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Minnema J, Polinder-Bos HA, Cesari M, Dockery F, Everink IHJ, Francis BN, Gordon AL, Grund S, Bazan LMP, Eruslanova K, Topinková E, Vassallo MA, Faes MC, van Tol LS, Caljouw MAA, Achterberg WP, Haaksma ML. The Impact of Delirium on Recovery in Geriatric Rehabilitation After Acute Infection. J Am Med Dir Assoc 2024:S1525-8610(24)00344-X. [PMID: 38670170 DOI: 10.1016/j.jamda.2024.03.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Delirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. DESIGN This study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. SETTING AND PARTICIPANTS Participants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. METHODS Data were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol-5 Dimensions-5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. RESULTS Of the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = -0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = -0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. CONCLUSIONS AND IMPLICATIONS Presence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.
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Affiliation(s)
- J Minnema
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - H A Polinder-Bos
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Cesari
- IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | | | - I H J Everink
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - B N Francis
- Fliman Geriatric Rehabilitation Centre, Haifa, Israel; Geriatric Division, Holy Family Hospital, Bar Ilan University, Safad, Israel
| | - A L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, United Kingdom
| | - S Grund
- Centre for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the Heidelberg University, Heidelberg, Germany
| | - L M Perez Bazan
- RE-FiT Barcelona Research Group, Parc Sanitari Pere Virgili Hospital and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - K Eruslanova
- Russian Clinical and Research Centre of Gerontology, Moscow, Russia
| | - E Topinková
- Department of Geriatric Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic; Faculty of Health and Social Sciences, South Bohemian University, České Budějovice, Czech Republic
| | | | - M C Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
| | - L S van Tol
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - M A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - W P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
| | - M L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
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2
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Zahra A, van Smeden M, Abbink EJ, van den Berg JM, Blom MT, van den Dries CJ, Gussekloo J, Wouters F, Joling KJ, Melis R, Mooijaart SP, Peters JB, Polinder-Bos HA, van Raaij BFM, Appelman B, la Roi-Teeuw HM, Moons KGM, Luijken K. External validation of six COVID-19 prognostic models for predicting mortality risk in older populations in a hospital, primary care, and nursing home setting. J Clin Epidemiol 2024; 168:111270. [PMID: 38311188 DOI: 10.1016/j.jclinepi.2024.111270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To systematically evaluate the performance of COVID-19 prognostic models and scores for mortality risk in older populations across three health-care settings: hospitals, primary care, and nursing homes. STUDY DESIGN AND SETTING This retrospective external validation study included 14,092 older individuals of ≥70 years of age with a clinical or polymerase chain reaction-confirmed COVID-19 diagnosis from March 2020 to December 2020. The six validation cohorts include three hospital-based (CliniCo, COVID-OLD, COVID-PREDICT), two primary care-based (Julius General Practitioners Network/Academisch network huisartsgeneeskunde/Network of Academic general Practitioners, PHARMO), and one nursing home cohort (YSIS) in the Netherlands. Based on a living systematic review of COVID-19 prediction models using Prediction model Risk Of Bias ASsessment Tool for quality and risk of bias assessment and considering predictor availability in validation cohorts, we selected six prognostic models predicting mortality risk in adults with COVID-19 infection (GAL-COVID-19 mortality, 4C Mortality Score, National Early Warning Score 2-extended model, Xie model, Wang clinical model, and CURB65 score). All six prognostic models were validated in the hospital cohorts and the GAL-COVID-19 mortality model was validated in all three healthcare settings. The primary outcome was in-hospital mortality for hospitals and 28-day mortality for primary care and nursing home settings. Model performance was evaluated in each validation cohort separately in terms of discrimination, calibration, and decision curves. An intercept update was performed in models indicating miscalibration followed by predictive performance re-evaluation. MAIN OUTCOME MEASURE In-hospital mortality for hospitals and 28-day mortality for primary care and nursing home setting. RESULTS All six prognostic models performed poorly and showed miscalibration in the older population cohorts. In the hospital settings, model performance ranged from calibration-in-the-large -1.45 to 7.46, calibration slopes 0.24-0.81, and C-statistic 0.55-0.71 with 4C Mortality Score performing as the most discriminative and well-calibrated model. Performance across health-care settings was similar for the GAL-COVID-19 model, with a calibration-in-the-large in the range of -2.35 to -0.15 indicating overestimation, calibration slopes of 0.24-0.81 indicating signs of overfitting, and C-statistic of 0.55-0.71. CONCLUSION Our results show that most prognostic models for predicting mortality risk performed poorly in the older population with COVID-19, in each health-care setting: hospital, primary care, and nursing home settings. Insights into factors influencing predictive model performance in the older population are needed for pandemic preparedness and reliable prognostication of health-related outcomes in this demographic.
