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Cristol JP, Thierry AR, Bargnoux AS, Morena-Carrere M, Canaud B. What is the role of the neutrophil extracellular traps in the cardiovascular disease burden associated with hemodialysis bioincompatibility? Front Med (Lausanne) 2023; 10:1268748. [PMID: 38034546 PMCID: PMC10684960 DOI: 10.3389/fmed.2023.1268748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023] Open
Abstract
Despite significant progress in dialysis modalities, intermittent renal replacement therapy remains an "unphysiological" treatment that imperfectly corrects uremic disorders and may lead to low-grade chronic inflammation, neutrophil activation, and oxidative stress due to repetitive blood/membrane interactions contributing to the "remaining uremic syndrome" and cardiovascular disease burden of hemodialysis patients. Understanding dialysis bioincompatibility pathways still remains a clinical and biochemical challenge. Indeed, surrogate biomarkers of inflammation including C-reactive protein could not discriminate between all components involved in these complex pathways. A few examples may serve to illustrate the case. Cytokine release during dialysis sessions may be underestimated due to their removal using high-flux dialysis or hemodiafiltration modalities. Complement activation is recognized as a key event of bioincompatibility. However, it appears as an early and transient event with anaphylatoxin level normalization at the end of the dialysis session. Complement activation is generally assumed to trigger leukocyte stimulation leading to proinflammatory mediators' secretion and oxidative burst. In addition to being part of the innate immune response involved in eliminating physically and enzymatically microbes, the formation of Neutrophil Extracellular Traps (NETs), known as NETosis, has been recently identified as a major harmful component in a wide range of pathologies associated with inflammatory processes. NETs result from the neutrophil degranulation induced by reactive oxygen species overproduction via NADPH oxidase and consist of modified chromatin decorated with serine proteases, elastase, bactericidal proteins, and myeloperoxidase (MPO) that produces hypochlorite anion. Currently, NETosis remains poorly investigated as a sensitive and integrated marker of bioincompatibility in dialysis. Only scarce data could be found in the literature. Oxidative burst and NADPH oxidase activation are well-known events in the bioincompatibility phenomenon. NET byproducts such as elastase, MPO, and circulating DNA have been reported to be increased in dialysis patients more specifically during dialysis sessions, and were identified as predictors of poor outcomes. As NETs and MPO could be taken up by endothelium, NETs could be considered as a vascular memory of intermittent bioincompatibility phenomenon. In this working hypothesis article, we summarized the puzzle pieces showing the involvement of NET formation during hemodialysis and postulated that NETosis may act as a disease modifier and may contribute to the comorbid burden associated with dialysis bioincompatibility.
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Affiliation(s)
- Jean-Paul Cristol
- PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France
- Charles Mion Foundation, AIDER-Santé, Montpellier, France
| | - Alain R. Thierry
- Research Institute of Cancerology of Montpellier, INSERM, IRCM, ICM, University of Montpellier, Montpellier, France
| | - Anne-Sophie Bargnoux
- PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France
| | - Marion Morena-Carrere
- PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France
| | - Bernard Canaud
- School of Medicine, University of Montpellier, Montpellier, France
- MTX Consulting Int., Montpellier, France
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Arslan G, Besci T, Özdemir G, Evren G, Ilgaz Tüzen H, Prencuva P, Turan B, Benligül EM. Predictive Value of PRISM-4, PIM-3, CRP, Albumin, CRP/Albumin Ratio and Lactate in Critically Ill Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1731. [PMID: 38002822 PMCID: PMC10670452 DOI: 10.3390/children10111731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
The accurate prediction of the prognosis for critically ill children is crucial, with the Pediatric Index of Mortality (PIM) and Pediatric Risk of Mortality (PRISM) being extensively utilized for this purpose. Albumin, C-reactive protein (CRP), and lactate levels, which are indicative of inflammation and circulatory status in critically ill children, have not been incorporated into existing scoring systems. This retrospective cohort study evaluated the association between biological markers and the clinical outcomes in children with critical illnesses. PRISM-4 and PIM-3 death probability (DP), albumin, lactate, CRP, and CRP/albumin ratio were recorded upon admission. The accuracy of the indexes in predicting mortality were assessed by calculating the area under the curve (AUC). There were 942 patients included and the 28-day mortality rate was 7.9%. The AUC for PRISM-4, PIM-3, CRP, CRP/albumin ratio, albumin, and lactate were 0.923, 0.896, 0.798, 0.795, 0.751, 0.728, respectively. The findings in the subgroup analysis of septic patients were similar to those found in the overall population. Although CRP, CRP/albumin ratio, albumin, and lactate levels are all linked to mortality in children, CRP and the CRP/albumin ratio have lower predictive values than albumin and lactate. Incorporation of albumin and lactate into scoring systems will improve predictability.
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Affiliation(s)
- Gazi Arslan
- Department of Pediatrics, Division of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylül University, Konak 35220, Turkey; (T.B.); (G.Ö.); (G.E.); (H.I.T.); (P.P.); (B.T.); (E.M.B.)
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Otvos JD, Shalaurova I, May HT, Muhlestein JB, Wilkins JT, McGarrah RW, Kraus WE. Multimarkers of metabolic malnutrition and inflammation and their association with mortality risk in cardiac catheterisation patients: a prospective, longitudinal, observational, cohort study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e72-e82. [PMID: 36738747 DOI: 10.1016/s2666-7568(23)00001-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Complex and incompletely understood metabolic dysfunction associated with inflammation and protein-energy wasting contribute to the increased mortality risk of older patients and those with chronic organ diseases affected by cachexia, sarcopenia, malnutrition, and frailty. However, these wasting syndromes have uncertain relevance for patients with cardiovascular disease or people at lower risk. Studies are hampered by imperfect objective clinical assessment tools for these intertwined metabolic malnutrition and inflammation syndromes. We aimed to assess, in two independent cohorts of patients who underwent cardiac catheterisation, the mortality risk associated with the metabolic vulnerability index (MVX), a multimarker derived from six simultaneously measured serum biomarkers plausibly linked to these dysmetabolic syndromes. METHODS In this prospective, longitudinal, observational study, we included patients aged ≥18 years recruited into the CATHGEN biorepository (Jan 2, 2001, to Dec 30, 2011) and the Intermountain Heart Collaborative Study (Sept 12, 2000, to Sept 21, 2006) who underwent coronary angiography and had clinical nuclear magnetic resonance metabolomic profiling done on frozen plasma obtained at catheterisation. We aggregated six mortality risk biomarkers (GlycA, small HDL, valine, leucine, isoleucine, and citrate concentrations) into sex-specific MVX multimarker scores using coefficients from predictive models for all-cause mortality in the CATHGEN cohort. We assessed associations of biomarkers and MVX with mortality in both cohorts using Cox proportional hazards models adjusted for 15 clinical covariates. FINDINGS We included 5876 participants from the CATHGEN biorepository and 2888 from the Intermountain Heart study. Median follow-up was 6·2 years (IQR 4·4-8·9) in CATHGEN and 8·2 years (6·9-9·2) in the Intermountain Heart study. The six nuclear magnetic resonance biomarkers and MVX made strong, independent contributions to 5-year mortality risk prediction in both cohorts (hazard ratio 2·18 [95% CI 2·03-2·34] in the CATHGEN cohort and 1·67 [1·50-1·87] in the Intermountain Heart cohort). CATHGEN subgroup analyses showed similar MVX associations in men and women, older and younger individuals, for death from cardiovascular or non-cardiovascular causes, and in patients with or without multiple comorbidities. INTERPRETATION MVX made a dominant contribution to mortality prediction in patients with cardiovascular disease and in low-risk subgroups without pre-existing disease, suggesting that metabolic malnutrition-inflammation syndromes might have a more universal role in survival than previously thought. FUNDING Labcorp.
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Affiliation(s)
- James D Otvos
- Labcorp Diagnostics, Morrisville, NC, USA; Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | | | - Heidi T May
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
| | - Joseph B Muhlestein
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
| | - John T Wilkins
- Division of Cardiology, Department of Medicine, and Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert W McGarrah
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
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Jang JH, Hong S, Ryu JA. Prognostic Value of C-Reactive Protein and Albumin in Neurocritically Ill Patients with Acute Stroke. J Clin Med 2022; 11:jcm11175067. [PMID: 36079002 PMCID: PMC9457411 DOI: 10.3390/jcm11175067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
We evaluated the prognostic value of C-reactive protein (CRP), albumin, CRP clearance (CRPc) and CRP/albumin ratio (CAR) in neurocritically ill patients with acute stroke. This is a retrospective, observational study. We included acute stroke patients who were hospitalized in the neurosurgical ICU from January 2013 to September 2019. The primary outcome was in-hospital mortality. A total of 307 patients were enrolled in the study. Among them, 267 (87.0%) survived until discharge from the hospital. CRP and CAR were significantly higher in non-survivors than in survivors (both p < 0.001). Serum albumin levels were significantly lower in the non-survivors than in the survivors (p < 0.001). In receiver operating characteristic curve analysis for prediction of in-hospital mortality, the area under the curve of CRP (C-statistic: 0.820) and CAR (C-statistic: 0.824) were greater than that of CRPc (C-statistic: 0.650) and albumin (C-statistic: 0.734) (all p < 0.005). However, there was no significant difference in the predictive performance between CRP and CAR (p = 0.287). In this study, CRP and CAR were more important than CRPc and albumin in predicting mortality of neurocritically ill patients with stroke. Early CRP level and CAR determination may help to predict the in-hospital mortality of these patients.
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Affiliation(s)
- Ji Hoon Jang
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea
| | - SungMin Hong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Korea
| | - Jeong-Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: ; Tel.: +82-2-3410-6399; Fax: +82-2-2148-7088
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5
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Altered peripheral factors affecting the absorption, distribution, metabolism, and excretion of oral medicines in Alzheimer's disease. Adv Drug Deliv Rev 2022; 185:114282. [PMID: 35421522 DOI: 10.1016/j.addr.2022.114282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) has traditionally been considered solely a neurological condition. Therefore, numerous studies have been conducted to identify the existence of pathophysiological changes affecting the brain and the blood-brain barrier in individuals with AD. Such studies have provided invaluable insight into possible changes to the central nervous system exposure of drugs prescribed to individuals with AD. However, there is now increasing recognition that extra-neurological systems may also be affected in AD, such as the small intestine, liver, and kidneys. Examination of these peripheral pathophysiological changes is now a burgeoning area of scientific research, owing to the potential impact of these changes on the absorption, distribution, metabolism, and excretion (ADME) of drugs used for both AD and other concomitant conditions in this population. The purpose of this review is to identify and summarise available literature reporting alterations to key organs influencing the pharmacokinetics of drugs, with any changes to the small intestine, liver, kidney, and circulatory system on the ADME of drugs described. By assessing studies in both rodent models of AD and samples from humans with AD, this review highlights possible dosage adjustment requirements for both AD and non-AD drugs so as to ensure the achievement of optimum pharmacotherapy in individuals with AD.
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Cheng L, Meng Z, Wang Q, Jian Z, Fan P, Feng X, Qiao X, Yang J, Yuan Z, Li B, Wu Y. The Usefulness of C-Reactive Protein to Albumin Ratio in the Prediction of Adverse Cardiovascular Events in Coronary Chronic Total Occlusion Undergoing Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 8:731261. [PMID: 34869630 PMCID: PMC8636141 DOI: 10.3389/fcvm.2021.731261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022] Open
Abstract
Inflammation and nutrition as main factors can affect the prognosis of patients with chronic total coronary occlusion (CTO) undergoing percutaneous coronary intervention (PCI). The C-reactive protein to albumin ratio (CAR) can clarify the inflammation and nutrition status, which are highly related to clinical outcomes. This study aims to investigate the association between CAR and adverse cardiovascular events in patients with CTO undergoing PCI. For this study, 664 patients were divided into three groups based on the tertiles of CAR. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular events (MACE). Over a median follow-up of 33.7 months, the primary endpoint occurred in 64 patients (9.6%) and the secondary endpoint occurred in 170 patients (25.6%). The patients with higher CAR represented a worse prognosis with all-cause death and cardiovascular death after the adjustment for the baseline risk factors. Adding the CAR values raised the predictive value for the incidence of the all-cause death and cardiovascular death but not MACE. The capacity of prognosis prediction was improved after the addition of the CAR value to the traditional prediction model.
