1
|
Rotbain Curovic V, Tavenier J, Ferreira-Divino LF, Poulsen CG, Houlind MB, Pedersen OB, Urbak L, Hansen TW, Sillesen H, Frimodt-Møller M, Hvas AM, Rossing P. Soluble urokinase plasminogen activator receptor, platelet aggregation, and carotid plaque thickness in diabetes: A cross-sectional analysis. J Diabetes Complications 2024; 38:108654. [PMID: 38042098 DOI: 10.1016/j.jdiacomp.2023.108654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 12/04/2023]
Affiliation(s)
| | - Juliette Tavenier
- Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | | | | | - Morten B Houlind
- Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Oliver B Pedersen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Lærke Urbak
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark; University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Iversen E, Bengaard AK, Leegaard Andersen A, Tavenier J, Nielsen RL, Juul-Larsen HG, Jørgensen LM, Bornæs O, Jawad BN, Aharaz A, Walls AB, Kallemose T, Dalhoff K, Nehlin JO, Hornum M, Feldt-Rasmussen B, Damgaard M, Andersen O, Houlind MB. Performance of Panel-Estimated GFR Among Hospitalized Older Adults. Am J Kidney Dis 2023; 82:715-724. [PMID: 37516299 DOI: 10.1053/j.ajkd.2023.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/29/2022] [Revised: 04/16/2023] [Accepted: 05/10/2023] [Indexed: 07/31/2023]
Abstract
RATIONALE & OBJECTIVE Older adults represent nearly half of all hospitalized patients and are vulnerable to inappropriate dosing of medications eliminated through the kidneys. However, few studies in this population have evaluated the performance of equations for estimating the glomerular filtration rate (GFR)-particularly those that incorporate multiple filtration markers. STUDY DESIGN Cross-sectional diagnostic test substudy of a randomized clinical trial. SETTING & PARTICIPANTS Adults≥65 years of age presenting to the emergency department of Copenhagen University Hospital Amager and Hvidovre in Hvidovre, Denmark, between October 2018 and April 2021. TESTS COMPARED Measured GFR (mGFR) determined using 99mTc-DTPA plasma clearance compared with estimated GFR (eGFR) calculated using 6 different equations based on creatinine; 3 based on creatinine and cystatin C combined; and 2 based on panels of markers including creatinine, cystatin C, β-trace protein (BTP) and/or β2-microglobulin (B2M). OUTCOME The performance of each eGFR equation compared with mGFR with respect to bias, relative bias, inaccuracy (1-P30), and root mean squared error (RMSE). RESULTS We assessed eGFR performance for 106 patients (58% female, median age 78.3 years, median mGFR 62.9mL/min/1.73m2). Among the creatinine-based equations, the 2009 CKD-EPIcr equation yielded the smallest relative bias (+4.2%). Among the creatinine-cystatin C combination equations, the 2021 CKD-EPIcomb equation yielded the smallest relative bias (-3.4%), inaccuracy (3.8%), and RMSE (0.139). Compared with the 2021 CKD-EPIcomb, the CKD-EPIpanel equation yielded a smaller RMSE (0.136) but larger relative bias (-4.0%) and inaccuracy (5.7%). LIMITATIONS Only White patients were included; only a subset of patients from the original clinical trial underwent GFR measurement; and filtration marker concentration can be affected by subclinical changes in volume status. CONCLUSIONS The 2009 CKD-EPIcr, 2021 CKD-EPIcomb, and CKD-EPIpanel equations performed best and notably outperformed their respective full-age spectrum equations. The addition of cystatin C to creatinine-based equations improved performance, while the addition of BTP and/or B2M yielded minimal improvement. FUNDING Grants from public sector industry (Amgros I/S) and government (Capital Region of Denmark). TRIAL REGISTRATION Registered at ClinicalTrials.gov with registration number NCT03741283. PLAIN-LANGUAGE SUMMARY Inaccurate kidney function assessment can lead to medication errors, a common cause of hospitalization and early readmission among older adults. Several novel methods have been developed to estimate kidney function based on a panel of kidney function markers that can be measured from a single blood sample. We evaluated the accuracy of these new methods (relative to a gold standard method) among 106 hospitalized older adults. We found that kidney function estimates combining 2 markers (creatinine and cystatin C) were highly accurate and noticeably more accurate than estimates based on creatinine alone. Estimates incorporating additional markers such as β-trace protein and β2-microglobulin did not further improve accuracy.