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Affiliation(s)
- Anum Zahra
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Evertine J Abbink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jesse M van den Berg
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands; PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Carline J van den Dries
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jacobijn Gussekloo
- Section Gerontology and Geriatrics, LUMC Center for Medicine for Older People & Department of Public Health and Primary Care & Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Fenne Wouters
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - René Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simon P Mooijaart
- LUMC Center for Medicine for Older People, LUMC, Leiden, The Netherlands
| | - Jeannette B Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Harmke A Polinder-Bos
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Bas F M van Raaij
- LUMC Center for Medicine for Older People, LUMC, Leiden, The Netherlands
| | - Brent Appelman
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
| | - Hannah M la Roi-Teeuw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kim Luijken
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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la Roi-Teeuw HM, Luijken K, Blom MT, Gussekloo J, Mooijaart SP, Polinder-Bos HA, van Smeden M, Geersing GJ, van den Dries CJ. Limited incremental predictive value of the frailty index and other vulnerability measures from routine care data for mortality risk prediction in older patients with COVID-19 in primary care. BMC Prim Care 2024; 25:70. [PMID: 38395766 PMCID: PMC10885372 DOI: 10.1186/s12875-024-02308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, older patients in primary care were triaged based on their frailty or assumed vulnerability for poor outcomes, while evidence on the prognostic value of vulnerability measures in COVID-19 patients in primary care was lacking. Still, knowledge on the role of vulnerability is pivotal in understanding the resilience of older people during acute illness, and hence important for future pandemic preparedness. Therefore, we assessed the predictive value of different routine care-based vulnerability measures in addition to age and sex for 28-day mortality in an older primary care population of patients with COVID-19. METHODS From primary care medical records using three routinely collected Dutch primary care databases, we included all patients aged 70 years or older with a COVID-19 diagnosis registration in 2020 and 2021. All-cause mortality was predicted using logistic regression based on age and sex only (basic model), and separately adding six vulnerability measures: renal function, cognitive impairment, number of chronic drugs, Charlson Comorbidity Index, Chronic Comorbidity Score, and a Frailty Index. Predictive performance of the basic model and the six vulnerability models was compared in terms of area under the receiver operator characteristic curve (AUC), index of prediction accuracy and the distribution of predicted risks. RESULTS Of the 4,065 included patients, 9% died within 28 days after COVID-19 diagnosis. Predicted mortality risk ranged between 7-26% for the basic model including age and sex, changing to 4-41% by addition of comorbidity-based vulnerability measures (Charlson Comorbidity Index, Chronic Comorbidity Score), more reflecting impaired organ functioning. Similarly, the AUC of the basic model slightly increased from 0.69 (95%CI 0.66 - 0.72) to 0.74 (95%CI 0.71 - 0.76) by addition of either of these comorbidity scores. Addition of a Frailty Index, renal function, the number of chronic drugs or cognitive impairment yielded no substantial change in predictions. CONCLUSION In our dataset of older COVID-19 patients in primary care, the 28-day mortality fraction was substantial at 9%. Six different vulnerability measures had little incremental predictive value in addition to age and sex in predicting short-term mortality.
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Affiliation(s)
- Hannah M la Roi-Teeuw
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Kim Luijken
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jacobijn Gussekloo
- LUMC Center for Medicine for Older People, Department of Public Health and Primary Care, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- LUMC Center for Medicine for Older People, Department of Public Health and Primary Care, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Harmke A Polinder-Bos
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten van Smeden
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Carline J van den Dries
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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Bakas AT, Polinder-Bos HA, Streng F, Mattace-Raso FUS, Ziere G, de Jong RJB, Sewnaik A. Frailty in Non-geriatric Patients With Head and Neck cancer. Otolaryngol Head Neck Surg 2023; 169:1215-1224. [PMID: 37264978 DOI: 10.1002/ohn.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Patients with head and neck cancer (HNC) are characterized by a poor lifestyle and comorbidity. The Geriatric 8 (G8) is an established screening tool to identify frail older patients with cancer. However, studies evaluating frailty in younger HNC patients are lacking. The aim of this study is to evaluate if the G8 can identify frailty and if it is related to mortality in younger HNC patients. STUDY DESIGN Case-control study design. SETTING Tertiary cancer center. METHODS We studied patients <70 years with HNC. Patients with G8 ≤ 14 were considered frail. Patients were matched to nonfrail (G8 > 14) control patients. Patients were matched according to sex, age, smoking, tumor location, and period of first consultation. Baseline health characteristics were compared between frail patients and nonfrail controls. Second, the treatment plan and adverse outcomes were compared. RESULTS Forty-five patients with G8 ≤ 14 were included and matched to 90 nonfrail controls. The median follow-up time was 357 days. Frail patients had a significantly lower body mass index and level of education, a worse World Health Organization performance status, and reported lower experienced overall health. 28.9% of the frail patients died after 1 year versus 10% of the nonfrail control patients (hazard ratio: 3.87 [95% confidence interval: 1.32-11.36], p = 0.014). CONCLUSION The G8 is a valid screening tool to identify frail patients in younger HNC patients.
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Affiliation(s)
- Ajay T Bakas
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harmke A Polinder-Bos
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | - Fleur Streng
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | | | - Gijsbertus Ziere
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | - Rob J Baatenburg de Jong
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Minnema J, Tap L, van der Bol JM, van Deudekom FJA, Faes MC, Jansen SWM, van der Linden CMJ, Lucke JA, Mooijaart SP, van Munster B, Noordam R, van Raaij BFM, Ruiter R, Smits RAL, Willems HC, Mattace-Raso FUS, Polinder-Bos HA. Delirium in older patients with COVID-19: Prevalence, risk factors and clinical outcomes across the first three waves of the pandemic. Int J Geriatr Psychiatry 2023; 38:e6024. [PMID: 37909117 DOI: 10.1002/gps.6024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES Delirium is a serious condition, which poses treatment challenges during hospitalisation for COVID-19. Improvements in testing, vaccination and treatment might have changed patient characteristics and outcomes through the pandemic. We evaluated whether the prevalence and risk factors for delirium, and the association of delirium with in-hospital mortality changed through the pandemic. METHODS This study was part of the COVID-OLD study in 19 Dutch hospitals including patients ≥70 years in the first (spring 2020), second (autumn 2020) and third wave (autumn 2021). Multivariable logistic regression models were used to study risk factors for delirium, and in-hospital mortality. Differences in effect sizes between waves were studied by including interaction terms between wave and risk factor in logistic regression models. RESULTS 1540, 884 and 370 patients were included in the first, second and third wave, respectively. Prevalence of delirium in the third wave (12.7%) was significantly lower compared to the first (22.5%) and second wave (23.5%). In multivariable-adjusted analyses, pre-existing memory problems was a consistent risk factor for delirium across waves. Previous delirium was a risk factor for delirium in the first wave (OR 4.02), but not in the second (OR 1.61) and third wave (OR 2.59, p-value interaction-term 0.028). In multivariable-adjusted analyses, delirium was not associated with in-hospital mortality in all waves. CONCLUSION Delirium prevalence declined in the third wave, which might be the result of vaccination and improved treatment strategies. Risk factors for delirium remained consistent across waves, although some attenuation was seen in the second wave.