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Affiliation(s)
- Lele Cheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Department of Medical Imaging, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Zixuan Meng
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qi Wang
- First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Zhijie Jian
- Department of Medical Imaging, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Pengcheng Fan
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xinxin Feng
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiangrui Qiao
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Jian Yang
- Department of Medical Imaging, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Bolin Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Yue Wu
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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7
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Baldemir R, Alagoz A. The Relationship Between Mortality, Nutritional Status, and Laboratory Parameters in Geriatric Chronic Obstructive Pulmonary Disease Patients. Cureus 2021; 13:e20526. [PMID: 35070560 PMCID: PMC8767440 DOI: 10.7759/cureus.20526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In geriatric patients, limitations in physical, mental, and/or social functions occur as a result of acute and/or chronic disease along with age-related degenerative changes. This study aimed to investigate the relationship between nutritional status, mean platelet volume (MPV), C-reactive protein (CRP)-to-albumin ratio (CAR), and mortality in geriatric chronic obstructive pulmonary disease (COPD) patients. METHODS Patients aged 65 years and older who were tertiary state hospitalized with COPD were included in the study. Demographic data of the patients, diagnosis, nutritional risk score-2002 (NRS-2002) score, and body mass index (BMI) were recorded. Glucose, MPV, CRP, albumin, CAR values of the patients, as well as 30-day and 90-day mortality status after nutritional evaluation, were determined. Patients hospitalized for a reason other than COPD, those using anti-inflammatory drugs, patients with missing data, and those in intensive care units were excluded from the study. Patients were divided into two groups based on NRS-2002: NRS-2002; 1 and 2, and NRS-2002; ≥3. RESULTS Four hundred eighteen patients were hospitalized for COPD. Of these patients, 279 were aged 65 and over, but due to missing data, only 261 patients' data were analyzed. The 30-day and 90-day mortality rates were quite high in patients with a diagnosis of COPD who needed nutritional support (37.5% and 49.8%). When the demographic data and laboratory values of the patients are examined according to the 30-day and 90-day mortality status, the MPV value is statistically significantly higher in those with mortality at the end of 90 days (p < 0.05). Despite the fact that the NRS-2002 ≥3 group had higher 30-day and 90-day mortality rates than the NRS-2002 1 or 2 groups, there was no statistically significant difference between the groups (p > 0.05). CONCLUSIONS As a result, 90-day mortality was observed in approximately half of the patients, and the majority of these patients were male. Parameters that could predict 30-day and 90-day mortality could not be determined without MPV. Inflammatory parameters such as MPV can guide the determination of nutritional needs, especially in geriatric patients with COPD. Because of the high mortality rates in geriatric patients with COPD who need nutritional support, nutritional support should be started without delay in these patients. There is a need for prospective randomized controlled multicenter studies on this subject.
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Affiliation(s)
- Ramazan Baldemir
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Ali Alagoz
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
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Minato-Inokawa S, Tsuboi A, Takeuchi M, Kitaoka K, Yano M, Kurata M, Kazumi T, Fukuo K. Associations of serum transthyretin with triglyceride in non-obese elderly Japanese women independently of insulin resistance, HDL cholesterol, and adiponectin. Diabetol Int 2021; 12:405-411. [PMID: 34567923 DOI: 10.1007/s13340-021-00496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
Objective Studies are limited on the association between serum transthyretin (TTR), a negative acute phase reactant, and triglyceride (TG). Research design and methods TG, TTR, and insulin resistance-related cardiometabolic variables were measured in 159 fasting and 185 nonfasting community-dwelling elderly women aged 50-96 years. Pearson correlation analysis and then stepwise multiple regression analyses were performed to further identify the most significant variables contributing to the variation of fasting and nonfasting TG. Results Multiple regression analysis for fasting TG as a dependent variable revealed that TTR (standardized β: 0.299) and HDL cholesterol (standardized β: -0.545) emerged as determinants of TG independently of percentage of body fat, homeostasis model assessment insulin resistance, serum leptin and adiponectin, and plasminogen activator inhibitor-1 (PAI-1) (R 2 = 0.36). For nonfasting TG, HDL cholesterol (standardized β: - 0.461), TTR (standardized β: 0.231), nonfasting insulin, a marker of insulin resistance, (standardized β: 0.202), and PAI-1 (standardized β: 0.187) emerged as determinants independently of percentage of body fat, nonfasting glucose, serum leptin and adiponectin, and high-sensitivity C-reactive protein (R 2 = 0.45). Conclusions Fasting and nonfasting TG showed positive association with TTR in community-dwelling elderly non-obese women independently of insulin resistance, HDL cholesterol, and adiponectin. These findings may provide a clue as to a physiological function of circulating TTR in human: an influence factor of TG-rich lipoproteins in the circulation.
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Affiliation(s)
- Satomi Minato-Inokawa
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan.,Laboratory of Community Health and Nutrition, Department of Bioscience, Graduate School of Agriculture, Ehime University, Matsuyama, Ehime, Japan
| | - Ayaka Tsuboi
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan.,Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
| | - Mika Takeuchi
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan
| | - Kaori Kitaoka
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan
| | - Megumu Yano
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan
| | - Miki Kurata
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan.,Department of Food Sciences and Nutrition, Mukogawa Women's University, Nishinomiya, Hyogo Japan
| | - Tsutomu Kazumi
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan.,Department of Medicine, Kohnan Kakogawa Hospital, Kakogawa, Hyogo Japan
| | - Keisuke Fukuo
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan.,Department of Food Sciences and Nutrition, Mukogawa Women's University, Nishinomiya, Hyogo Japan
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9
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Wu Q, Liu JH, Ma QH, Xu Y, Pan CW. White blood cell count as a mediator of the relationship between depressive symptoms and all-cause mortality: A community-based cohort study. Arch Gerontol Geriatr 2021; 94:104343. [PMID: 33493955 DOI: 10.1016/j.archger.2021.104343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/28/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES One possible pathway by which depressive symptoms influence all-cause mortality is through their relationship with markers of inflammatory response. We aimed to examine whether white blood cell (WBC) count mediated the relationship between the presence of depressive symptoms and all-cause mortality among older Chinese people. METHODS This community-based cohort study targeted 4053 individuals aged 60 years or over. A bootstrapping approach was applied to examine whether WBC count mediated the relationship between the presence of depressive symptoms and all-cause mortality. WBC count was evaluated as a mediator. The presence of depressive symptoms was assessed by the nine-item Patient Health Questionnaire (PHQ-9). The mediating effect was considered significant if the 95% confidence interval (CI) did not include 0. RESULTS Mediation analysis indicated that WBC count played an important mediating role in the relationship between PHQ-9 score and all-cause mortality based on the significance of indirect effect (β = -0.0039, 95% CI = -0.01, -0.0009). The direct effect from PHQ-9 score to all-cause mortality was not statistically significant (P = 0.11) after adjusting for WBC count. CONCLUSION WBC count was associated with depressive symptoms and all-cause mortality. The association of depressive symptoms with all-cause mortality was fully mediated by WBC count.
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Affiliation(s)
- Qian Wu
- School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Jing-Hong Liu
- School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Qing-Hua Ma
- The 3rd People's Hospital of Xiangcheng District, Suzhou, China
| | - Yong Xu
- School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China.
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10
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Acehan S, Gulen M, Satar S, Kuvvetli A, Isikber C, Yesiloglu O, Toptas Firat B, Sonmez A, Segmen MS, Ince C. Evaluation of Nutrition Risk in Patients Over 65 Years of Age With Nontraumatic Acute Abdominal Syndrome. Nutr Clin Pract 2020; 35:1070-1079. [PMID: 32935880 DOI: 10.1002/ncp.10575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/11/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate the power of CRP/Albumin ratio, NRS-2002, mNUTRIC scores to predict nutritional needs and mortality in patients over 65 years of age diagnosed with acute abdominal syndrome in the emergency department and then transferred to the surgical intensive care unit. MATERIAL AND METHOD CRP/Albumin ratio, APACHE II, SOFA, NRS-2002 and mNUTRIC scores were calculated. The analysis of the data was conducted in IBM SPSS Statistics Base 22.0 package program. RESULTS In the analytical evaluation made for nutritional needs, AUC value for mNUTRIC was found to be: 0,683, 95% CI 0,611-0,755, p < 0.001. It was found out that mortality of patients had a statistically significant and moderate correlation with mNUTRIC score (r = 0.537; p < 0.001). In the analytical evaluation made for mortality, mNUTRIC's AUC value (AUC: 0.808, 95% CI 0.736-0.880, p < 0.001) was found to be the highest. When the cut-off value determined to predict mortality was taken as 3.5 for mNUTRIC score, sensitivity was 75.9% and specificity was 69.4%. CONCLUSION The evaluation of the risk of malnutrition through nutritional risk tools in intensive care patients over 65 years of age with acute abdominal syndrome can also predict nutritional needs in the early period besides mortality. Based on our data, the fact that mNUTRIC score cut-off value in older patients hospitalized in intensive care is 3.5 and higher may be a predictor for ICU mortality.
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Affiliation(s)
- Selen Acehan
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Muge Gulen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Salim Satar
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Adnan Kuvvetli
- Department of General Surgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Cem Isikber
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Onder Yesiloglu
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Basak Toptas Firat
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Sonmez
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Mustafa Sencer Segmen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Cagdas Ince
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
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11
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Schaller MS, Chen M, Colas RA, Sorrentino TA, Lazar AA, Grenon SM, Dalli J, Conte MS. Treatment With a Marine Oil Supplement Alters Lipid Mediators and Leukocyte Phenotype in Healthy Patients and Those With Peripheral Artery Disease. J Am Heart Assoc 2020; 9:e016113. [PMID: 32696697 PMCID: PMC7792251 DOI: 10.1161/jaha.120.016113] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Peripheral artery disease (PAD) is an advanced form of atherosclerosis characterized by chronic inflammation. Resolution of inflammation is a highly coordinated process driven by specialized pro‐resolving lipid mediators endogenously derived from omega‐3 fatty acids. We investigated the impact of a short‐course, oral, enriched marine oil supplement on leukocyte phenotype and biochemical mediators in patients with symptomatic PAD and healthy volunteers. Methods and Results This was a prospective, open‐label study of 5‐day oral administration of an enriched marine oil supplement, assessing 3 escalating doses in 10 healthy volunteers and 10 patients with PAD. Over the course of the study, there was a significant increase in the plasma level of several lipid mediator families, total specialized pro‐resolving lipid mediators, and specialized pro‐resolving lipid mediator:prostaglandin ratio. Supplementation was associated with an increase in phagocytic activity of peripheral blood monocytes and neutrophils. Circulating monocyte phenotyping demonstrated reduced expression of multiple proinflammatory markers (cluster of differentiation 18, 163, 54, and 36, and chemokine receptor 2). Similarly, transcriptional profiling of monocyte‐derived macrophages displayed polarization toward a reparative phenotype postsupplementation. The most notable cellular and biochemical changes over the study occurred in patients with PAD. There were strong correlations between integrated biochemical measures of lipid mediators (specialized pro‐resolving lipid mediators:prostaglandin ratio) and phenotypic changes in circulating leukocytes in both healthy individuals and patients with PAD. Conclusions These data suggest that short‐term enriched marine oil supplementation dramatically remodels downstream lipid mediator pathways and induces a less inflammatory and more pro‐resolution phenotype in circulating leukocytes and monocyte‐derived macrophages. Further studies are required to determine the potential clinical relevance of these findings in patients with PAD. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02719665.
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Affiliation(s)
- Melinda S Schaller
- Division of Vascular and Endovascular Surgery Cardiovascular Research Institute University of California, San Francisco San Francisco CA
| | - Mian Chen
- Division of Vascular and Endovascular Surgery Cardiovascular Research Institute University of California, San Francisco San Francisco CA
| | - Romain A Colas
- William Harvey Research InstituteBarts and The London School of Medicine and Dentistry Queen Mary University of London London United Kingdom
| | - Thomas A Sorrentino
- Division of Vascular and Endovascular Surgery Cardiovascular Research Institute University of California, San Francisco San Francisco CA
| | - Ann A Lazar
- Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco CA
| | - S Marlene Grenon
- Division of Vascular and Endovascular Surgery Cardiovascular Research Institute University of California, San Francisco San Francisco CA
| | - Jesmond Dalli
- William Harvey Research InstituteBarts and The London School of Medicine and Dentistry Queen Mary University of London London United Kingdom.,Centre for Inflammation and Therapeutic Innovation Queen Mary University of London London United Kingdom
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery Cardiovascular Research Institute University of California, San Francisco San Francisco CA
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12
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Seidu S, Kunutsor SK, Khunti K. Serum albumin, cardiometabolic and other adverse outcomes: systematic review and meta-analyses of 48 published observational cohort studies involving 1,492,237 participants. SCAND CARDIOVASC J 2020; 54:280-293. [PMID: 32378436 DOI: 10.1080/14017431.2020.1762918] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives. A general body of evidence suggests that low serum albumin might be associated with increased risk of adverse cardiometabolic outcomes, but findings are divergent. We aimed to quantify associations of serum albumin with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), all-cause mortality, and other adverse outcomes using a systematic review and meta-analyses of published observational cohort studies. Design. MEDLINE, Embase, Web of Science, and manual search of relevant bibliographies were systematically searched to January 2020. Relative risks (RRs) with 95% confidence intervals (CIs) comparing top versus bottom thirds of serum albumin levels were pooled. Results. Fifty-four articles based on 48 unique observational cohort studies comprising of 1,492,237 participants were eligible. Multivariable adjusted RRs (95% CIs) comparing the top vs bottom third of serum albumin levels were: 1.03 (0.86-1.22) for T2D; 0.60 (0.53-0.67) for CVD; 0.74 (0.66-0.84) for coronary heart disease (CHD); 0.57 (0.36-0.91) for CHD death; 0.76 (0.65-0.87) for myocardial infarction; 0.66 (0.55-0.77) for all-cause mortality; 0.71 (0.61-0.83) for venous thromboembolism; 0.65 (0.48-0.88) for cancer mortality; and 0.62 (0.46-0.84) for fracture. Heterogeneity between contributing studies of T2D was partly explained by sample sizes of studies (p for meta-regression = .035). Conclusions. Elevated levels of serum albumin are associated with reduced risk of vascular outcomes, all-cause mortality, certain cancers, and fracture. Inconsistent findings for T2D may be attributed to selective reporting by studies. Further research is needed to assess any potential causal relevance to these findings and the role of serum albumin concentrations in disease prevention.Systematic review registration: PROSPERO 2019: CRD42019125869.