Collapse
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre.
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | | | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Olivia Bornæs
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Anissa Aharaz
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Capital Region Pharmacy, Herlev, Denmark
| | - Anne Byriel Walls
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Jan Olof Nehlin
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| |
Collapse
|
3
|
Rotbain Curovic V, Houlind MB, Kroonen MYAM, Jongs N, Zobel EH, Hansen TW, Tavenier J, Eugen-Olsen J, Laverman GD, Kooy A, Persson F, Rossing P, Heerspink HJL. Overall and inter-individual effect of four different drug classes on soluble urokinase plasminogen activator receptor in type 1 and type 2 diabetes. Diabetes Obes Metab 2023; 25:3152-3160. [PMID: 37417375 DOI: 10.1111/dom.15209] [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: 04/28/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
AIM To evaluate the effect of four different drug classes on soluble urokinase plasminogen activator receptor (suPAR), a biomarker active in multiple inflammatory processes and a risk factor for complications, in people with type 1 and type 2 diabetes. METHODS We conducted post hoc analyses of a randomized, open-label, crossover trial including 26 adults with type 1 and 40 with type 2 diabetes with urinary albumin-creatinine ratio ≥30 and ≤500 mg/g assigned to 4-week treatments with telmisartan 80 mg, empagliflozin 10 mg, linagliptin 5 mg and baricitinib 2 mg, separated by 4-week washouts. Plasma suPAR was measured before and after each treatment. SuPAR change after each treatment was calculated and, for each individual, the best suPAR-reducing drug was identified. Subsequently, the effect of the best individual drug was compared against the mean of the other three drugs. Repeated-measures linear mixed-effects models were employed. RESULTS The baseline median (interquartile range) plasma suPAR was 3.5 (2.9, 4.3) ng/mL. No overall effect on suPAR levels was observed for any one drug. The individual best-performing drug varied, with baricitinib being selected for 20 participants (30%), followed by empagliflozin for 19 (29%), linagliptin for 16 (24%) and telmisartan for 11 (17%). The individual best-performing drug reduced suPAR by 13.3% (95% confidence interval [CI] 3.7, 22.8; P = 0.007). The difference in suPAR response between the individual best-performing drug and the other three was -19.7% (95% CI -23.1, -16.3; P < 0.001). CONCLUSIONS We demonstrated no overall effect of 4-week treatment with telmisartan, empagliflozin, linagliptin or baricitinib on suPAR. However, individualization of treatment might significantly reduce suPAR levels.