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Affiliation(s)
- Julia Minnema
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lisanne Tap
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | | | - Miriam C Faes
- Department of Geriatrics, Amphia Hospital, Breda, The Netherlands
| | - Steffy W M Jansen
- Department of Geriatrics, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Jacinta A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Simon P Mooijaart
- Department of Internal Medicine, Section of Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
- LUMC Center of Medicine for Older People, Leiden University Medical Centre, Leiden, The Netherlands
| | - Barbara van Munster
- Department of Internal Medicine and Geriatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section of Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bas F M van Raaij
- Department of Internal Medicine, Section of Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Rosalinde A L Smits
- Department of Internal Medicine, Section of Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hanna C Willems
- Department of Internal Medicine and Geriatrics, AmsterdamUMC, Amsterdam, The Netherlands
| | - Francesco U S Mattace-Raso
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Harmke A Polinder-Bos
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Kuiper LM, Polinder-Bos HA, Bizzarri D, Vojinovic D, Vallerga CL, Beekman M, Dollé MET, Ghanbari M, Voortman T, Reinders MJT, Verschuren WMM, Slagboom PE, van den Akker EB, van Meurs JBJ. Epigenetic and Metabolomic Biomarkers for Biological Age: A Comparative Analysis of Mortality and Frailty Risk. J Gerontol A Biol Sci Med Sci 2023; 78:1753-1762. [PMID: 37303208 PMCID: PMC10562890 DOI: 10.1093/gerona/glad137] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Indexed: 06/13/2023] Open
Abstract
Biological age captures a person's age-related risk of unfavorable outcomes using biophysiological information. Multivariate biological age measures include frailty scores and molecular biomarkers. These measures are often studied in isolation, but here we present a large-scale study comparing them. In 2 prospective cohorts (n = 3 222), we compared epigenetic (DNAm Horvath, DNAm Hannum, DNAm Lin, DNAm epiTOC, DNAm PhenoAge, DNAm DunedinPoAm, DNAm GrimAge, and DNAm Zhang) and metabolomic-based (MetaboAge and MetaboHealth) biomarkers in reflection of biological age, as represented by 5 frailty measures and overall mortality. Biomarkers trained on outcomes with biophysiological and/or mortality information outperformed age-trained biomarkers in frailty reflection and mortality prediction. DNAm GrimAge and MetaboHealth, trained on mortality, showed the strongest association with these outcomes. The associations of DNAm GrimAge and MetaboHealth with frailty and mortality were independent of each other and of the frailty score mimicking clinical geriatric assessment. Epigenetic, metabolomic, and clinical biological age markers seem to capture different aspects of aging. These findings suggest that mortality-trained molecular markers may provide novel phenotype reflecting biological age and strengthen current clinical geriatric health and well-being assessment.
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Affiliation(s)
- Lieke M Kuiper
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Center for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands
| | | | - Daniele Bizzarri
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Pattern Recognition and Bioinformatics, Delft University of Technology, Delft, The Netherlands
| | - Dina Vojinovic
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Marian Beekman
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martijn E T Dollé
- Center for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Marcel J T Reinders
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Pattern Recognition and Bioinformatics, Delft University of Technology, Delft, The Netherlands
| | - W M Monique Verschuren
- Center for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P Eline Slagboom
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Max Planck Institute for the Biology of Ageing, Cologne, Germany
| | - Erik B van den Akker
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Pattern Recognition and Bioinformatics, Delft University of Technology, Delft, The Netherlands
| | - Joyce B J van Meurs
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus MC, Rotterdam, The Netherlands
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7
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Mattace-Raso F, Goudzwaard JA, Polinder-Bos HA, Tap L. Cardiovascular Risk Management for All Older Patients? J Alzheimers Dis 2023:JAD230382. [PMID: 37393507 DOI: 10.3233/jad-230382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
Current guidelines on cardiovascular risk management are extrapolated to all older adults. It is, however, highly debatable whether recommendations also apply for patients with dementia since previous studies have not included this specific population. Time to benefit as well as higher risk of adverse events play a crucial role in the decision process of prescribing or deprescribing. Regular monitoring is needed in older patients with dementia, in order to make individual-based treatment strategies. Cardiovascular risk management in older patients with dementia should focus on quality of life, preventing cognitive and functional deterioration, and maintaining independence.