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Affiliation(s)
- Samuel Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
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13
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Fanelli Kuczmarski M, Stave Shupe E, Pohlig RT, Rawal R, Zonderman AB, Evans MK. A Longitudinal Assessment of Diet Quality and Risks Associated with Malnutrition in Socioeconomic and Racially Diverse Adults. Nutrients 2019; 11:nu11092046. [PMID: 31480661 PMCID: PMC6770204 DOI: 10.3390/nu11092046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 01/07/2023] Open
Abstract
Little is known about the effects of diet quality through adulthood and its association with malnutrition later in life. The first research objective was to evaluate diet quality assessed by Mean Adequacy Ratio (MAR) of United States African American and White adults (n = 2066), examined at baseline and two follow-up waves in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. The sample was split into cohorts by age at study baseline: Younger, <50, and older, ≥50 years. The second objective was to assess the association of MAR and risk for malnutrition in adults who were ≥60 years at wave 4 (n = 746). The Mini Nutritional Assessment was used to determine risk for malnutrition. At each of the three study waves, 17 micronutrients from two 24 h dietary recalls were used to calculate MAR. Over 13 years MAR changed minimally in the younger cohort as they aged from early to middle adulthood. In contrast, a statistically significant decline in MAR was observed for the older cohort between baseline (2004–2009) and wave 4 (2013–2017), with a greater degree of worsening at low energy levels. The risk for malnutrition was significantly associated with consuming a diet low in energy, lower protein as a percent of energy at baseline, as well as being food insecure, a current smoker, and having income <125% poverty. The risk for malnutrition was not associated with a change in protein intake in years prior to age 60, change in MAR scores across waves, MAR at wave 4, age, sex, race, or having hypertension or diabetes. These longitudinal study findings revealed that diet quality was not predictive of risk for malnutrition.
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Affiliation(s)
- Marie Fanelli Kuczmarski
- Department of Behavioral Health and Nutrition, University of Delaware, 206C McDowell Hall, Newark, DE 19716, USA.
| | - Emily Stave Shupe
- Department of Behavioral Health and Nutrition, University of Delaware, 206C McDowell Hall, Newark, DE 19716, USA
| | - Ryan T Pohlig
- College of Health Sciences, University of Delaware, STAR, Newark, DE 19716, USA
| | - Rita Rawal
- Department of Medical Laboratory Sciences, University of Delaware, 206C McDowell Hall, Newark, DE 19716, USA
| | - Alan B Zonderman
- National Institute on Aging, Laboratory of Epidemiology and Population Sciences, NIH, 251 Bayview Blvd, Baltimore, MD 21224, USA
| | - Michele K Evans
- National Institute on Aging, Laboratory of Epidemiology and Population Sciences, NIH, 251 Bayview Blvd, Baltimore, MD 21224, USA
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14
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Wang R, Wen X, Huang C, Liang Y, Mo Y, Xue L. Association between inflammation-based prognostic scores and in-hospital outcomes in elderly patients with acute myocardial infarction. Clin Interv Aging 2019; 14:1199-1206. [PMID: 31308643 PMCID: PMC6615021 DOI: 10.2147/cia.s214222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/12/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Emerging evidence suggests that systemic inflammation is a predictor of poor prognosis in acute myocardial infarction (AMI). In this study, we sought to assess whether inflammation-based prognostic scores are associated with in-hospital outcomes in elderly patients with AMI. Methods In this retrospective study, patients who were over 75-years-old and met the diagnostic criteria for AMI were consecutively recruited from January 1, 2016, to March 31, 2019. Logistic regression and receiver-operating characteristic (ROC) analyses were performed to evaluate the predictive value of the inflammation-based Glasgow Prognostic Score (GPS), Prognostic Index (PI) and Prognostic Nutritional Index (PNI). Results A total of 273 patients were enrolled. The incidence of major cardiovascular adverse events (MACEs) and mortality during hospitalization increased significantly with increasing GPS and PI scores. Multiple logistic regression showed that the GPS was independently associated with MACEs (score 1, RR: 6.711, 95% CI: 1.409–31.968; score 2, RR: 14.063, 95% CI: 3.018–65.535) and mortality (score 1, RR: 8.656, 95% CI: 1.068–70.126; score 2, RR: 10.549, 95% CI: 1.317–84.465). The PI was also independently predictive of MACEs (score 2, RR: 5.132, 95% CI: 1.451–18.148). No significant difference was observed in the PNI between patients with different in-hospital outcomes. When in-hospital MACEs were used as an endpoint, the area under the curve (AUC) of the GPS was 0.740 (95% CI 0.678–0.802), and the AUC of the PI was 0.703 (95% CI 0.634–0.773). When mortality was used as an endpoint, the AUC of the GPS was 0.677 (95% CI 0.602–0.753), and the AUC of the PI was 0.667 (95% CI 0.577–0.757). Conclusion The severity of systemic inflammation is a strong predictor of poor prognosis in elderly patients with AMI. Among these three inflammation-based prognostic scores, the GPS has a better predictive value than the PI and PNI for in-hospital MACEs and mortality.
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Affiliation(s)
- Rui Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Xiaodan Wen
- Department of Geriatrics, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Cheng Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yingcong Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yujing Mo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Ling Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
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15
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Kim SH, Kim JW, Hwang IG, Jang JS, Hong S, Kim TY, Baek JY, Shin SH, Sun DS, Hong DS, Kim HJ, Hong YS, Woo IS, Lee JH, Kim JH. Serum biomarkers for predicting overall survival and early mortality in older patients with metastatic solid tumors. J Geriatr Oncol 2019; 10:749-756. [PMID: 30952517 DOI: 10.1016/j.jgo.2019.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/20/2018] [Accepted: 03/22/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We aimed to explore serum biomarkers for predicting survival of older patients with metastatic solid tumors who received first line palliative chemotherapy. MATERIALS AND METHODS Serum samples were prospectively collected before first-line chemotherapy at 11 academic centers in Korea. All patients were participants in a prospective cohort study of older patients with metastatic solid tumors. Serum levels of C-reactive protein (CRP), CXCL10, SIRT1, VEGF-A, activin A, C-terminal telopeptide of type I collagen (CTx), total 25-hydroxyvitamin D were measured by ELISA and interleukin-6 (IL-6), myostatin, irisin, FGF-19, FGF-21, FGF-23 by Luminex multiplex assay. Overall survival (OS) was determined. RESULTS Serum samples from 138 patients (median age: 75 years, range: 70-92 years) were collected from February 2014 to December 2016. During a median follow up time of 13.8 months, 73 (52.9%) patients died. Among 13 serum markers, CRP (log-rank, P = 0.009), activin A (P = 0.007), and myostatin (P = 0.047) were significantly correlated with OS in univariate analyses. Activin A (hazard ratio [HR] 2.22, 95% confidence interval [CI] 1.32-3.72; P = 0.003) and myostatin (HR 3.02, 95% CI 1.39-6.57; P = 0.005) were significantly associated with OS after adjustment for other clinical factors. In predicting early (6-month) mortality, two inflammatory markers, IL-6 and CRP, were included in the decision-tree model. CONCLUSION In older patients with cancer, high serum concentrations of activin A and myostatin were predictive of poor OS. IL-6 and CRP might be useful to select older patients at risk of early mortality. These markers could be incorporated into predictive tools for clinical decision-making and warrant further investigation.
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Affiliation(s)
- Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Gyu Hwang
- Diveision of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Joung Soon Jang
- Diveision of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Soojung Hong
- Departmenet of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeon Baek
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Der Sheng Sun
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Dae-Sik Hong
- Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Republic of Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, Seoul, Republic of Korea
| | - In Sook Woo
- Department of Internal Medicine, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju-Hyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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16
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Miao JP, Quan XQ, Zhang CT, Zhu H, Ye M, Shen LY, Guo QH, Zhu GY, Mei QJ, Wu YX, Li SG, Zhou HL. Comparison of two malnutrition risk screening tools with nutritional biochemical parameters, BMI and length of stay in Chinese geriatric inpatients: a multicenter, cross-sectional study. BMJ Open 2019; 9:e022993. [PMID: 30782871 PMCID: PMC6411257 DOI: 10.1136/bmjopen-2018-022993] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess malnutrition risk in Chinese geriatric inpatients using Nutritional Risk Screening 2002 (NRS2002) and Mini-Nutritional Assessment (MNA), and to identify the most appropriate nutritional screening tool for these patients. DESIGN Cross-sectional study. SETTING Eight medical centres in Hubei Province, China. PARTICIPANTS A total of 425 inpatients aged ≥70 years were consecutively recruited between December 2014 and May 2016. PRIMARY AND SECONDARY OUTCOME MEASURES Nutritional risk was assessed using NRS2002, MNA, anthropometric measurements and biochemical parameters within 24 hours of admission. Comorbidities and length of hospitalisation were recorded. Nutritional parameters, body mass index (BMI) and length of hospital stay (LOS) were employed to compare MNA and NRS2002. Kappa analysis was used to evaluate the consistency of the two tools. RESULTS The average age was 81.2±5.9 years (range, 70-98). The prevalence of undernutrition classified by NRS2002 and MNA was 40.9% and 58.6%, respectively. Patients undergoing malnutrition had lower BMI, haemoglobin, albumin and prealbumin (p<0.05), and longer LOS (p<0.05). The NRS2002 showed moderate agreement (κ=0.521, p<0.001) with MNA. Both tools presented significant correlation with age, BMI and laboratory parameters (p<0.001). In addition, a significant association between both tools and LOS was found (p<0.05). In addition, the NRS2002 was not different from MNA in predicting nutritional risk in terms of the area under the receiver operating characteristic curve (p>0.05). CONCLUSIONS The results show a relatively high prevalence of malnutrition risk in our sample cohort. We found that NRS2002 and MNA were both suitable in screening malnutrition risk among Chinese geriatric inpatients.
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Affiliation(s)
- Jian-Ping Miao
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
- Wuhan Clinical Research Center for Treatment and Rehabilitation of Elderly Multi-Organ Dysfunction, Wuhan, China
| | - Xiao-Qing Quan
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
- Wuhan Clinical Research Center for Treatment and Rehabilitation of Elderly Multi-Organ Dysfunction, Wuhan, China
| | - Cun-Tai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
- Wuhan Clinical Research Center for Treatment and Rehabilitation of Elderly Multi-Organ Dysfunction, Wuhan, China
| | - Hong Zhu
- Department of Geriatrics, The Central Hospital of Wuhan University, Wuhan, China
| | - Mei Ye
- Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Li-Ya Shen
- Department of Geriatrics, Wuhan No 6 Hospital, Wuhan, China
| | - Qiu-Hui Guo
- Department of Geriatrics, Wuhan No 6 Hospital, Wuhan, China
| | - Gang-Yan Zhu
- Department of Geriatrics, Hubei General Hospital, Wuhan, China
| | - Qi-Jian Mei
- Department of Geriatrics, General Hospital of the Yangtze River Shipping, Wuhan, China
| | - Yan-Xia Wu
- Department of Geriatrics, Wuhan No 1 Hospital, Wuhan, China
| | - Shu-Guo Li
- Department of Geriatrics, First Clinical Medical College, Three Gorges University and Yichang Central People’s Hospital, Yichang, China
| | - Hong-Lian Zhou
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
- Wuhan Clinical Research Center for Treatment and Rehabilitation of Elderly Multi-Organ Dysfunction, Wuhan, China
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17
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Edvardsson M, Sund-Levander M, Milberg A, Wressle E, Marcusson J, Grodzinsky E. Differences in levels of albumin, ALT, AST, γ-GT and creatinine in frail, moderately healthy and healthy elderly individuals. Clin Chem Lab Med 2018; 56:471-478. [PMID: 28988219 DOI: 10.1515/cclm-2017-0311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/28/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reference intervals are widely used as decision tools, providing the physician with information about whether the analyte values indicate ongoing disease process. Reference intervals are generally based on individuals without diagnosed diseases or use of medication, which often excludes elderly. The aim of the study was to assess levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine and γ-glutamyl transferase (γ-GT) in frail, moderately healthy and healthy elderly indivuduals. METHODS Blood samples were collected from individuals >80 years old, nursing home residents, in the Elderly in Linköping Screening Assessment and Nordic Reference Interval Project, a total of 569 individuals. They were divided into three cohorts: frail, moderately healthy and healthy, depending on cognitive and physical function. Albumin, ALT, AST, creatinine and γ-GT were analyzed using routine methods. RESULTS Linear regression predicted factors for 34% of the variance in albumin were activities of daily living (ADL), gender, stroke and cancer. ADLs, gender and weight explained 15% of changes in ALT. For AST levels, ADLs, cancer and analgesics explained 5% of changes. Kidney disease, gender, Mini Mental State Examination (MMSE) and chronic obstructive pulmonary disease explained 25% of the variation in creatinine levels and MMSE explained three per cent of γ-GT variation. CONCLUSIONS Because a group of people are at the same age, they should not be assessed the same way. To interpret results of laboratory tests in elderly is a complex task, where reference intervals are one part, but far from the only one, to take into consideration.