Collapse
Affiliation(s)
| | - Morten B Houlind
- Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | | - Niels Jongs
- University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Juliette Tavenier
- Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | | | - Adriaan Kooy
- University Medical Center Groningen, Groningen, Netherlands
- Bethesda Diabetes Research Center, Hoogeveen, Netherlands
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
4
|
Nielsen RL, Bornaes O, Storgaard IK, Kallemose T, Jørgensen LM, Jawad BN, Altintas I, Juul-Larsen HG, Tavenier J, Durhuus JA, Bengaard AKP, Holst JJ, Kolko M, Sonne DP, Breindahl T, Damgaard M, Porrini E, Hornum M, Andersen O, Pedersen MM, Rasmussen HH, Munk T, Lund TM, Jensen PS, Andersen AL, Houlind MB. Appetite stimulation with cannabis-based medicine and methods for assessment of glomerular filtration in older patients with medical illness: A study protocol. Basic Clin Pharmacol Toxicol 2023; 133:237-253. [PMID: 37314893 DOI: 10.1111/bcpt.13914] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIM Malnutrition in older patients is linked to poor appetite. Cannabis-based medicine may have orexigenic properties in older patients, but this has to our knowledge never been investigated. In older patients, uncertainty applies to the accuracy of estimated glomerular filtration rate (eGFR) based on creatinine, which is crucial for medication prescribing. In older patients with poor appetite, the study aims (1) to assess the efficacy of Sativex® (8.1-mg delta-9-tetrahydrocannabinol [THC] and 7.5-mg cannabidiol [CBD]) to stimulate appetite and (2) to compare the performance of various GFR-estimates and measured-GFR (mGFR) for determining gentamicin clearance utilizing population pharmacokinetic (popPK) modelling methods. METHODS AND OBJECTIVES This study is composed of two substudies. Substudy 1 is an investigator-initiated single-center, double-blinded, randomized, placebo-controlled, superiority, cross-over study. Substudy 1 will recruit 17 older patients with poor appetite, who will also be invited to substudy 2. Substudy 2 is a single-dose pharmacokinetics study and will recruit 55 patients. Participants will receive Sativex® and placebo in substudy 1 and gentamicin with simultaneous measurements of GFR in substudy 2. The primary endpoints are as follows: Substudy 1-the difference in energy intake between Sativex® and placebo conditions; substudy 2- the accuracy of different eGFR equations compared to mGFR. The secondary endpoints include safety parameters, changes in the appetite hormones, total ghrelin and GLP-1 and subjective appetite sensations, and the creation of popPK models of THC, CBD, and gentamicin.
Collapse
Affiliation(s)
- R L Nielsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - O Bornaes
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - I K Storgaard
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - T Kallemose
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - L M Jørgensen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - B N Jawad
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - I Altintas
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - H G Juul-Larsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - J Tavenier
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - J A Durhuus
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Cellular and Molecular Medicine, Center for Healthy Aging, Copenhagen, Denmark
| | - A K P Bengaard
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - J J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - D P Sonne
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Breindahl
- Department of Clinical Biochemistry, North Denmark Regional Hospital, Hjørring, Denmark
| | - M Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - E Porrini
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, La Laguna, Spain
| | - M Hornum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - O Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - M M Pedersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H H Rasmussen
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - T Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - T M Lund
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - P S Jensen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Orthopeadic Surgery, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - A L Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M B Houlind
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- The Hospital Pharmacy, Herlev, Denmark
| |
Collapse
|
5
|
Wunderlich B, Laskow T, Li H, Zhang L, Abrams E, Tian J, Yu J, Chen Y, Tavenier J, Huang Y, Talaat K, Bream JH, Xue QL, Pawelec G, Leng SX. Interseason waning of vaccine-induced hemagglutination inhibition antibody titers and contributing factors to pre-existing humoral immunity against influenza in community-dwelling older adults 75 years and older. Immun Ageing 2023; 20:38. [PMID: 37525151 PMCID: PMC10388475 DOI: 10.1186/s12979-023-00362-8] [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] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Seasonal influenza causes significant morbidity and mortality with a disproportionately high disease burden in older adults. Strain-specific hemagglutination-inhibition (HAI) antibody titer is a well-established measure of humoral immunity against influenza and pre-vaccination HAI titer is a valuable indicator of pre-existing humoral immunity at the beginning of each influenza season in highly vaccinated older adults. While vaccine-induced HAI antibody titers are known to wane over time, accurate assessment of their interseason waning has been challenging. This is because pre-vaccination HAI titers are routinely measured using current season vaccine strain antigens instead of the prior season vaccines with which individuals were immunized; as such, they do not accurately represent residual antibody titers from prior season vaccination. This study took advantage of available pre-vaccination HAI titers measured using both current and prior season vaccine strain antigens in a longitudinal influenza immunization study with participants enrolled for multiple consecutive influenza seasons from 2014 through 2017. Influenza A virus (IAV) H3N2 and influenza B virus (IBV) strains in the vaccine formula changed in 2015 and again in 2016 season. IAV H1N1 vaccine strain remained the same from 2014 through 2016 seasons, but changed in 2017. We also investigated factors contributing to pre-existing humoral immunity. RESULTS Interseason waning of HAI titers was evident, but rates of waning varied among vaccine strains and study seasons, from 18% (p = .43) to 61% (p < .01). Rates of waning were noticeably greater when pre-vaccination HAI titers were measured by the routine approach, i.e., using current season vaccine strain antigens, from 33% (p = .12) to 83% (p < .01), adjusting for age at prior study season, sex, race, and education. This was largely because the routinely measured pre-vaccination HAI titers underrepresented residual HAI titers from prior season vaccinations. Moreover, interseason antibody waning and prior season post-vaccination HAI titers had significant and independent associations with pre-vaccination HAI titers. CONCLUSIONS The routinely measured pre-vaccination HAI titer overestimates interseason HAI antibody waning as it underestimates residual antibody titers from prior season vaccination when virus strains in the vaccine formula change. Moreover, interseason antibody waning and prior season post-vaccination HAI titers independently contribute to pre-existing humoral immunity in this highly vaccinated, community-dwelling older adult population.