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Affiliation(s)
- Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jeannette A Goudzwaard
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harmke A Polinder-Bos
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lisanne Tap
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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8
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Zahra A, Luijken K, Abbink EJ, van den Berg JM, Blom MT, Elders P, Festen J, Gussekloo J, Joling KJ, Melis R, Mooijaart S, Peters JB, Polinder-Bos HA, van Raaij BFM, Smorenberg A, la Roi-Teeuw HM, Moons KGM, van Smeden M. A study protocol of external validation of eight COVID-19 prognostic models for predicting mortality risk in older populations in a hospital, primary care, and nursing home setting. Diagn Progn Res 2023; 7:8. [PMID: 37013651 PMCID: PMC10069944 DOI: 10.1186/s41512-023-00144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/27/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has a large impact worldwide and is known to particularly affect the older population. This paper outlines the protocol for external validation of prognostic models predicting mortality risk after presentation with COVID-19 in the older population. These prognostic models were originally developed in an adult population and will be validated in an older population (≥ 70 years of age) in three healthcare settings: the hospital setting, the primary care setting, and the nursing home setting. METHODS Based on a living systematic review of COVID-19 prediction models, we identified eight prognostic models predicting the risk of mortality in adults with a COVID-19 infection (five COVID-19 specific models: GAL-COVID-19 mortality, 4C Mortality Score, NEWS2 + model, Xie model, and Wang clinical model and three pre-existing prognostic scores: APACHE-II, CURB65, SOFA). These eight models will be validated in six different cohorts of the Dutch older population (three hospital cohorts, two primary care cohorts, and a nursing home cohort). All prognostic models will be validated in a hospital setting while the GAL-COVID-19 mortality model will be validated in hospital, primary care, and nursing home settings. The study will include individuals ≥ 70 years of age with a highly suspected or PCR-confirmed COVID-19 infection from March 2020 to December 2020 (and up to December 2021 in a sensitivity analysis). The predictive performance will be evaluated in terms of discrimination, calibration, and decision curves for each of the prognostic models in each cohort individually. For prognostic models with indications of miscalibration, an intercept update will be performed after which predictive performance will be re-evaluated. DISCUSSION Insight into the performance of existing prognostic models in one of the most vulnerable populations clarifies the extent to which tailoring of COVID-19 prognostic models is needed when models are applied to the older population. Such insight will be important for possible future waves of the COVID-19 pandemic or future pandemics.
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Affiliation(s)
- Anum Zahra
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands.
| | - Kim Luijken
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Evertine J Abbink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jesse M van den Berg
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Petra Elders
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Jacobijn Gussekloo
- Department of Public Health and Primary Care & Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| | - René Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simon Mooijaart
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeannette B Peters
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Harmke A Polinder-Bos
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bas F M van Raaij
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Annemieke Smorenberg
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hannah M la Roi-Teeuw
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, the Netherlands
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9
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van Son JE, Kahn ECP, van der Bol JM, Barten DG, Blomaard LC, van Dam C, Ellerbroek J, Jansen SWM, Lekx A, van der Linden CMJ, Looman R, Maas HAAM, Mattace-Raso FUS, Mooijaart SP, van Munster BC, Peters A, Polinder-Bos HA, Smits RAL, Spies PE, Wassenburg A, Wassenburg N, Willems HC, Schouten HJ, Robben SHM. Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes. Eur Geriatr Med 2023; 14:333-343. [PMID: 36749454 PMCID: PMC9902812 DOI: 10.1007/s41999-022-00736-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/24/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE Older patients with COVID-19 can present with atypical complaints, such as falls or delirium. In other diseases, such an atypical presentation is associated with worse clinical outcomes. However, it is not known whether this extends to COVID-19. We aimed to study the association between atypical presentation of COVID-19, frailty and adverse outcomes, as well as the incidence of atypical presentation. METHODS We conducted a retrospective observational multi-center cohort study in eight hospitals in the Netherlands. We included patients aged ≥ 70 years hospitalized with COVID-19 between February 2020 until May 2020. Atypical presentation of COVID-19 was defined as presentation without fever, cough and/or dyspnea. We collected data concerning symptoms on admission, demographics and frailty parameters [e.g., Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS)]. Outcome data included Intensive Care Unit (ICU) admission, discharge destination and 30-day mortality. RESULTS We included 780 patients, 9.5% (n = 74) of those patients had an atypical presentation. Patients with an atypical presentation were older (80 years, IQR 76-86 years; versus 79 years, IQR 74-84, p = 0.044) and were more often classified as severely frail (CFS 6-9) compared to patients with a typical presentation (47.6% vs 28.7%, p = 0.004). Overall, there was no significant difference in 30-day mortality between the two groups in univariate analysis (32.4% vs 41.5%; p = 0.173) or in multivariate analysis [OR 0.59 (95% CI 0.34-1.0); p = 0.058]. CONCLUSIONS In this study, patients with an atypical presentation of COVID-19 were more frail compared to patients with a typical presentation. Contrary to our expectations, an atypical presentation was not associated with worse outcomes.