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Affiliation(s)
- Maria Edvardsson
- Laboratoriet, Närsjukvården i Finspång, Lasarettsvägen 12 - 16, 612 25 Finspång, Sweden, Phone: +46 101042412, Fax: +46 101042441
- Primary Health Care and Department of Medicine and Health Sciences, Linköping University, Finspång, Sweden
| | - Märtha Sund-Levander
- Department of Nursing, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Anna Milberg
- Department of Social and Welfare Studies, Palliative Education and Research Centre and Faculty of Medicine, Linköping University, Norrköping, Sweden
| | - Ewa Wressle
- Department of Acute Internal Medicine and Geriatric and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jan Marcusson
- Department of Acute Internal Medicine and Geriatric and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ewa Grodzinsky
- Division of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine and Department of Pharmaceutic Research, Faculty of Medicine, Linköping University, Linköping, Sweden
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18
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Oh TK, Song IA, Lee JH. Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: A retrospective analysis. Sci Rep 2018; 8:14977. [PMID: 30297724 PMCID: PMC6175848 DOI: 10.1038/s41598-018-33361-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022] Open
Abstract
This study aimed to examine the prognostic value of C-reactive protein (CRP)/albumin (ALB) ratio among patients who were admitted to the intensive care unit (ICU) in predicting 30-day mortality rate. This retrospective cohort study was conducted by examining the medical records of adult patients who were admitted to the ICU at Seoul National University Bundang Hospital between 1 January 2012 and 31 December 2016. Data from 6,972 individuals were included in the final analysis, and 547 of these individuals (7.1%) died within 30 days after their ICU admission. The multivariable Cox regression analysis revealed that an increase of 1 for the CRP/ALB ratio was associated with an 11% increase in the risk of 30-day mortality (hazard ratio: 1.11, 95% confidence interval: 1.09–1.14, P < 0.001). However, the area under curve of CRP/ALB ratio in receiver operating characteristic analysis was lower than that of Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II, Charlson comorbidity index, or serum albumin alone. Although an elevated CRP/ALB ratio on ICU admission was an independent risk factor for 30-day mortality rate, the predictive power of CRP/ALB ratio was lower than that of albumin alone, APACHE II, and Charlson comorbidity index.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospita, Seongnam, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospita, Seongnam, Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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19
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Kim D, Park Y. Association between the Dietary Inflammatory Index and Risk of Frailty in Older Individuals with Poor Nutritional Status. Nutrients 2018; 10:nu10101363. [PMID: 30249038 PMCID: PMC6213380 DOI: 10.3390/nu10101363] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022] Open
Abstract
Both inflammation and poor nutritional status are major risk factors of frailty, and the dietary inflammatory index (DII) has been suggested as being associated with the risk of frailty. The present study aimed to investigate whether DII scores were positively associated with the risk of frailty in older individuals, particularly those with poor nutritional status. In total, 321 community-dwelling older individuals aged 70–85 years were recruited and categorized as non-frail, pre-frail, and frail according to the Cardiovascular Health Study index. DII scores were calculated based on 24-h dietary recall, and nutritional status was assessed using the Mini Nutritional Assessment. Multinomial logistic regression analysis showed that DII scores were positively associated with the risk of frailty in older individuals (odds ratio, OR 1.64, 95% confidence interval, 95% CI 1.25–2.17), particularly those with poor nutritional status (OR 1.68, 95% CI 1.21–2.34). Among the frailty criteria, weight loss (OR 1.29, 95% CI 1.03–1.60), low walking speed (OR 1.33, 95% CI 1.10–1.61), and low grip strength (OR 1.34, 95% CI 1.13–1.60) were associated with DII scores. In addition, the optimal DII cut-off score for frailty was ≥0.93 (sensitivity 71%; specificity: 72%; area under the receiver operating characteristic curve, AUC = 0.792). The present study showed that a pro-inflammatory diet was associated with increased risk of frailty, particularly in older individuals with poor nutritional status. Future randomized controlled trials with a low DII diet for the prevention of frailty are needed to confirm our finding.
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Affiliation(s)
- Doyeon Kim
- Department of Food and Nutrition, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea.
| | - Yongsoon Park
- Department of Food and Nutrition, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea.
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Orwoll ES, Wiedrick J, Jacobs J, Baker ES, Piehowski P, Petyuk V, Gao Y, Shi T, Smith RD, Bauer DC, Cummings SR, Nielson CM, Lapidus J. High-throughput serum proteomics for the identification of protein biomarkers of mortality in older men. Aging Cell 2018; 17. [PMID: 29399943 PMCID: PMC5847880 DOI: 10.1111/acel.12717] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 01/17/2023] Open
Abstract
The biological perturbations associated with incident mortality are not well elucidated, and there are limited biomarkers for the prediction of mortality. We used a novel high‐throughput proteomics approach to identify serum peptides and proteins associated with 5‐year mortality in community‐dwelling men age ≥65 years who participated in a longitudinal observational study of musculoskeletal aging (Osteoporotic Fractures in Men: MrOS). In a discovery phase, serum specimens collected at baseline in 2473 men were analyzed using liquid chromatography–ion mobility–mass spectrometry, and incident mortality in the subsequent 5 years was ascertained by tri‐annual questionnaire. Rigorous statistical methods were utilized to identify 56 peptides (31 proteins) that were associated with 5‐year mortality. In an independent replication phase, selected reaction monitoring was used to examine 21 of those peptides in baseline serum from 750 additional men; 81% of those peptides remained significantly associated with mortality. Mortality‐associated proteins included a variety involved in inflammation or complement activation; several have been previously linked to mortality (e.g., C‐reactive protein, alpha 1‐antichymotrypsin) and others are not previously known to be associated with mortality. Other novel proteins of interest included pregnancy‐associated plasma protein, VE‐cadherin, leucine‐rich α‐2 glycoprotein 1, vinculin, vitronectin, mast/stem cell growth factor receptor, and Saa4. A panel of peptides improved the predictive value of a commonly used clinical predictor of mortality. Overall, these results suggest that complex inflammatory pathways, and proteins in other pathways, are linked to 5‐year mortality risk. This work may serve to identify novel biomarkers for near‐term mortality.
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Affiliation(s)
| | | | - Jon Jacobs
- Biological Science Division; Pacific Northwest National Laboratory; Richland WA USA
| | - Erin S. Baker
- Biological Science Division; Pacific Northwest National Laboratory; Richland WA USA
| | - Paul Piehowski
- Biological Science Division; Pacific Northwest National Laboratory; Richland WA USA
| | - Vladislav Petyuk
- Biological Science Division; Pacific Northwest National Laboratory; Richland WA USA
| | - Yuqian Gao
- Biological Science Division; Pacific Northwest National Laboratory; Richland WA USA
| | - Tujin Shi
- Biological Science Division; Pacific Northwest National Laboratory; Richland WA USA
| | - Richard D. Smith
- Biological Science Division; Pacific Northwest National Laboratory; Richland WA USA
| | - Douglas C. Bauer
- Department of Medicine; University of California; San Francisco CA USA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute; San Francisco CA USA
| | | | - Jodi Lapidus
- Oregon Health & Science University; Portland OR USA
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Vojinovic D, van der Lee SJ, van Duijn CM, Vernooij MW, Kavousi M, Amin N, Demirkan A, Ikram MA, van der Lugt A, Bos D. Metabolic profiling of intra- and extracranial carotid artery atherosclerosis. Atherosclerosis 2018; 272:60-65. [PMID: 29550646 DOI: 10.1016/j.atherosclerosis.2018.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS Increasing evidence shows that intracranial carotid artery atherosclerosis may develop under the influence of a differential metabolic risk factor profile than atherosclerosis in the extracranial part of the carotid artery. To further elucidate these differences, we investigated associations of a wide range of circulating metabolites with intracranial and extracranial carotid artery atherosclerosis. METHODS From the population-based Rotterdam Study, blood samples from 1111 participants were used to determine a wide range of metabolites by proton nuclear magnetic resonance (NMR). Moreover, these participants underwent non-contrast computed tomography of the neck and head to quantify the amount of extra- and intracranial carotid artery calcification (ECAC and ICAC), as a proxy of atherosclerosis. We assessed associations of the metabolites with ICAC and ECAC and compared the metabolic association patterns of the two. RESULTS We found that one standard deviation (SD) increase in concentration of 3-hydroxybutyrate, a ketone body, was significantly associated with a 0.11 SD increase in ICAC volume (p = 1.8 × 10-4). When we compared the metabolic association pattern of ICAC with that of ECAC, we observed differences in glycolysis-related metabolite measures, lipoprotein subfractions, and amino acids. Interestingly, glycoprotein acetyls were associated with calcification in both studied vessel beds. These associations were most prominent in men. CONCLUSIONS We found that a higher circulating level of 3-hydroxybutyrate was associated with an increase in ICAC. Furthermore, we found differences in metabolic association patterns of ICAC and ECAC, providing further evidence for location-specific differences in the etiology of atherosclerosis.
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Affiliation(s)
- Dina Vojinovic
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sven J van der Lee
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Najaf Amin
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ayşe Demirkan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
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C-Reactive Protein to Albumin Ratio Predicts 30-Day and 1-Year Mortality in Postoperative Patients after Admission to the Intensive Care Unit. J Clin Med 2018; 7:jcm7030039. [PMID: 29495423 PMCID: PMC5867565 DOI: 10.3390/jcm7030039] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 11/17/2022] Open
Abstract
C-reactive protein and albumin are associated with poor outcomes in critically ill patients. This study aimed to investigate the significance of the C-reactive protein/albumin (CRP/ALB) ratio as a novel prognostic factor for 30-day or 1-year mortality after admission to the postoperative intensive care unit (ICU). This retrospective study was conducted by examining the medical records of postoperative patients aged 19 years or older admitted to the ICU at a tertiary care hospital from January 2007 to July 2016. This study included data on 11,832 postoperative patients in the analysis. The cut-off value of the CRP/ALB ratio was set at 1.75 and 1.58 for 30-day and 1-year mortality after ICU admission, respectively. In postoperative patients with a high CRP/ALB ratio (>1.75 or >1.58), the probability of death within 30 days or 1 year after ICU admission were 30% or 43% higher than that in the group with the least CRP/ALB ratio, respectively (≤1.75 or ≤1.58)(p < 0.05). This study found the CRP/ALB ratio measured immediately after ICU admission to be an independent risk factor for 30-day and 1-year mortality in postoperative patients admitted to the ICU.
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Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, Espaulella J, Villanueva A, Oller R, Martori JC, Constante C. Utility of the NECPAL CCOMS-ICO © tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study. Palliat Med 2017; 31:754-763. [PMID: 27815556 DOI: 10.1177/0269216316676647] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO© (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. AIM To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. DESIGN Longitudinal, prospective and observational cohort study. SETTING/PARTICIPANTS Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months. RESULTS Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) ( p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL. CONCLUSION SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.