Collapse
Affiliation(s)
- Bettina Wunderlich
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas Laskow
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Huifen Li
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Li Zhang
- Department of Geriatrics, The First People's Hospital of Yunnan Province, Kunming, China
| | - Engle Abrams
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Jing Tian
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jun Yu
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Yiyin Chen
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | | | - Kawsar Talaat
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jay H Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Immunology Training Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Graham Pawelec
- Department of Immunology, University of Tübingen, Tübingen, Germany
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA.
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
6
|
Iversen E, Walls AB, Petersen A, Jensen PS, Kallemose T, Andersen A, Nielsen RL, Bengaard AK, Juul-Larsen HG, Bornaes O, Damgaard M, Andersen O, Tavenier J, Houlind MB. Estimated glomerular filtration rate based on creatinine, cystatin C, β-trace protein and β2 microglobulin in patients undergoing nontraumatic lower extremity amputation. Br J Clin Pharmacol 2023; 89:1789-1798. [PMID: 36511684 DOI: 10.1111/bcp.15639] [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: 06/24/2022] [Revised: 10/28/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS The study's aim is to compare current and new equations for estimating glomerular filtration rate (GFR) based on creatinine, cystatin C, β-trace protein (BTP) and β2 microglobulin (B2M) among patients undergoing major amputation. METHODS This is a secondary analysis of data from a prospective cohort study investigating patients undergoing nontraumatic lower extremity amputation. Estimated GFR (eGFR) was calculated using equations based on creatinine (eGFRcre[2009] and eGFRcre[2021]), cystatin C (eGFRcys), the combination of creatinine and cystatin C (eGFRcomb[2012] and eGFRcomb[2021]) or a panel of all 4 filtration markers (eGFRpanel). Primary outcome was changed in eGFR across amputation according to each equation. Two case studies of prior amputation with GFR measured by 99mTc-DTPA clearance are described to illustrate the relative accuracies of each eGFR equation. RESULTS Analysis of the primary outcome included 29 patients (median age 75 years, 31% female). Amputation was associated with a significant decrease in creatinine concentration (-0.09 mg/dL, P = 0.004), corresponding to a significant increase in eGFRcre[2009] (+6.1 mL/min, P = 0.006) and eGFRcre[2021] (+6.3 mL/min, P = 0.006). Change across amputation was not significant for cystatin C, BTP, B2M or equations incorporating these markers (all P > 0.05). In both case studies, eGFRcre[2021] yielded the largest positive bias, eGFRcys yielded the largest negative bias and eGFRcomb[2012] and eGFRcomb[2021] yielded the smallest absolute bias. CONCLUSION Creatinine-based estimates were substantially higher than cystatin C-based estimates before amputation and significantly increased across amputation. Estimates combining creatinine and cystatin were stable across amputation, while the addition of BTP and B2M is unlikely to be clinically relevant.