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Affiliation(s)
- Joy E. van Son
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC Tilburg, The Netherlands
| | - Elisabeth C. P. Kahn
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | | | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Laura C. Blomaard
- Section Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Carmen van Dam
- Division of Geriatric Medicine, Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Jacobien Ellerbroek
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Steffy W. M. Jansen
- Department of Geriatric Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Anita Lekx
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | | | - Roy Looman
- Division of Geriatric Medicine, Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Huub A. A. M. Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC Tilburg, The Netherlands
| | - Francesco U. S. Mattace-Raso
- Department of Internal Medicine, Division of Geriatric Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Simon P. Mooijaart
- Section Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Barbara C. van Munster
- Department of Internal Medicine and Geriatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annefleur Peters
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Harmke A. Polinder-Bos
- Department of Internal Medicine, Division of Geriatric Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rosalinde A. L. Smits
- Section Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Petra E. Spies
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Anna Wassenburg
- Department of Geriatric Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Nora Wassenburg
- Department of Geriatric Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Hanna C. Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Henrike J. Schouten
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Sarah H. M. Robben
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC Tilburg, The Netherlands
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10
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Zorge NE, Scheerders ERY, Dudink K, Oudshoorn C, Polinder-Bos HA, Waalboer-Spuij R, Schlejen PM, van Montfrans C. A prospective, multicentre study to assess frailty in elderly patients with leg ulcers (GERAS study). J Eur Acad Dermatol Venereol 2023; 37:428-435. [PMID: 36152005 PMCID: PMC10092866 DOI: 10.1111/jdv.18586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although leg ulcers are a burdensome disease most common in those aged 65 years and older, frailty in this population has not yet been well established. OBJECTIVES The aim of this study was to prospectively explore and compare the presence of frailty in elderly patients with chronic leg or foot ulcers by applying different validated frailty screening methods in three healthcare settings and to assess the feasibility of frailty screening. METHODS We compared frailty of leg ulcer patients referred to an academic hospital with a non-academic hospital, leg ulcer patients receiving (primary) homecare, and a dermato-oncology patient population (control group). Frailty and quality of life were assessed using four validated questionnaires: the Groninger Frailty Indicator, Geriatric-8, Mini-Cog and Wound Quality of Life. To analyse data multiple (non)-parametric tests were performed. RESULTS Fifty of 60 included leg ulcer patients (83%) scored "frail" on at least one frailty questionnaire (GFI, G8 or Mini-Cog). The number of patients scoring "frail" on two or three out of three applied frailty questionnaires were significantly higher in the academic and homecare ulcer population compared with the non-academic ulcer population and control group (p = 0.002). In the academic ulcer population mean Wound Quality of Life scores were 30.2 (SD 17.6), compared with 17.7 (SD 13.1) in the non-academic and 15.0 (SD 10.4) in the homecare ulcer population (p = 0.002). CONCLUSION The majority of patients suffering from leg ulcers in this study was frail. The highest frailty prevalence was observed in the academic and homecare ulcer populations. The largest impaired quality of life was reported in the academic ulcer population. In dermatology practice, implementing frailty screening and initiating appropriate (paramedical) supportive care should be considered to improve patient outcomes.
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Affiliation(s)
- Nadja E Zorge
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Koen Dudink
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christian Oudshoorn
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Rick Waalboer-Spuij
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter M Schlejen
- Department of Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands
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11
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Overbeek FCMS, Goudzwaard JA, van Hemmen J, van Bruchem-Visser RL, Papma JM, Polinder-Bos HA, Mattace-Raso FUS. The Multidimensional Prognostic Index Predicts Mortality in Older Outpatients with Cognitive Decline. J Clin Med 2022; 11:jcm11092369. [PMID: 35566497 PMCID: PMC9103737 DOI: 10.3390/jcm11092369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
Since the heterogeneity of the growing group of older outpatients with cognitive decline, it is challenging to evaluate survival rates in clinical shared decision making. The primary outcome was to determine whether the Multidimensional Prognostic Index (MPI) predicts mortality, whilst assessing the MPI distribution was considered secondary. This retrospective chart review included 311 outpatients aged ≥65 years and diagnosed with dementia or mild cognitive impairment (MCI). The MPI includes several domains of the comprehensive geriatric assessment (CGA). All characteristics and data to calculate the risk score and mortality data were extracted from administrative information in the database of the Alzheimer’s Center and medical records. The study population (mean age 76.8 years, men = 51.4%) was divided as follows: 34.1% belonged to MPI category 1, 52.1% to MPI category 2 and 13.8% to MPI category 3. Patients with dementia have a higher mean MPI risk score than patients with MCI (0.47 vs. 0.32; p < 0.001). The HRs and corresponding 95% CIs for mortality in patients in MPI categories 2 and 3 were 1.67 (0.81−3.45) and 3.80 (1.56−9.24) compared with MPI category 1, respectively. This study shows that the MPI predicts mortality in outpatients with cognitive decline.
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Affiliation(s)
- Femke C. M. S. Overbeek
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Jeannette A. Goudzwaard
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Judy van Hemmen
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (J.v.H.); (J.M.P.)
| | - Rozemarijn L. van Bruchem-Visser
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Janne M. Papma
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (J.v.H.); (J.M.P.)
| | - Harmke A. Polinder-Bos
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Francesco U. S. Mattace-Raso
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
- Correspondence: ; Tel.: +31-10-7035979
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12
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Smits RAL, Trompet S, van der Linden CMJ, van der Bol JM, Jansen SWM, Polinder-Bos HA, Willems HC, Barten DG, Blomaard LC, de Boer MGJ, van Deudekom FJA, Ellerbroek JLJ, Festen J, van de Glind EMM, Kampschreur LM, Karimi O, Kroon B, van Lanen MGJA, Lucke JA, Maas HAAM, Mattace-Raso FUS, van Munster BC, Reijerse L, Robben SHM, Ruiter R, Schouten HJ, Spies PE, Wassenburg A, Wijngaarden MA, Mooijaart SP. Characteristics and outcomes of older patients hospitalised for COVID-19 in the first and second wave of the pandemic in The Netherlands: the COVID-OLD study. Age Ageing 2022; 51:6540140. [PMID: 35235650 PMCID: PMC8890695 DOI: 10.1093/ageing/afac048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background as the coronavirus disease of 2019 (COVID-19) pandemic progressed diagnostics and treatment changed. Objective to investigate differences in characteristics, disease presentation and outcomes of older hospitalised COVID-19 patients between the first and second pandemic wave in The Netherlands. Methods this was a multicentre retrospective cohort study in 16 hospitals in The Netherlands including patients aged ≥ 70 years, hospitalised for COVID-19 in Spring 2020 (first wave) and Autumn 2020 (second wave). Data included Charlson comorbidity index (CCI), disease severity and Clinical Frailty Scale (CFS). Main outcome was in-hospital mortality. Results a total of 1,376 patients in the first wave (median age 78 years, 60% male) and 946 patients in the second wave (median age 79 years, 61% male) were included. There was no relevant difference in presence of comorbidity (median CCI 2) or frailty (median CFS 4). Patients in the second wave were admitted earlier in the disease course (median 6 versus 7 symptomatic days; P < 0.001). In-hospital mortality was lower in the second wave (38.1% first wave versus 27.0% second wave; P < 0.001). Mortality risk was 40% lower in the second wave compared with the first wave (95% confidence interval: 28–51%) after adjustment for differences in patient characteristics, comorbidity, symptomatic days until admission, disease severity and frailty. Conclusions compared with older patients hospitalised in the first COVID-19 wave, patients in the second wave had lower in-hospital mortality, independent of risk factors for mortality. The better prognosis likely reflects earlier diagnosis, the effect of improvement in treatment and is relevant for future guidelines and treatment decisions.