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Affiliation(s)
- Xavier Gómez-Batiste
- 1 The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC), Catalan Institute of Oncology (CIO), Department of Health (DoH), Barcelona, Spain.,2 Chair of Palliative Care, University of Vic, Barcelona, Spain
| | - Marisa Martínez-Muñoz
- 1 The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC), Catalan Institute of Oncology (CIO), Department of Health (DoH), Barcelona, Spain.,2 Chair of Palliative Care, University of Vic, Barcelona, Spain
| | - Carles Blay
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,3 Programme for the Prevention and Care of Patients with Chronic Conditions, Department of Health (DoH), Government of Catalonia, Barcelona, Spain
| | - Jordi Amblàs
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,4 Hospital de la Santa Creu, Hospital General de Vic, Barcelona, Spain
| | - Laura Vila
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,5 Institut Català de la Salut - SAP Osona, Barcelona, Spain
| | - Xavier Costa
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,5 Institut Català de la Salut - SAP Osona, Barcelona, Spain
| | - Joan Espaulella
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,4 Hospital de la Santa Creu, Hospital General de Vic, Barcelona, Spain
| | | | - Ramon Oller
- 7 Department of Economics and Business, University of Vic, Barcelona, Spain
| | | | - Carles Constante
- 8 Department of Health (DoH), Government of Catalonia, Barcelona, Spain
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Singh-Manoux A, Shipley MJ, Bell JA, Canonico M, Elbaz A, Kivimäki M. Association between inflammatory biomarkers and all-cause, cardiovascular and cancer-related mortality. CMAJ 2016; 189:E384-E390. [PMID: 27895145 DOI: 10.1503/cmaj.160313] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The inflammatory biomarker α1-acid glycoprotein (AGP) was found to have the strongest association with 5-year mortality in a recent study of 106 biomarkers. We examined whether AGP is a better biomarker of mortality risk than the more widely used inflammatory biomarkers interleukin-6 (IL-6) and C-reactive protein (CRP). METHODS We analyzed data for 6545 men and women aged 45-69 (mean 55.7) years from the Whitehall II cohort study. We assayed AGP, IL-6 and CRP levels from fasting serum samples collected in 1997-1999. Mortality followup was until June 2015. Cox regression analysis was used to model associations of inflammatory biomarkers with all-cause, cardiovascular and cancer-related mortality. RESULTS Over the mean follow-up of 16.7 years, 736 deaths occurred, of which 181 were from cardiovascular disease and 347 from cancer. In the model adjusted for all covariates (age, sex, socioeconomic status, body mass index, health behaviours and chronic disease), AGP did not predict mortality beyond the first 5 years of follow-up; over this period, IL-6 and CRP had stronger associations with mortality. When we considered all covariates and biomarkers simultaneously, AGP no longer predicted all-cause mortality over the entire follow-up period (adjusted hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.90-1.08). Only IL-6 predicted all-cause mortality (adjusted HR 1.22, 95% CI 1.12-1.33) and cancer-related mortality (adjusted HR 1.13, 95% CI 1.00-1.29) over the entire follow-up period, whereas CRP predicted only cardiovascular mortality (adjusted HR 1.30, 95% CI 1.06-1.61). INTERPRETATION Our findings suggest that AGP is not a better marker of short-or long-term mortality risk than the more commonly used biomarkers IL-6 and CRP.
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Affiliation(s)
- Archana Singh-Manoux
- INSERM U1018 Centre de recherche en Epidémiologie et Santé des Populations (Singh-Manoux, Canonico, Elbaz), Hôpital universitaire Paul-Brousse, Villejuif, France; Department of Epidemiology and Public Health (Shipley, Bell, Kivimäki), University College London, London, UK
| | - Martin J Shipley
- INSERM U1018 Centre de recherche en Epidémiologie et Santé des Populations (Singh-Manoux, Canonico, Elbaz), Hôpital universitaire Paul-Brousse, Villejuif, France; Department of Epidemiology and Public Health (Shipley, Bell, Kivimäki), University College London, London, UK
| | - Joshua A Bell
- INSERM U1018 Centre de recherche en Epidémiologie et Santé des Populations (Singh-Manoux, Canonico, Elbaz), Hôpital universitaire Paul-Brousse, Villejuif, France; Department of Epidemiology and Public Health (Shipley, Bell, Kivimäki), University College London, London, UK
| | - Marianne Canonico
- INSERM U1018 Centre de recherche en Epidémiologie et Santé des Populations (Singh-Manoux, Canonico, Elbaz), Hôpital universitaire Paul-Brousse, Villejuif, France; Department of Epidemiology and Public Health (Shipley, Bell, Kivimäki), University College London, London, UK
| | - Alexis Elbaz
- INSERM U1018 Centre de recherche en Epidémiologie et Santé des Populations (Singh-Manoux, Canonico, Elbaz), Hôpital universitaire Paul-Brousse, Villejuif, France; Department of Epidemiology and Public Health (Shipley, Bell, Kivimäki), University College London, London, UK
| | - Mika Kivimäki
- INSERM U1018 Centre de recherche en Epidémiologie et Santé des Populations (Singh-Manoux, Canonico, Elbaz), Hôpital universitaire Paul-Brousse, Villejuif, France; Department of Epidemiology and Public Health (Shipley, Bell, Kivimäki), University College London, London, UK
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Orosomucoid is an independent predictor of prognosis in chronic heart failure. Wien Klin Wochenschr 2016; 128:870-874. [PMID: 27380510 DOI: 10.1007/s00508-016-1034-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 06/07/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Heart failure is associated with low-grade inflammation. In the present study we sought to assess the prognostic impact of orosomucoid, a marker of inflammation, in outpatients with heart failure. METHODS In outpatients with chronic heart failure (no change in clinical status and/or therapy >3 months prior to inclusion), baseline levels of orosomucoid were determined. Clinical follow-up was obtained and the rate of heart failure-related deaths and hospitalisations recorded. RESULTS A total of 134 patients (median age 71, 33.3 % female, mean left ventricular ejection fraction [LVEF] 36 %) were included. During a median follow-up of 695 (456-811) days, 54 patients (40.1 %) experienced an event. On Cox multivariate analysis, orosomucoid levels above the median (>497 mg/l) emerged as an independent predictor of prognosis (hazard ratio = 2.86, 95 % confidence interval 1.48-5.52 after adjusting for age, gender, ischaemic vs. non-ischaemic aetiology, LVEF, NT-proBNP and NYHA class). CONCLUSION Orosomucoid levels are an independent predictor of heart failure-related mortality and hospitalisations in patients with chronic heart failure.
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Duprez DA, Otvos J, Sanchez OA, Mackey RH, Tracy R, Jacobs DR. Comparison of the Predictive Value of GlycA and Other Biomarkers of Inflammation for Total Death, Incident Cardiovascular Events, Noncardiovascular and Noncancer Inflammatory-Related Events, and Total Cancer Events. Clin Chem 2016; 62:1020-31. [PMID: 27173011 DOI: 10.1373/clinchem.2016.255828] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND GlycA is a biomarker that reflects integrated concentrations and glycosylation states of several acute-phase proteins. We studied the association of GlycA and inflammatory biomarkers with future death and disease. METHODS A total of 6523 men and women in the Multi-Ethnic Study of Atherosclerosis who were free of overt cardiovascular disease (CVD) and in generally good health had a baseline blood sample taken. We assayed high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and d-dimer. A spectral deconvolution algorithm was used to quantify GlycA signal amplitudes from automated nuclear magnetic resonance (NMR) LipoProfile® test spectra. Median follow-up was 12.1 years. Among 4 primary outcomes, CVD events were adjudicated, death was by death certificate, and chronic inflammatory-related severe hospitalization and death (ChrIRD) and total cancer were classified using International Classification of Diseases (ICD) codes. We used Poisson regression to study baseline GlycA, hsCRP, IL-6, and d-dimer in relation to total death, CVD, ChrIRD, and total cancer. RESULTS Relative risk per SD of GlycA, IL-6, and d-dimer for total death (n = 915); for total CVD (n = 922); and for ChrIRD (n = 1324) ranged from 1.05 to 1.20, independently of covariates. In contrast, prediction from hsCRP was statistically explained by adjustment for other inflammatory variables. Only GlycA was predictive for total cancer (n = 663). Women had 7% higher values of all inflammatory biomarkers than men and had a significantly lower GlycA prediction coefficient than men in predicting total cancer. CONCLUSIONS The composite biomarker GlycA derived from NMR is associated with risk for total death, CVD, ChrIRD, and total cancer after adjustment for hsCRP, IL-6, and d-dimer. IL-6 and d-dimer contribute information independently of GlycA.
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Affiliation(s)
- Daniel A Duprez
- Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, MN;
| | | | - Otto A Sanchez
- Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Rachel H Mackey
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Russell Tracy
- Department of Pathology & Laboratory Medicine, and Biochemistry, University of Vermont College of Medicine, Colchester, VT
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Nouvenne A, Ticinesi A, Lauretani F, Maggio M, Lippi G, Prati B, Borghi L, Meschi T. The Prognostic Value of High-sensitivity C-reactive Protein and Prealbumin for Short-term Mortality in Acutely Hospitalized Multimorbid Elderly Patients: A Prospective Cohort Study. J Nutr Health Aging 2016; 20:462-8. [PMID: 26999249 DOI: 10.1007/s12603-015-0626-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To establish the predictive value on mortality after 2 months from hospital admission of two laboratory markers of nutritional and inflammatory status, high-sensitivity C-reactive protein (hs-CRP) and prealbumin, in a cohort of frail multimorbid elderly without terminal illness. DESIGN Prospective cohort study. SETTING Internal medicine ward of a large teaching hospital in Italy. PARTICIPANTS 544 Caucasian patients with acute disease consecutively admitted from January to June 2013. 102 were excluded for being younger than 65 years old, having life expectancy <30 days or not having frailty syndrome. Further 42 patients were excluded for missing data or withdrawn at follow-up. Final analysis was performed on 400 subjects (179 M, 221 F, mean age 79±10). MEASUREMENTS Serum prealbumin and hs-CRP were measured at admission. Death within 2 months from hospital admission was assessed through a telephonic interview with the caregiver for each patient discharged alive. Inhospital mortality was also recorded. Survival was calculated from date of admission to our unit. RESULTS Mean prealbumin at admission was 17.3±7.7 mg/dl, while hs-CRP median was 24.2 mg/L (IQR 8.7 to 51.8). 108 patients (27%) died within two months from admission. In an age- and sex-adjusted analysis, log(hs-CRP) levels at admission, but not prealbumin, were independently associated with an increased risk for mortality (HR 1.40, 95% CI 1.18 to 1.66, p<0.001). After multiple adjustments for covariates, including comorbidity burden measured through Charlson score, log(hs-CRP) remained significantly associated with mortality (HR 1.38, 95% CI 1.08 to 1.76, p=0.01). A Receiver Operating Characteristic (ROC) curve was performed to test the predictive value of hs-CRP at admission on two-month mortality (AUC 0.68, 95% CI 0.63 to 0.72, p<0.001). Cut-off value was set at 38.4 mg/L. After dichotomization of hs-CRP values according to this cut-off, hs-CRP≥38.4 mg/L at admission proved to be a significant risk factor for mortality (HR 2.10, 95% CI 1.23 to 3.58, p=0.006). CONCLUSION Serum hs-CRP, but not prealbumin, values at admission are predictors of short-term mortality at hospital admission in elderly multimorbid patients. Inflammation seems to affect prognosis more than malnutrition in this setting and may therefore guide clinicians' attitude towards therapeutic choices.
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Affiliation(s)
- A Nouvenne
- Antonio Nouvenne M.D., Ph. D. University of Parma, Department of Clinical and Experimental Medicine, Via A. Gramsci 14, 43126 Parma, Italy, Phone: +39 0521 703626, Mobile: +39 3492258317, Fax: +39 0521 702383, e-mail:
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Laks R, Araújo LMQ, Almada Filho CDM, Cendoroglo MS. The importance of HDL-C and CRP in cardiovascular risk evaluation in longevous elderly individuals. EINSTEIN-SAO PAULO 2016; 9:397-403. [PMID: 26761114 DOI: 10.1590/s1679-45082011rw1953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 09/02/2011] [Indexed: 11/21/2022] Open
Abstract
The association between total mortality, lipoproteinS, and inflammatory markers, and their implications with aging and longevity are often controversial. Among the most often studied markers are low HDL cholesterol and high C-reactive protein. Particularly in octogenarians, it is expected that the impact of the inclusion of HDL cholesterol and C-reactive protein will improve the stratification of absolute cardiovascular risk. In the present study, we performed a literature review in PubMed about the relation between HDL cholesterol, inflammation and longevity. Applying the inclusion and exclusion criteria adopted, we selected 30 studies, among which one systematic review on the relation between HDL cholesterol and stroke, one meta-analysis on the relation between total cholesterol and HDL cholesterol with mortality, 22 longitudinal studies, and six cross-sectional studies. The results show an inverse association between HDL cholesterol and total mortality, and between cardiovascular mortality and C-reactive protein, as well as a positive association between C-reactive protein and mortality in longevous individuals. C-reactive protein and HDL cholesterol displayed promising characteristics as predictors of cardiovascular mortality in longevous elderly persons.
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Affiliation(s)
- Renato Laks
- Department of Geriatrics and Gerontology, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Sao Paulo, SP, BR
| | - Lara Miguel Quirino Araújo
- Department of Geriatrics and Gerontology, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Sao Paulo, SP, BR
| | - Clineu de Mello Almada Filho
- Department of Geriatrics and Gerontology, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Sao Paulo, SP, BR
| | - Maysa Seabra Cendoroglo
- Department of Geriatrics and Gerontology, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, Sao Paulo, SP, BR
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Kuster N, Monnier K, Baptista G, Dupuy AM, Badiou S, Bargnoux AS, Jeandel C, Cristol JP. Estimation of age- and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly. Clin Chem Lab Med 2016; 53:691-8. [PMID: 25153394 DOI: 10.1515/cclm-2014-0121] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/01/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac troponin level measured by high-sensitivity assays (hs-cTn) in the elderly is frequently found higher than the 99th percentile upper reference limit, making the diagnosis of acute coronary syndromes (ACS) difficult. This study aimed at: 1) identifying determinants of hs-cTnT levels in an unselected population of elderly subjects; and 2) assessing the prognosis value of increased hs-cTnT in elderly people free of ACS. METHODS Hs-cTnT was measured in 591 individuals aged over 65 years without suspicion of ACS. Comorbidities were assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). C-reactive protein, α1-acid glycoprotein, albumin and creatinine were measured. Factors influencing hs-cTnT levels were assessed through linear regression and quantile regression was used to model percentiles of hs-cTnT. Risk of mortality was assessed through Cox regression. RESULTS Age, gender, cardiac CIRS-G, estimated glomerular filtration rate (p<0.001 for all), albumin (p<0.028) and α1-acid glycoprotein (p=0.002) were independent predictors of hs-cTnT. After exclusion of outliers, the median was 15 ng/L and 99th percentile was 64 ng/L. After controlling for comorbidities, the 99th percentile increased from 24 ng/L at age 65 to 53 ng/L at age 90 in females and from 33 ng/L to 75 ng/L in males. In multivariate analysis, hs-cTnT level was significantly related to mortality. CONCLUSIONS Hs-cTnT level is associated with inflammation and renal function in the elderly. Independently of comorbidities, hs-cTnT concentration increases exponentially with age after 65 years. Decision limits adapted to age and sex may be useful to patient management.
