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Mazurkiewicz M, Lizurej W, Mazurkiewicz L, Majewski A, Tobis S, Cymerys M. C-Reactive Protein and Albumin Levels as Useful Tools for Predicting In-Hospital Outcomes in Polish Nonagenarians. Clin Interv Aging 2023; 18:1547-1554. [PMID: 37727448 PMCID: PMC10506667 DOI: 10.2147/cia.s422895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose The admissions of nonagenarians to internal medicine wards are rising. The aim of this study was to analyse the causes of ward admission and blood and renal parameters as potential mortality predictors in this age group. Patients and Methods Out of 1140 patients, 111 nonagenarians aged 90+ admitted to the Internal Medicine Ward in one general hospital in Poznan in 2019 were studied. Medical records of these patients were analysed to find factors attributable to the hospitalisation. Results The leading causes of admission were infections and cardiovascular diseases, and the main causes of death were cardiovascular diseases. Elevated C-reactive protein (CRP) level was a statistically significant death predictor. Equally, decreased albumin level was found to be a mortality predictor. No such relationships were obtained for haematological or renal parameters. Conclusion Our study uniquely analysed a relatively large group of hospitalised nonagenarians and identified those who need particular attention in the ward by identifying those with the highest risk of death. CRP and albumin levels may serve as useful indicators of in-hospital mortality in this age group.
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Affiliation(s)
- Michal Mazurkiewicz
- Department of Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Lizurej
- Department of Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Lukasz Mazurkiewicz
- Department of Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Arkadiusz Majewski
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Slawomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Cymerys
- Department of Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Kamper RS, Schultz M, Hansen SK, Andersen H, Ekmann A, Nygaard H, Helland F, Wejse MR, Rahbek CB, Noerst T, Pressel E, Nielsen FE, Suetta C. Biomarkers for length of hospital stay, changes in muscle mass, strength and physical function in older medical patients: protocol for the Copenhagen PROTECT study-a prospective cohort study. BMJ Open 2020; 10:e042786. [PMID: 33376179 PMCID: PMC7778767 DOI: 10.1136/bmjopen-2020-042786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sarcopenia is generally used to describe the age-related loss of muscle mass and strength believed to play a major role in the pathogenesis of physical frailty and functional impairment that may occur with old age. The knowledge surrounding the prevalence and determinants of sarcopenia in older medical patients is scarce, and it is unknown whether specific biomarkers can predict physical deconditioning during hospitalisation. We hypothesise that a combination of clinical, functional and circulating biomarkers can serve as a risk stratification tool and can (i) identify older acutely ill medical patients at risk of prolonged hospital stays and (ii) predict changes in muscle mass, muscle strength and function during hospitalisation. METHOD AND ANALYSIS The Copenhagen PROTECT study is a prospective cohort study consisting of acutely ill older medical patients admitted to the acute medical ward at Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark. Assessments are performed within 24 hours of admission and include blood samples, body composition, muscle strength, physical function and questionnaires. A subgroup of patients transferred to the Geriatric Department are included in a smaller geriatric cohort and have additional assessments at discharge to evaluate the relative change in circulating biomarker concentrations, body composition, muscle strength and physical function during hospitalisation. Enrolment commenced 4 November 2019, and proceeds until August 2021. ETHICS AND DISSEMINATION The study protocol has been approved by the local ethics committee of Copenhagen and Frederiksberg (H-19039214) and the Danish Data Protection Agency (P-2019-239) and all experimental procedures were performed in accordance with the Declaration of Helsinki. Findings from the project, regardless of the outcome, will be published in relevant peer-reviewed scientific journals in online (www.clinicaltrials.gov). TRIAL REGISTRATION NUMBER NCT04151108.