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Affiliation(s)
- Rosalinde A L Smits
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Address correspondence to: Rosalinde A. L. Smits, Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden. Tel: 071-5261850; Fax: 071-5266881.
| | - Stella Trompet
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Steffy W M Jansen
- Department of Geriatrics, Catharina Hospital, Eindhoven, The Netherlands
| | - Harmke A Polinder-Bos
- Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Hanna C Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Laura C Blomaard
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Floor J A van Deudekom
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, The Netherlands
| | | | | | | | - Linda M Kampschreur
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Ouafae Karimi
- Department of Geriatric Medicine, St Jansdal Hospital, Harderwijk, The Netherlands
| | - Bart Kroon
- Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Marc G J A van Lanen
- Department of Pulmonary Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Jacinta A Lucke
- Department of Emergency Medicine, Spaarne Hospital, Haarlem, The Netherlands
| | - Huub A A M Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Francesco U S Mattace-Raso
- Section Geriatrics, Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Barbara C van Munster
- Department of Internal Medicine and Geriatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lisette Reijerse
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Sarah H M Robben
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Henrike J Schouten
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Petra E Spies
- Geriatrician and Clinical Pharmacologist, Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands
| | - Anna Wassenburg
- Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Marjolein A Wijngaarden
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Simon P Mooijaart
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
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13
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van Essen GA, Bakas A, Sewnaik A, Mattace-Raso FU, Baatenburg de Jong RJ, Polinder-Bos HA. Health outcome priorities in older patients with head and neck cancer. J Geriatr Oncol 2022; 13:698-705. [DOI: 10.1016/j.jgo.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/15/2021] [Accepted: 02/02/2022] [Indexed: 11/12/2022]
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14
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Bakas AT, Sewnaik A, van Straaten J, Baatenburg de Jong RJ, Mattace-Raso FUS, Polinder-Bos HA. The Multidimensional Prognostic Index as a Measure of Frailty in Elderly Patients with Head and Neck Cancer. Clin Interv Aging 2021; 16:1679-1689. [PMID: 34556980 PMCID: PMC8453644 DOI: 10.2147/cia.s323740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/08/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose The multidimensional prognostic index (MPI) is a prognostic model derived from the comprehensive geriatric assessment (CGA) which can predict 1-year mortality risk in elderly individuals. We hypothesized that the MPI also reflects the degree of frailty and thus will correlate with established measures of frailty. Therefore, the aim of this study is to explore whether the MPI-score is a measure of frailty in older head and neck cancer patients and is associated with several physical functioning measurements. Patients and Methods From November 2019 to July 2020, a prospective cohort study enrolled patients with head and neck cancer aged ≥70 years, and patients <70 years with an abnormal G8 score. The MPI-score ranged from 0 to 1 and was categorized in MPI-stage 1 (≤0.33, non-frail); MPI-stage 2 (0.34-0.66, mildly frail), and MPI-stage 3 (≥0.67, severe frail). Pearson's correlation coefficient and multivariable linear regression were used to study the association between MPI-score and the physical functioning measurements handgrip strength, gait speed, and the timed up and go test (TUGT). Results A total of 163 patients were included. One hundred four (63.8%) patients were categorized as non-frail according MPI-stage 1, and 59 (36.2%) patients as mildly or severe frail (n=55 MPI-stage 2; n=4 MPI-stage 3, respectively). A higher MPI-score was significantly associated with lower hand grip strength (B -0.49 [95% CI -0.71; -0.28] p<0.001), lower gait speed (B -0.41 [95% CI -0.55; -0.25] p<0.001), and a slower TUGT (B 0.53 [95% CI 0.66; 0.85] p<0.001). Conclusion Almost one-third of the included patients with head and neck cancer was mild or severe frail. A higher MPI-score, indicating higher degree of frailty, was associated with worse physical performance by lower handgrip strength, gait speed, and a slower TUGT. Thus, the MPI reflects the degree of frailty.