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Grenon SM, Owens CD, Nosova EV, Hughes-Fulford M, Alley HF, Chong K, Perez S, Yen PK, Boscardin J, Hellmann J, Spite M, Conte MS. Short-Term, High-Dose Fish Oil Supplementation Increases the Production of Omega-3 Fatty Acid-Derived Mediators in Patients With Peripheral Artery Disease (the OMEGA-PAD I Trial). J Am Heart Assoc 2015; 4:e002034. [PMID: 26296857 PMCID: PMC4599461 DOI: 10.1161/jaha.115.002034] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/15/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) experience significant morbidity and mortality. The OMEGA-PAD I Trial, a randomized, double-blinded, placebo-controlled trial, addressed the hypothesis that short-duration, high-dose n-3 polyunsaturated fatty acids (n-3 PUFA) oral supplementation improves endothelial function and inflammation in PAD. METHODS AND RESULTS Eighty patients with stable claudication received 4.4 g of fish oil or placebo for 1 month. The primary end point was endothelial function as measured by brachial artery flow-mediated vasodilation. Secondary end points included biomarkers of inflammation, n-3 polyunsaturated fatty acids metabolome changes, lipid profile, and walking impairment questionnaires. Although there was a significant increase in FMD in the fish oil group following treatment (0.7±1.8% increase from baseline, P=0.04), this response was not different then the placebo group (0.6±2.5% increase from baseline, P=0.18; between-group P=0.86) leading to a negative finding for the primary endpoint. There was, however, a significant reduction in triglycerides (fish oil: -34±46 mg/dL, P<0.001; placebo -10±43 mg/dL, P=0.20; between-group differential P-value: 0.02), and an increase in the omega-3 index of 4±1% (P<0.001) in the fish oil group (placebo 0.1±0.9%, P=0.49; between-group P<0.0001). We observed a significant increase in the production of pathway markers of specialized pro-resolving mediators generated from n-3 polyunsaturated fatty acids in the fish oil group. CONCLUSIONS High-dose, short-duration fish oil supplementation did not lead to a different response in the primary end point of endothelial function between the treatment and placebo group, but improved serum triglycerides and increased the production of downstream n-3 polyunsaturated fatty acids-derived products and mediators in patients with PAD. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01310270.
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Affiliation(s)
- S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, CA (M.G., C.D.O., E.V.N., M.H.F., H.F.A., K.C., M.S.C.) Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA (M.G., C.D.O., M.H.F., S.P.) Vascular Integrated Physiology and Experimental Therapeutics (VIPERx) Lab, San Francisco, CA (M.G., C.D.O., H.F.A., K.C., S.P.)
| | - Christopher D Owens
- Department of Surgery, University of California, San Francisco, San Francisco, CA (M.G., C.D.O., E.V.N., M.H.F., H.F.A., K.C., M.S.C.) Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA (M.G., C.D.O., M.H.F., S.P.) Vascular Integrated Physiology and Experimental Therapeutics (VIPERx) Lab, San Francisco, CA (M.G., C.D.O., H.F.A., K.C., S.P.)
| | - Emily V Nosova
- Department of Surgery, University of California, San Francisco, San Francisco, CA (M.G., C.D.O., E.V.N., M.H.F., H.F.A., K.C., M.S.C.)
| | - Millie Hughes-Fulford
- Department of Surgery, University of California, San Francisco, San Francisco, CA (M.G., C.D.O., E.V.N., M.H.F., H.F.A., K.C., M.S.C.) Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA (M.G., C.D.O., M.H.F., S.P.)
| | - Hugh F Alley
- Department of Surgery, University of California, San Francisco, San Francisco, CA (M.G., C.D.O., E.V.N., M.H.F., H.F.A., K.C., M.S.C.) Vascular Integrated Physiology and Experimental Therapeutics (VIPERx) Lab, San Francisco, CA (M.G., C.D.O., H.F.A., K.C., S.P.)
| | - Karen Chong
- Department of Surgery, University of California, San Francisco, San Francisco, CA (M.G., C.D.O., E.V.N., M.H.F., H.F.A., K.C., M.S.C.) Vascular Integrated Physiology and Experimental Therapeutics (VIPERx) Lab, San Francisco, CA (M.G., C.D.O., H.F.A., K.C., S.P.)
| | - Sandra Perez
- Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA (M.G., C.D.O., M.H.F., S.P.) Vascular Integrated Physiology and Experimental Therapeutics (VIPERx) Lab, San Francisco, CA (M.G., C.D.O., H.F.A., K.C., S.P.)
| | - Priscilla K Yen
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA (P.K.Y.)
| | - John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (J.B.)
| | - Jason Hellmann
- Center for Experimental Therapeutics and Reperfusion Injury, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.H., M.S.)
| | - Matthew Spite
- Center for Experimental Therapeutics and Reperfusion Injury, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.H., M.S.)
| | - Michael S Conte
- Department of Surgery, University of California, San Francisco, San Francisco, CA (M.G., C.D.O., E.V.N., M.H.F., H.F.A., K.C., M.S.C.)
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Barron E, Lara J, White M, Mathers JC. Blood-borne biomarkers of mortality risk: systematic review of cohort studies. PLoS One 2015; 10:e0127550. [PMID: 26039142 PMCID: PMC4454670 DOI: 10.1371/journal.pone.0127550] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 04/16/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lifespan and the proportion of older people in the population are increasing, with far reaching consequences for the social, political and economic landscape. Unless accompanied by an increase in health span, increases in age-related diseases will increase the burden on health care resources. Intervention studies to enhance healthy ageing need appropriate outcome measures, such as blood-borne biomarkers, which are easily obtainable, cost-effective, and widely accepted. To date there have been no systematic reviews of blood-borne biomarkers of mortality. AIM To conduct a systematic review to identify available blood-borne biomarkers of mortality that can be used to predict healthy ageing post-retirement. METHODS Four databases (Medline, Embase, Scopus, Web of Science) were searched. We included prospective cohort studies with a minimum of two years follow up and data available for participants with a mean age of 50 to 75 years at baseline. RESULTS From a total of 11,555 studies identified in initial searches, 23 fulfilled the inclusion criteria. Fifty-one blood borne biomarkers potentially predictive of mortality risk were identified. In total, 20 biomarkers were associated with mortality risk. Meta-analyses of mortality risk showed significant associations with C-reactive protein (Hazard ratios for all-cause mortality 1.42, p<0.001; Cancer-mortality 1.62, p<0.009; CVD-mortality 1.31, p = 0.033), N Terminal-pro brain natriuretic peptide (Hazard ratios for all-cause mortality 1.43, p<0.001; CHD-mortality 1.58, p<0.001; CVD-mortality 1.67, p<0.001) and white blood cell count (Hazard ratios for all-cause mortality 1.36, p = 0.001). There was also evidence that brain natriuretic peptide, cholesterol fractions, erythrocyte sedimentation rate, fibrinogen, granulocytes, homocysteine, intercellular adhesion molecule-1, neutrophils, osteoprotegerin, procollagen type III aminoterminal peptide, serum uric acid, soluble urokinase plasminogen activator receptor, tissue inhibitor of metalloproteinases 1 and tumour necrosis factor receptor II may predict mortality risk. There was equivocal evidence for the utility of 14 biomarkers and no association with mortality risk for CD40 ligand, cortisol, dehydroepiandrosterone, ferritin, haemoglobin, interleukin-12, monocyte chemoattractant protein 1, matrix metalloproteinase 9, myelopereoxidase, P-selectin, receptor activator of nuclear factor KappaB ligand, sex hormone binding globulin, testosterone, transferrin, and thyroid stimulating hormone and thyroxine. CONCLUSIONS Twenty biomarkers should be prioritised as potential predictors of mortality in future studies. More studies using standardised protocols and reporting methods, and which focus on mortality rather than risk of disease or health status as an outcome, are needed.
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Affiliation(s)
- Evelyn Barron
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Jose Lara
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Martin White
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Faculty of Medical Sciences, Newcastle upon Tyne, NE2 4AX, United Kingdom
- Fuse, UKCRC Centre for Translational Research in Public Health, Institute of Health & Society, Baddiley-Clark Building, Faculty of Medical Sciences, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - John C. Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
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Comparison of the malnutrition–inflammation score in chronic kidney disease patients and kidney transplant recipients. Int Urol Nephrol 2015; 47:1025-33. [DOI: 10.1007/s11255-015-0984-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/13/2015] [Indexed: 01/02/2023]
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Valentini L, Pinto A, Bourdel-Marchasson I, Ostan R, Brigidi P, Turroni S, Hrelia S, Hrelia P, Bereswill S, Fischer A, Leoncini E, Malaguti M, Blanc-Bisson C, Durrieu J, Spazzafumo L, Buccolini F, Pryen F, Donini LM, Franceschi C, Lochs H. Impact of personalized diet and probiotic supplementation on inflammation, nutritional parameters and intestinal microbiota - The "RISTOMED project": Randomized controlled trial in healthy older people. Clin Nutr 2014; 34:593-602. [PMID: 25453395 DOI: 10.1016/j.clnu.2014.09.023] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/23/2014] [Accepted: 09/29/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess the impact of a personalized diet, with or without addition of VSL#3 preparation, on biomarkers of inflammation, nutrition, oxidative stress and intestinal microbiota in 62 healthy persons aged 65-85 years. DESIGN Open label, randomized, multicenter study. PRIMARY ENDPOINT High-sensitivity C-reactive protein. SETTING Community. INTERVENTIONS Eight week web-based dietary advice (RISTOMED platform) alone or with supplementation of VSL#3 (2 capsules per day). The RISTOMED diet was optimized to reduce inflammation and oxidative stress. MEASUREMENTS Blood and stool samples were collected on days 1 and 56. RESULTS Diet alone reduced ESR (p = 0.02), plasma levels of cholesterol (p < 0.01) and glucose (p = 0.03). Addition of VSL#3 reduced ESR (p = 0.05) and improved folate (p = 0.007), vitamin B12 (p = 0.001) and homocysteine (p < 0.001) plasma levels. Neither intervention demonstrated any further effects on inflammation. Subgroup analysis showed 40 participants without signs of low-grade inflammation (hsCRP<3 mg/l, subgroup 1) and 21 participants with low-grade inflammation at baseline (hsCRP≥3 mg/l, subgroup 2). In subgroup 2 addition of VSL#3 increased bifidobacteria (p = 0.005) in more participants and improved both folate (p = 0.015) and vitamin B12 (p = 0.035) levels compared with subgroup 1. The increases were positively correlated to the change in the bifidobacteria concentration for folate (p = 0.023) and vitamin B12 (p = 0.001). As expected change in homocysteine correlated negatively to change in folate (r = -0.629, p = 0.002) and vitamin B12 (r = -0.482, p = 0.026). CONCLUSIONS Addition of VSL#3 increased bifidobacteria and supported adequate folate and vitamin B12 concentrations in subjects with low-grade inflammation. Decrease in homocysteine with VSL#3 was clinically relevant. suggesting protective potentials for aging-associated conditions, e.g. cardiovascular or neurological diseases. ClinicalTrials.gov: NCT01069445-NCT01179789.
