein and neutrophils. Colonoscopy revealed a severely ulcerated and inflamed terminal ileal mucosa. Histopathological analysis of biopsies showed a typical cytopathic effect with ballooned cells and intranuclear inclusions, confirmed by positive immunological marking with anti-cytomegalovirus antibodies. Cytomegalovirus polymerase chain reaction in the plasma showed positive activity. The patient was successfully treated with valganciclovir.

CONCLUSION

The predominant or isolated ileal location of cytomegalovirus infection should be known, especially in the elderly because aging could be a risk factor.