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Affiliation(s)
- Ajay T Bakas
- Department of Otorhinolaryngology, Erasmus MC University Cancer Institute, Rotterdam, the Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology, Erasmus MC University Cancer Institute, Rotterdam, the Netherlands
| | - Jaclyn van Straaten
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Francesco U S Mattace-Raso
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Harmke A Polinder-Bos
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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15
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Blomaard LC, van der Linden CMJ, van der Bol JM, Jansen SWM, Polinder-Bos HA, Willems HC, Festen J, Barten DG, Borgers AJ, Bos JC, van den Bos F, de Brouwer EJM, van Deudekom FJA, van Dijk SC, Emmelot-Vonk MH, Geels RES, van de Glind EMM, de Groot B, Hempenius L, Kamper AM, Kampschreur LM, de Koning MMM, Labots G, Looman R, Lucke JA, Maas HAAM, Mattace-Raso FUS, el Moussaoui R, van Munster BC, van Nieuwkoop C, Oosterwijk L(BLE, Regtuijt M(EM, Robben SHM, Ruiter R, Salarbaks AM, Schouten HJ, Smit OM, Smits RAL, Spies PE, Vreeswijk R, de Vries OJ, Wijngaarden MA, Wyers CE, Mooijaart SP. Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study. Age Ageing 2021; 50:631-640. [PMID: 33951156 PMCID: PMC7929372 DOI: 10.1093/ageing/afab018] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 01/04/2023] Open
Abstract
Background During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting. Objective The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands. Methods This was a multicentre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality. Results A total of 1,376 patients were included (median age 78 years (interquartile range 74–84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6–9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 versus 7 days), lower oxygen demand and lower levels of C-reactive protein. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared with patients with CFS 1–3, patients with CFS 4–5 had a two times higher risk (odds ratio (OR) 2.0 (95% confidence interval (CI) 1.3–3.0)) and patients with CFS 6–9 had a three times higher risk of in-hospital mortality (OR 2.8 (95% CI 1.8–4.3)). Conclusions The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.
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Affiliation(s)
- Laura C Blomaard
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Steffy W M Jansen
- Department of Geriatrics, Catharina Hospital, Eindhoven, the Netherlands
| | - Harmke A Polinder-Bos
- Section Geriatrics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hanna C Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | | | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Anke J Borgers
- Department of Geriatrics, Deventer Hospital, Deventer, the Netherlands
| | - Jeannet C Bos
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Floor J A van Deudekom
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Suzanne C van Dijk
- Department of Geriatric Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | | | - Raya E S Geels
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Department of Geriatrics, Alrijne Hospital, Leiderdorp, the Netherlands
| | | | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Liesbeth Hempenius
- Department of Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Ad M Kamper
- Department of Internal Medicine, Isala Hospital, Zwolle, the Netherlands
| | - Linda M Kampschreur
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Marre M M de Koning
- Department of Geriatric Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Geert Labots
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Roy Looman
- Section Geriatrics, Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - Jacinta A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Huub A A M Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | | | - Barbara C van Munster
- Department of Internal Medicine and Geriatrics, University Medical Center Groningen, Groningen, the Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Leanne (B L E) Oosterwijk
- Section Geriatrics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Sarah H M Robben
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Aisha M Salarbaks
- Department of Geriatrics, Hospital Group Twente, Almelo, the Netherlands
| | - Henrike J Schouten
- Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Orla M Smit
- Section Geriatrics, Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - Rosalinde A L Smits
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Petra E Spies
- Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Ralph Vreeswijk
- Department of Geriatrics, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Oscar J de Vries
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Marjolein A Wijngaarden
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Simon P Mooijaart
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Groothof D, Post A, Polinder-Bos HA, Hazenberg BPC, Gans ROB, Bakker SJL. Muscle mass versus body mass index as predictor of adverse outcome. J Cachexia Sarcopenia Muscle 2021; 12:517-518. [PMID: 33583115 PMCID: PMC8061409 DOI: 10.1002/jcsm.12686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Dion Groothof
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9700RB, The Netherlands
| | - Adrian Post
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9700RB, The Netherlands
| | - Harmke A Polinder-Bos
- Department of Internal Medicine, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Bouke P C Hazenberg
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Reinold O B Gans
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9700RB, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9700RB, The Netherlands
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17
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Polinder-Bos HA, Elting JWJ, Aries MJ, García DV, Willemsen AT, van Laar PJ, Kuipers J, Krijnen WP, Slart RH, Luurtsema G, Westerhuis R, Gansevoort RT, Gaillard CA, Franssen CF. Changes in cerebral oxygenation and cerebral blood flow during hemodialysis - A simultaneous near-infrared spectroscopy and positron emission tomography study. J Cereb Blood Flow Metab 2020; 40:328-340. [PMID: 30540219 PMCID: PMC7370620 DOI: 10.1177/0271678x18818652] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Near-infrared spectroscopy (NIRS) is used to monitor cerebral tissue oxygenation (rSO2) depending on cerebral blood flow (CBF), cerebral blood volume and blood oxygen content. We explored whether NIRS might be a more easy applicable proxy to [15O]H2O positron emission tomography (PET) for detecting CBF changes during hemodialysis. Furthermore, we compared potential determinants of rSO2 and CBF. In 12 patients aged ≥ 65 years, NIRS and PET were performed simultaneously: before (T1), early after start (T2), and at the end of hemodialysis (T3). Between T1 and T3, the relative change in frontal rSO2 (ΔrSO2) was -8 ± 9% (P = 0.001) and -5 ± 11% (P = 0.08), whereas the relative change in frontal gray matter CBF (ΔCBF) was -11 ± 18% (P = 0.009) and -12 ± 16% (P = 0.007) for the left and right hemisphere, respectively. ΔrSO2 and ΔCBF were weakly correlated for the left (ρ 0.31, P = 0.4), and moderately correlated for the right (ρ 0.69, P = 0.03) hemisphere. The Bland-Altman plot suggested underestimation of ΔCBF by NIRS. Divergent associations of pH, pCO2 and arterial oxygen content with rSO2 were found compared to corresponding associations with CBF. In conclusion, NIRS could be a proxy to PET to detect intradialytic CBF changes, although NIRS and PET capture different physiological parameters of the brain.