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Affiliation(s)
- Luzia Valentini
- Dept Gastroenterology and Hepatology, Charité-Universitätsmedizin Berlin, CCM, Charitéplatz 1, 10117 Berlin, Germany.
| | - Alessandro Pinto
- Experimental Medicine Department, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy
| | - Isabelle Bourdel-Marchasson
- CHU Bordeaux, Clinical Gerontology, France; CNRS, RMSB, UMR 5536, France; University Bordeaux, RMSB, UMR 5536, Bordeaux, France
| | - Rita Ostan
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 12, 40126 Bologna, Italy
| | - Patrizia Brigidi
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
| | - Silvia Turroni
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
| | - Silvana Hrelia
- Dept Life Quality Studies, Alma Mater Studiorum University of Bologna, Via Irnerio 48, 40126 Bologna, Italy
| | - Patrizia Hrelia
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
| | - Stefan Bereswill
- Dept Microbiology and Hygiene, Charité-Universitätsmedizin Berlin, CBF, Hindenburgdamm 27, 12203 Berlin, Germany
| | - André Fischer
- Dept Microbiology and Hygiene, Charité-Universitätsmedizin Berlin, CBF, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Emanuela Leoncini
- Dept Life Quality Studies, Alma Mater Studiorum University of Bologna, Via Irnerio 48, 40126 Bologna, Italy
| | - Marco Malaguti
- Dept Life Quality Studies, Alma Mater Studiorum University of Bologna, Via Irnerio 48, 40126 Bologna, Italy
| | | | | | - Liana Spazzafumo
- Biostatistical Center INRCA, Via S. Margherita 5, 60100 Ancona, Italy
| | - Fabio Buccolini
- R&D, VoxNet CEO, Via Giovanni Paisiello 32, 00198 Rome, Italy
| | - Florence Pryen
- Actial Farmaceutica Lda, Praca Severiano Ferraz 258, 09000 082 Funchal, Portugal
| | - Lorenzo Maria Donini
- Experimental Medicine Department, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy
| | - Claudio Franceschi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 12, 40126 Bologna, Italy
| | - Herbert Lochs
- Experimental Medicine Department, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
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Gómez-Cabello A, Carnicero JA, Alonso-Bouzón C, Tresguerres JÁ, Alfaro-Acha A, Ara I, Rodriguez-Mañas L, García-García FJ. Age and gender, two key factors in the associations between physical activity and strength during the ageing process. Maturitas 2014; 78:106-12. [PMID: 24720906 DOI: 10.1016/j.maturitas.2014.03.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/27/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aims of this study were to identify if the associations of physical activity (PA) and muscle strength may vary throughout the ageing process; to study the differences among genders in the relationships between PA and strength in elderly people and to test whether these differences are explained by the hormonal, nutritional and inflammatory status. STUDY DESIGN A total of 1741 people ≥65 years of age participated in this cross-sectional study. MAIN OUTCOME MEASURES Upper- and lower-limbs maximal voluntary isometric strength was obtained using standardized techniques and equipment. PA was recorded by a validated questionnaire. The associations of PA with strength were assessed using generalized linear regression models with a Gamma-distributed dependent variable. RESULTS A significant gender by PA interaction was found for all strength-related variables (all P<0.01). Moreover, when sexual hormones, albumin or C-Reactive protein were taken into account in the model, the results did not significantly change. In women, PA was positively associated with upper and lower-body strength; however in men, PA was only associated with grip and knee strength (both P<0.01). Higher strength values were associated with higher levels of PA, especially in women. However, this tendency had a different pattern across the age range, showing a stronger association in the 'young' elderly compared with the 'old' elderly. CONCLUSION Higher levels of PA are related to greater muscle strength, especially in women and those who were younger.
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Affiliation(s)
| | - Jose A Carnicero
- Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain
| | | | | | - Ana Alfaro-Acha
- Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain
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Fischer K, Kettunen J, Würtz P, Haller T, Havulinna AS, Kangas AJ, Soininen P, Esko T, Tammesoo ML, Mägi R, Smit S, Palotie A, Ripatti S, Salomaa V, Ala-Korpela M, Perola M, Metspalu A. Biomarker profiling by nuclear magnetic resonance spectroscopy for the prediction of all-cause mortality: an observational study of 17,345 persons. PLoS Med 2014; 11:e1001606. [PMID: 24586121 PMCID: PMC3934819 DOI: 10.1371/journal.pmed.1001606] [Citation(s) in RCA: 243] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 01/14/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Early identification of ambulatory persons at high short-term risk of death could benefit targeted prevention. To identify biomarkers for all-cause mortality and enhance risk prediction, we conducted high-throughput profiling of blood specimens in two large population-based cohorts. METHODS AND FINDINGS 106 candidate biomarkers were quantified by nuclear magnetic resonance spectroscopy of non-fasting plasma samples from a random subset of the Estonian Biobank (n = 9,842; age range 18-103 y; 508 deaths during a median of 5.4 y of follow-up). Biomarkers for all-cause mortality were examined using stepwise proportional hazards models. Significant biomarkers were validated and incremental predictive utility assessed in a population-based cohort from Finland (n = 7,503; 176 deaths during 5 y of follow-up). Four circulating biomarkers predicted the risk of all-cause mortality among participants from the Estonian Biobank after adjusting for conventional risk factors: alpha-1-acid glycoprotein (hazard ratio [HR] 1.67 per 1-standard deviation increment, 95% CI 1.53-1.82, p = 5×10⁻³¹), albumin (HR 0.70, 95% CI 0.65-0.76, p = 2×10⁻¹⁸), very-low-density lipoprotein particle size (HR 0.69, 95% CI 0.62-0.77, p = 3×10⁻¹²), and citrate (HR 1.33, 95% CI 1.21-1.45, p = 5×10⁻¹⁰). All four biomarkers were predictive of cardiovascular mortality, as well as death from cancer and other nonvascular diseases. One in five participants in the Estonian Biobank cohort with a biomarker summary score within the highest percentile died during the first year of follow-up, indicating prominent systemic reflections of frailty. The biomarker associations all replicated in the Finnish validation cohort. Including the four biomarkers in a risk prediction score improved risk assessment for 5-y mortality (increase in C-statistics 0.031, p = 0.01; continuous reclassification improvement 26.3%, p = 0.001). CONCLUSIONS Biomarker associations with cardiovascular, nonvascular, and cancer mortality suggest novel systemic connectivities across seemingly disparate morbidities. The biomarker profiling improved prediction of the short-term risk of death from all causes above established risk factors. Further investigations are needed to clarify the biological mechanisms and the utility of these biomarkers for guiding screening and prevention.
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Affiliation(s)
- Krista Fischer
- The Estonian Genome Center, University of Tartu, Tartu, Estonia
- * E-mail: (KF); (PW)
| | - Johannes Kettunen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Computational Medicine, Institute of Health Sciences, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Peter Würtz
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Computational Medicine, Institute of Health Sciences, University of Oulu and Oulu University Hospital, Oulu, Finland
- * E-mail: (KF); (PW)
| | - Toomas Haller
- The Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Aki S. Havulinna
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Antti J. Kangas
- Computational Medicine, Institute of Health Sciences, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Pasi Soininen
- Computational Medicine, Institute of Health Sciences, University of Oulu and Oulu University Hospital, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Tõnu Esko
- The Estonian Genome Center, University of Tartu, Tartu, Estonia
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Division of Genetics, Children's Hospital, Boston, Massachusetts, United States of America
- Division of Endocrinology, Children's Hospital, Boston, Massachusetts, United States of America
- Program in Genomics, Children's Hospital, Boston, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Reedik Mägi
- The Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Steven Smit
- The Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Aarno Palotie
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Veikko Salomaa
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Mika Ala-Korpela
- Computational Medicine, Institute of Health Sciences, University of Oulu and Oulu University Hospital, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Computational Medicine, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Markus Perola
- The Estonian Genome Center, University of Tartu, Tartu, Estonia
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Andres Metspalu
- The Estonian Genome Center, University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
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Comba M, Fonte G, Isaia G, Pricop L, Sciarrillo I, Michelis G, Bo M. Cardiac and inflammatory biomarkers and in-hospital mortality in older medical patients. J Am Med Dir Assoc 2013; 15:68-72. [PMID: 24314700 DOI: 10.1016/j.jamda.2013.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/18/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Increasing evidence has mounted in recent years on the potential prognostic role of biomarkers out of cardiac-specific medical settings. We aimed to test whether cardiac and inflammatory biomarkers are independently associated with in-hospital mortality in older unselected medical inpatients undergoing standardized multidimensional evaluation. DESIGN Observational study conducted in a metropolitan university-teaching hospital. A standardized, multidimensional analysis was carried out on all patients by using medical and hospital discharge documentation and interview results integrated with information collected from family members or caregivers. PARTICIPANTS AND SETTING Patients older than 65 years consecutively admitted to the acute geriatric ward and to 2 acute medical wards of the hospital. RESULTS Male sex; low systolic blood pressure; APACHE score; functional impairment in activities of daily living (ADLs), instrumental ADLs, and Short Physical Performance Battery (SPPB); cognitive impairment; malnutrition; low albumin values; and elevated values of inflammatory and cardiac biomarkers were significantly associated with in-hospital mortality at univariate analysis. After multivariate analysis, male sex, low systolic blood pressure values at entry, severe cognitive impairment, and low functional performance measured by the SPPB resulted to be independently associated with in-hospital mortality. CONCLUSIONS The main finding of the present study is that these biomarkers, although associated with in-hospital mortality, do not have independent predictive significance when a comprehensive and multidimensional evaluation is conducted. The main clinical implication is that our findings should discourage the indiscriminate recourse to measurement of cardiac and inflammatory biomarkers, at least in older medical inpatients, thereby reducing a patient's hospital cost and potentially minimizing further unnecessary diagnostic procedures.
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Affiliation(s)
- Monica Comba
- Geriatric Section, Department of Medical and Surgical Disciplines, San Giovanni Battista Hospital, Torino, Italy
| | - Gianfranco Fonte
- Geriatric Section, Department of Medical and Surgical Disciplines, San Giovanni Battista Hospital, Torino, Italy
| | - Gianluca Isaia
- Division of Geriatric, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, Regione Gonzole, Orbassano, Torino, Italy.
| | - Larisa Pricop
- Geriatric Section, Department of Medical and Surgical Disciplines, San Giovanni Battista Hospital, Torino, Italy
| | - Irene Sciarrillo
- Geriatric Section, Department of Medical and Surgical Disciplines, San Giovanni Battista Hospital, Torino, Italy
| | - Giuliana Michelis
- Geriatric Section, Department of Medical and Surgical Disciplines, San Giovanni Battista Hospital, Torino, Italy
| | - Mario Bo
- Geriatric Section, Department of Medical and Surgical Disciplines, San Giovanni Battista Hospital, Torino, Italy
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Carrière I, Ryan J, Norton J, Scali J, Stewart R, Ritchie K, Ancelin ML. Anxiety and mortality risk in community-dwelling elderly people. Br J Psychiatry 2013; 203:303-9. [PMID: 23929442 DOI: 10.1192/bjp.bp.112.124685] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are conflicting data on the role of anxiety in predicting mortality. AIMS To evaluate the 10-year mortality risk associated with anxiety in community-dwelling elderly people. METHOD Using data from 718 men and 1046 women aged 65 years and over, gender-stratified associations of anxiety symptoms (Spielberger State-Trait Anxiety Inventory, third tertile) and current DSM-IV anxiety disorder including generalised anxiety disorder (GAD) and phobia with all-cause and cardiovascular mortality were determined. RESULTS In women, mortality risk was increased for anxiety disorder and GAD in multivariate Cox models (hazard ratio (HR) = 1.53, 95% CI 1.02-2.27 and HR = 2.04, 95% CI 1.08-3.86 respectively), whereas for phobia it was nearly significant (HR = 1.52, 95% CI 0.94-2.47). Anxiety trait symptoms became non-significant as a result of the confounding effect of depressive symptoms. Anxiety disorder was associated with cardiovascular mortality in univariate analysis (HR = 2.42, 95% CI 1.16-5.07). No significant associations were found in men. CONCLUSIONS Our study suggests a gender-specific association of anxiety and mortality.
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Affiliation(s)
- Isabelle Carrière
- Isabelle Carrière, PhD, Inserm U1061 and University of Montpellier I, Montpellier, France; Joanne Ryan, PhD, Inserm U1061 and University of Montpellier I, Montpellier, France, and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Joanna Norton, PhD, Jacqueline Scali, MSc, Inserm U1061 and University of Montpellier I, Montpellier, France; Robert Stewart, PhD, Institute of Psychiatry, King's College London, UK; Karen Ritchie, PhD, Inserm U1061 and University of Montpellier I, Montpellier, France, and Faculty of Medicine, Imperial College, St Mary's Hospital, London, UK; Marie Laure Ancelin, PhD, Inserm U1061 and University of Montpellier I, Montpellier, France
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Lechleitner M. Lipidsenkende Therapie bei geriatrischen Patienten. Z Gerontol Geriatr 2013; 46:577-85; quiz 586-7. [DOI: 10.1007/s00391-013-0516-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Association between n-3 polyunsaturated fatty acid content of red blood cells and inflammatory biomarkers in patients with peripheral artery disease. J Vasc Surg 2013; 58:1283-90. [PMID: 23830313 DOI: 10.1016/j.jvs.2013.05.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The n-3 polyunsaturated fatty acids are dietary components derived from fish oil with beneficial cardiovascular effects that may relate in part to anti-inflammatory properties. Peripheral artery disease (PAD) is characterized by a marked proinflammatory state. We hypothesized that the n-3 polyunsaturated fatty acids content of red blood cells (omega-3 index) would be correlated with biomarkers of inflammation and vascular function in a PAD cohort. METHODS This was a cross-sectional study of subjects who presented to an outpatient vascular surgery clinic for evaluation of PAD. We used linear regression to evaluate the independent association between the omega-3 index, inflammatory biomarkers (C-reactive protein [CRP], intercellular adhesion molecule-1, interleukin-6, and tumor-necrosis-factor-α) and endothelial function (brachial artery flow mediated dilation). RESULTS 64 subjects (61 claudicants and three with critical limb ischemia) were recruited for the study. The mean CRP level was 5.0 ± 5.0 mg/L, and the mean omega-3 index was 5.0% ± 1.8%. In an unadjusted model, the omega-3 index was negatively associated with CRP (38% increase in CRP for one standard deviation decrease in the omega-3 index; P = .007), which remained significant after adjustment for age, body mass index, smoking, ankle-brachial index, and high-density lipoprotein (33%; P = .04). There was also evidence for independent associations between the omega-3 index and IL-6 (P = .001). There were no significant associations between the omega-3 index and vascular function tests. CONCLUSIONS In a cohort of patients with PAD, the omega-3 index was inversely associated with biomarkers of inflammation even after adjustment for covariates including the ankle-brachial index. Because patients with PAD have a high inflammatory burden, further studies should be conducted to determine if manipulation of omega-3 index via dietary changes or fish oil supplementation could improve inflammation and symptoms in these patients.