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Affiliation(s)
- Rikke S Kamper
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- CopenAge; Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - Martin Schultz
- Geriatric Research Unit, Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- CopenAge; Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - Sofie K Hansen
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- CopenAge; Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - Helle Andersen
- Department of Occupational and Physiotherapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- CopenAge; Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - Anette Ekmann
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- CopenAge; Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Nygaard
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- CopenAge; Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Helland
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Miriam R Wejse
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Camilla B Rahbek
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tim Noerst
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Eckart Pressel
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Finn Erland Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Geriatric Research Unit, Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
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Ticinesi A, Lauretani F, Nouvenne A, Porro E, Fanelli G, Maggio M, Meschi T. C-reactive protein (CRP) measurement in geriatric patients hospitalized for acute infection. Eur J Intern Med 2017; 37:7-12. [PMID: 27594414 DOI: 10.1016/j.ejim.2016.08.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/31/2016] [Accepted: 08/21/2016] [Indexed: 11/19/2022]
Abstract
The physiology of inflammatory response is modified by the aging process and is substantially affected by multimorbidity and disability. Infection is the most frequent cause of acute inflammation in both adult and older subjects. C-reactive protein (CRP) is the most used biomarker of inflammation, and a substantial amount of literature has demonstrated its importance and clinical usefulness in adult subjects. However, the clinical significance of serum CRP determination has not been completely clarified in older subjects with acute infection, especially in the light of the age-related rearrangements in immunity and cytokine production. Thus, in the present review, we focus on the existing knowledge about serum CRP level interpretation in geriatric patients hospitalized with acute infection. Our aims were to determine the significance of CRP measurement at hospital admission for establishing a diagnosis of infection and/or a prognosis and to evaluate whether it is indicated to repeat hs-CRP measurements during hospital stay for monitoring disease course and, possibly, guiding the discharge timing. We concluded that CRP dosage at hospital admission is helpful to detect acute infection, and particularly sepsis, in geriatric patients, and that CRP elevation may provide valuable short-term prognostic information. At the current state of art, serial CRP measurements are instead not indicated to monitor disease course and plan hospital discharge in this setting.
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Affiliation(s)
- Andrea Ticinesi
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy.
| | - Fulvio Lauretani
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Antonio Nouvenne
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Emanuela Porro
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Guido Fanelli
- Department of Surgical Sciences, University of Parma, Italy; Anesthesia, Intensive Care and Pain Therapy Unit, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Marcello Maggio
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Clinical Geriatrics Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Tiziana Meschi
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
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Zhang X, Bansal N, Go AS, Hsu CY. Gastrointestinal symptoms, inflammation and hypoalbuminemia in chronic kidney disease patients: a cross-sectional study. BMC Nephrol 2015; 16:211. [PMID: 26651991 PMCID: PMC4676825 DOI: 10.1186/s12882-015-0209-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 12/07/2015] [Indexed: 01/06/2023] Open
Abstract
Background Few studies have focused on investigating hypoalbuminemia in patients during earlier stages of chronic kidney disease (CKD). In particular, little is known about the role of gastrointestinal (GI) symptoms. Our goal in this paper is to study how GI symptoms relate to serum albumin levels in CKD, especially in the context of and compared with inflammation. Methods We performed a cross-sectional study of 3599 patients with chronic kidney disease enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. All subjects were asked to complete the Modification of Diet in Renal Disease (MDRD) study patient symptom form. Our main predictor is GI symptom score. Serum level of C-reactive protein (CRP) was measured as well. Main outcome measures are serum albumin levels and prevalence of hypoalbuminemia. Results Of the participants assessed, mean serum albumin was 3.95 ± 0.46 g/dL; 12.7 % had hypoalbuminemia. Patients with lower estimated glomerular filtration rate (eGFR) were likely to have more GI symptoms (apparent at an eGFR <45 ml/min/1.73 m2). Patients with worse GI symptoms had lower dietary protein intake. GI symptoms, like inflammation, were risk factors for lower serum albumin levels. However, adding GI symptom score or CRP into the multivariable regression analysis, did not attenuate the association between lower eGFR and lower albumin or hypoalbuminemia. Conclusions Increased prevalence of GI symptoms become apparent among CKD patients at relatively high eGFR levels (45 ml/min/1.73 m2), long before ESRD. Patients with more severe GI symptoms scores are more likely to have hypoalbuminemia. But our data do not support GI symptoms/decreased protein intake or inflammation as being the main determinants of serum albumin level in CKD patients. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0209-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuehan Zhang
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. .,Division of Nephrology, University of California-San Francisco, San Francisco, CA, USA.
| | - Nisha Bansal
- Division of Nephrology, University of Washington, Seattle, WA, USA.
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California-San Francisco, San Francisco, CA, USA. .,Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
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