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Affiliation(s)
- Harmke A Polinder-Bos
- Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Willem J Elting
- Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcel Jh Aries
- Department of Intensive Care, University of Maastricht, University Medical Center Maastricht, Maastricht, The Netherlands
| | - David Vállez García
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Antoon Tm Willemsen
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter J van Laar
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Johann Bernoulli Institute for Mathematics and Computer Science, University of Groningen, Groningen, The Netherlands
| | - Riemer Hja Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Gert Luurtsema
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Ron T Gansevoort
- Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carlo Ajm Gaillard
- Division of Internal Medicine and Dermatology, Department of Nephrology, University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Casper Fm Franssen
- Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Polinder-Bos HA, van Diepen M, Dekker FW, Hoogeveen EK, Franssen CFM, Gansevoort RT, Gaillard CAJM. Publisher Correction: Lower body mass index and mortality in older adults starting dialysis. Sci Rep 2018; 8:14231. [PMID: 30228289 PMCID: PMC6143525 DOI: 10.1038/s41598-018-32555-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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19
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Polinder-Bos HA, Diepen MV, Dekker FW, Hoogeveen EK, Franssen CFM, Gansevoort RT, Gaillard CAJM. Lower body mass index and mortality in older adults starting dialysis. Sci Rep 2018; 8:12858. [PMID: 30150623 PMCID: PMC6110755 DOI: 10.1038/s41598-018-30952-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/06/2018] [Indexed: 01/08/2023] Open
Abstract
Lower body mass index (BMI) has consistently been associated with mortality in elderly in the general and chronic disease populations. Remarkably, in older incident dialysis patients no association of BMI with mortality was found. We performed an in-depth analysis and explored possible time-stratified effects of BMI. 908 incident dialysis patients aged ≥65 years of the NECOSAD study were included, and divided into tertiles by baseline BMI (<23.1 (lower), 23.1–26.0 (reference), ≥26.0 (higher) kg/m2). Because the hazards changed significantly during follow-up, the effect of BMI was modeled for the short-term (<1 year) and longer-term (≥1 year after dialysis initiation). During follow-up (median 3.8 years) 567 deaths occurred. Lower BMI was associated with higher short-term mortality risk (adjusted-HR 1.63 [1.14–2.32] P = 0.007), and lower longer-term mortality risk (adjusted-HR 0.81 [0.63–1.04] P = 0.1). Patients with lower BMI who died during the first year had significantly more comorbidity, and worse self-reported physical functioning compared with those who survived the first year. Thus, lower BMI is associated with increased 1-year mortality, but conditional on surviving the first year, lower BMI yielded a similar or lower mortality risk compared with the reference. Those patients with lower BMI, who had limited comorbidity and better physical functioning, had better survival.
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Affiliation(s)
- Harmke A Polinder-Bos
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen K Hoogeveen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Casper F M Franssen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carlo A J M Gaillard
- Division of Internal Medicine and Dermatology, Department of Nephrology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
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20
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Polinder-Bos HA, García DV, Kuipers J, Elting JWJ, Aries MJH, Krijnen WP, Groen H, Willemsen ATM, van Laar PJ, Strijkert F, Luurtsema G, Slart RHJA, Westerhuis R, Gansevoort RT, Gaillard CAJM, Franssen CFM. Hemodialysis Induces an Acute Decline in Cerebral Blood Flow in Elderly Patients. J Am Soc Nephrol 2018; 29:1317-1325. [PMID: 29496888 DOI: 10.1681/asn.2017101088] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/11/2018] [Indexed: 12/30/2022] Open
Abstract
The initiation of hemodialysis is associated with an accelerated decline of cognitive function and an increased incidence of cerebrovascular accidents and white matter lesions. Investigators have hypothesized that the repetitive circulatory stress of hemodialysis induces ischemic cerebral injury, but the mechanism is unclear. We studied the acute effect of conventional hemodialysis on cerebral blood flow (CBF), measured by [15O]H2O positron emission tomography-computed tomography (PET-CT). During a single hemodialysis session, three [15O]H2O PET-CT scans were performed: before, early after the start of, and at the end of hemodialysis. We used linear mixed models to study global and regional CBF change during hemodialysis. Twelve patients aged ≥65 years (five women, seven men), with a median dialysis vintage of 46 months, completed the study. Mean (±SD) arterial BP declined from 101±11 mm Hg before hemodialysis to 93±17 mm Hg at the end of hemodialysis. From before the start to the end of hemodialysis, global CBF declined significantly by 10%±15%, from a mean of 34.5 to 30.5 ml/100g per minute (difference, -4.1 ml/100 g per minute; 95% confidence interval, -7.3 to -0.9 ml/100 g per minute; P=0.03). CBF decline (20%) was symptomatic in one patient. Regional CBF declined in all volumes of interest, including the frontal, parietal, temporal, and occipital lobes; cerebellum; and thalamus. Higher tympanic temperature, ultrafiltration volume, ultrafiltration rate, and pH significantly associated with lower CBF. Thus, conventional hemodialysis induces a significant reduction in global and regional CBF in elderly patients. Repetitive intradialytic decreases in CBF may be one mechanism by which hemodialysis induces cerebral ischemic injury.
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Affiliation(s)
| | - David Vállez García
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, and
| | | | | | - Marcel J H Aries
- Department of Intensive Care, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Johann Bernoulli Institute for Mathematics and Computer Science, University of Groningen, Groningen, The Netherlands; and
| | | | - Antoon T M Willemsen
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, and
| | | | - Fijanne Strijkert
- Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gert Luurtsema
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, and
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, and
| | | | | | - Carlo A J M Gaillard
- Division of Internal Medicine and Dermatology, Department of Nephrology, University Medical Center Utrecht, University of Utrecht, The Netherlands
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21
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Polinder-Bos HA, Kok EE, van de Wiel A, Spiering W, Wielders JPM, Bloemendal HJ. Severe hypertriglyceridaemia associated with the use of capecitabine. Neth J Med 2012; 70:104. [PMID: 22418760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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