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Cheng S, Hou W, Li S, Yang S, Liu Y, Jiang Z, Wang Y, Xiao J, Guo H, Wang Z. The effect of undernutrition on circadian genes and rhythmic induction in NIH3T3 cells. BIOL RHYTHM RES 2013. [DOI: 10.1080/09291016.2012.704797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One 2013; 8:e59321. [PMID: 23555017 PMCID: PMC3595283 DOI: 10.1371/journal.pone.0059321] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 02/13/2013] [Indexed: 11/20/2022] Open
Abstract
Introduction Residual inflammation at ICU discharge may have impact upon long-term mortality. However, the significance of ongoing inflammation on mortality after ICU discharge is poorly described. C-reactive protein (CRP) and albumin are measured frequently in the ICU and exhibit opposing patterns during inflammation. Since infection is a potent trigger of inflammation, we hypothesized that CRP levels at discharge would correlate with long-term mortality in septic patients and that the CRP/albumin ratio would be a better marker of prognosis than CRP alone. Methods We evaluated 334 patients admitted to the ICU as a result of severe sepsis or septic shock who were discharged alive after a minimum of 72 hours in the ICU. We evaluated the performance of both CRP and CRP/albumin to predict mortality at 90 days after ICU discharge. Two multivariate logistic models were generated based on measurements at discharge: one model included CRP (Model-CRP), and the other included the CRP/albumin ratio (Model-CRP/albumin). Results There were 229 (67%) and 111 (33%) patients with severe sepsis and septic shock, respectively. During the 90 days of follow-up, 73 (22%) patients died. CRP/albumin ratios at admission and at discharge were associated with a poor outcome and showed greater accuracy than CRP alone at these time points (p = 0.0455 and p = 0.0438, respectively). CRP levels and the CRP/albumin ratio were independent predictors of mortality at 90 days (Model-CRP: adjusted OR 2.34, 95% CI 1.14–4.83, p = 0.021; Model-CRP/albumin: adjusted OR 2.18, 95% CI 1.10–4.67, p = 0.035). Both models showed similar accuracy (p = 0.2483). However, Model-CRP was not calibrated. Conclusions Residual inflammation at ICU discharge assessed using the CRP/albumin ratio is an independent risk factor for mortality at 90 days in septic patients. The use of the CRP/albumin ratio as a long-term marker of prognosis provides more consistent results than standard CRP values alone.
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Iradukunda D, Moser MAJ, Rodych N, Lim HJ, Mondal P, Shaw JM. Patients aged 80 years and older accrue similar benefits from total parenteral nutrition compared to middle-aged patients. J Nutr Gerontol Geriatr 2013; 32:233-243. [PMID: 23924256 DOI: 10.1080/21551197.2013.810126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Age is becoming less of a consideration to aggressive medical and surgical interventions. The aim of this study was to evaluate whether patients older than 80 years showed similar gains from total parenteral nutrition (TPN) in terms of nutritional and inflammatory markers compared to patients 35 to 50 years old. A database of patients aged ≥80 years old (group 1) and patients between 35 and 50 (group 2), on TPN for greater than 1 week, was compiled from the Nutrition Support Service (NSS) database. Patients had C-reactive protein (CRP), prealbumin, and albumin drawn twice weekly. Patients were matched 1:1 based on gender, diabetes, smoking, Subjective Global Assessment score, and diagnosis. Both groups showed comparable improvements in nutritional and inflammatory markers. There were no statistically significant differences in weekly changes to prealbumin, albumin, CRP, and CRP:prealbumin (C:P) ratio between group 1 and group 2 patients. Both groups had similar complication rates (line-related thrombosis, catheter-related bloodstream infections, intra-abdominal sepsis), days on TPN, length of hospitalization, and mortality rate. Patients older than 80 years benefit from aggressive nutritional support by administration of TPN. Age should not be used as an exclusion criterion for patients requiring TPN.
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Affiliation(s)
- Diphile Iradukunda
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Differential white blood cell count and all-cause mortality in the Korean elderly. Exp Gerontol 2012; 48:103-8. [PMID: 23228954 DOI: 10.1016/j.exger.2012.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 11/28/2012] [Accepted: 11/30/2012] [Indexed: 11/23/2022]
Abstract
The circulating white blood cell (WBC) count has been considered a good biomarker of systemic inflammation, but the predictive value of this inexpensive and universally obtained test result has not been fully explored in the elderly. The objective of this study was to assess the independent association of WBC count and its individual components with mortality in an elderly population. We studied a total of 9996 participants (age ≥65 years) who underwent routine health examinations at the 2 healthcare centers affiliated with Seoul National University. Mortality data were obtained from the National Statistics Office of Korea. The mean age of the study population was 69.7 (SD 4.3) years, and 5491 of the subjects (54.9%) were male. The median length of follow-up was 44.9 months (range, 1.2-78.7 months). There were 118 deaths (1.2%) during the follow-up period. The leading cause of death was cancer. Compared with the survivors, the deceased subjects were older, predominantly male, had increased levels of inflammatory markers, and had poor nutritional status. A significant difference in mortality was identified among patients in different WBC and WBC subtype quartile groups. Cox proportional hazards analysis indicated that monocyte count (HR: 5.18, 95% CI: 2.44-11.02) was a strongest predictor of all-cause mortality than total WBC count (HR: 1.57, 95% CI: 0.88-2.80), granulocyte count (HR: 2.11, 95% CI: 1.15-3.88), and lymphocyte count (HR: 1.11, 95% CI: 0.66-1.86), even after adjusting for possible confounding variables. Monocyte counts were associated with an increased risk of cardiovascular and cancer-related mortality in the elderly population. In conclusion, the total WBC count is an independent predictor of mortality in older adults, but the monocyte subtype provides greater predictive ability.
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Owens CD. Statins and other agents for vascular inflammation. J Vasc Surg 2012; 56:1799-806. [DOI: 10.1016/j.jvs.2012.08.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 08/09/2012] [Accepted: 08/09/2012] [Indexed: 02/04/2023]
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Serum and cerebrospinal fluid levels of transthyretin in Lewy body disorders with and without dementia. PLoS One 2012; 7:e48042. [PMID: 23133543 PMCID: PMC3485000 DOI: 10.1371/journal.pone.0048042] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/20/2012] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) without (non-demented, PDND) and with dementia (PDD), and dementia with Lewy bodies (DLB) are subsumed under the umbrella term Lewy body disorders (LBD). The main component of the underlying pathologic substrate, i.e. Lewy bodies and Lewy neurites, is misfolded alpha-synuclein (Asyn), and--in particular in demented LBD patients--co-occurring misfolded amyloid-beta (Abeta). Lowered blood and cerebrospinal fluid (CSF) levels of transthyretin (TTR)--a clearance protein mainly produced in the liver and, autonomously, in the choroid plexus--are associated with Abeta accumulation in Alzheimer's disease. In addition, a recent study suggests that TTR is involved in Asyn clearance. We measured TTR protein levels in serum and cerebrospinal fluid of 131 LBD patients (77 PDND, 26 PDD, and 28 DLB) and 72 controls, and compared TTR levels with demographic and clinical data as well as neurodegenerative markers in the CSF. Five single nucleotide polymorphisms of the TTR gene which are considered to influence the ability of the protein to carry its ligands were also analyzed. CSF TTR levels were significantly higher in LBD patients compared to controls. Post-hoc analysis demonstrated that this effect was driven by PDND patients. In addition, CSF TTR levels correlated negatively with CSF Abeta(1-42), total tau and phospho-tau levels. Serum TTR levels did not significantly differ among the studied groups. There were no relevant associations between TTR levels and genetic, demographic and clinical data, respectively. These results suggest an involvement of the clearance protein TTR in LBD pathophysiology, and should motivate to elucidate TTR-related mechanisms in LBD in more detail.
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Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy. Int J Pharm 2012; 430:197-206. [DOI: 10.1016/j.ijpharm.2012.04.022] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 01/03/2023]
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Kane RL, Shamliyan T, Talley K, Pacala J. The Association Between Geriatric Syndromes and Survival. J Am Geriatr Soc 2012; 60:896-904. [DOI: 10.1111/j.1532-5415.2012.03942.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Kristine Talley
- School of Nursing, University of Minnesota; Minneapolis; Minnesota
| | - James Pacala
- Medical School, University of Minnesota; Minneapolis; Minnesota
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Cubedo J, Padró T, Alonso R, Cinca J, Mata P, Badimon L. Differential proteomic distribution of TTR (pre-albumin) forms in serum and HDL of patients with high cardiovascular risk. Atherosclerosis 2012; 222:263-9. [PMID: 22420894 DOI: 10.1016/j.atherosclerosis.2012.02.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 01/24/2012] [Accepted: 02/15/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED Inflammation is a common condition contributing to cardiovascular disease progression which leads to clinical manifestations such as acute myocardial infarction (AMI). By applying a proteomic expression profiling approach we have investigated changes in transthyretin (TTR) in AMI-patients and its distribution patterns in HDL samples of patients with high cardiovascular risk, such as those with familiar hypercholesterolemia (FH). METHODS AND RESULTS The characterization by bidimensional electrophoresis (2-DE), followed by mass-spectrometry (MALDI-TOF) of serum samples revealed changes in the intensity of the TTR spot with a pI of 5.6 and a Mw of 42kDa (tTTR) between AMI-patients in association to diabetic dyslipemia. Serum TTR levels, determined by commercial ELISA, were significantly lower (p<0.0001) in AMI-patients (n=39) and FH-patients (n=100) than in healthy controls (n=60). Western blot and 2-DE analysis showed a differential distribution profile of TTR forms between serum, where 3 TTR forms of 42 (tTTR), 28 (dTTR), and 14kDa (mTTR) were detected, and HDL samples, where only mTTR was present. CONCLUSIONS Our results demonstrate alterations in TTR proteomic profile in relation to the clustering of risk factors which seems to highlight the implication of TTR in cardiovascular risk. The significant differences in TTR between serum (tTTR) and HDL (mTTR) underscore the importance of TTR-forms in the circulation and deserve further investigation to understand their function.
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Affiliation(s)
- Judit Cubedo
- Cardiovascular Research Center (CSIC-ICCC), Spain
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Ujszaszi A, Czira ME, Fornadi K, Novak M, Mucsi I, Molnar MZ. Quality of life and protein-energy wasting in kidney transplant recipients. Int Urol Nephrol 2012; 44:1257-68. [PMID: 22246594 DOI: 10.1007/s11255-012-0122-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 01/05/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE Chronic kidney disease has profound effects on the health-related quality of life (HRQoL) of patients, with serious physiological, psychological and socio-economic implications. The co-occurrence of protein-energy wasting and inflammation in end-stage renal disease patients is associated with worse HRQoL and increased mortality. We designed this study to examine the relationship between nutritional and inflammatory status and HRQoL in kidney transplant recipients. METHODS Data from 100 randomly selected kidney transplant patients were analyzed in a cross-sectional survey. Socio-demographic parameters, laboratory results, transplantation-related data, comorbidities, medication and malnutrition-inflammation score (MIS) (Kalantar Score) were tabulated at baseline. Patients completed the Kidney Disease Quality of Life-SF (KDQoL-SF™) self-administered questionnaire. RESULTS Mean age was 51 ± 13 years, median (interquartile range, IQR) time since transplantation 66 (83) months, 57% were men, and 19% had diabetes. The median (IQR) MIS was 3 (3). The MIS significantly and negatively correlated with almost all HRQoL domains analyzed, and this association remained significant in multivariate linear regression analysis for the log-transformed scores on energy/fatigue (β = -0.059 P < 0.001), bodily pain (β = -0.056 P = 0.004), physical functioning (β = -0.029, P = 0.022) and symptoms/problems (β = -0.023 P = 0.005) domains after statistical correction for age, gender, eGFR, dialysis vintage, Charlson Comorbidity Index and occupational status. Additionally, cubic spline analyses revealed linearly increasing, "dose-response" relationship between almost all domains of KDQoL-SF™ and the MIS. CONCLUSIONS Malnutrition-inflammation score is independently associated with different dimensions of HRQoL in kidney transplant recipients.
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Affiliation(s)
- Akos Ujszaszi
- Institute of Pathophysiology, Semmelweis University, Nagyvarad ter 4, 1089 Budapest, Hungary
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