Collapse
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Anne Byriel Walls
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
| | - Annamarie Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
| | - Pia Søe Jensen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- The Research Unit of Orthopedic Nursing, Department of Orthopedic Surgery, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Aino Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Olivia Bornaes
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
| |
Collapse
|
7
|
Iversen E, Kallemose T, Hornum M, Bengaard AK, Nehlin JO, Rasmussen LJH, Sandholdt H, Tavenier J, Feldt-Rasmussen B, Andersen O, Eugen-Olsen J, Houlind MB. OUP accepted manuscript. Clin Kidney J 2022; 15:1534-1541. [PMID: 35892012 PMCID: PMC9308102 DOI: 10.1093/ckj/sfac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Capital Region Pharmacy, Herlev, Denmark
| | - Jan Olof Nehlin
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Haakon Sandholdt
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Tavenier J, Andersen O, Nehlin JO, Petersen J. Longitudinal course of GDF15 levels before acute hospitalization and death in the general population. Innov Aging 2021. [PMCID: PMC8681599 DOI: 10.1093/geroni/igab046.2513] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Growth differentiation 15 (GDF15) is a potential novel biomarker of biological aging. To separate the effects of chronological age and birth cohort from biological age, longitudinal studies investigating associations of GDF15 levels with adverse health outcomes are needed. We investigated changes in GDF15 levels over 10 years in an age-stratified sample of the general population and their relation to the risk of acute hospitalization and death. Serum levels of GDF15 were measured three times in 5-year intervals in 2176 participants aged 30, 40, 50, or 60 years from the Danish population-based DAN-MONICA cohort. We assessed the association of single and repeated GDF15 measurements with the risk of non-traumatic acute hospitalizations. We tested whether changes in GDF15 levels over 10 years differed according to the frequency of hospitalizations within 2 years, or survival within 20 years, after the last GDF15 measurement. The change in GDF15 levels over time was dependent on age and sex. Higher GDF15 levels and a greater increase in GDF15 levels were associated with an increased risk of acute hospitalization in adjusted Cox regression analyses. Participants with more frequent admissions within 2 years, and those who died within 20 years, after the last GDF15 measurement already had elevated GDF15 levels at baseline and experienced greater increases in GDF15 levels during the study. The change in GDF15 levels was associated with changes in C-reactive protein and biomarkers of kidney, liver, and cardiac function. Monitoring of GDF15 starting in middle-age could be valuable for the prediction of adverse health outcomes.
Collapse
Affiliation(s)
- Juliette Tavenier
- Copenhagen University Hospital Hvidovre, Hvidovre, Hovedstaden, Denmark
| | - Ove Andersen
- Copenhagen University Hospital Hvidovre, Hvidovre, Hovedstaden, Denmark
| | - Jan O Nehlin
- Copenhagen University Hospital Hvidovre, Hvidovre, Hovedstaden, Denmark
| | - Janne Petersen
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Hovedstaden, Denmark
| |
Collapse
|
9
|
Andersen AL, Nielsen RL, Houlind MB, Tavenier J, Rasmussen LJH, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, Petersen J. Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study. Nutrients 2021; 13:nu13082757. [PMID: 34444917 PMCID: PMC8398199 DOI: 10.3390/nu13082757] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
There is a lack of knowledge about malnutrition and risk of malnutrition upon admission and after discharge in older medical patients. This study aimed to describe prevalence, risk factors, and screening tools for malnutrition in older medical patients. In a prospective observational study, malnutrition was evaluated in 128 older medical patients (≥65 years) using the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment-Short Form (MNA-SF) and the Eating Validation Scheme (EVS). The European Society of Clinical Nutrition (ESPEN) diagnostic criteria from 2015 were applied for diagnosis. Agreement between the screening tools was evaluated by kappa statistics. Risk factors for malnutrition included polypharmacy, dysphagia, depression, low functional capacity, eating-related problems and lowered cognitive function. Malnutrition or risk of malnutrition were prevalent at baseline (59-98%) and follow-up (30-88%). The baseline, follow-up and transitional agreements ranged from slight to moderate. NRS-2002 and MNA-SF yielded the highest agreement (kappa: 0.31 (95% Confidence Interval (CI) 0.18-0.44) to 0.57 (95%CI 0.42-0.72)). Prevalence of risk factors ranged from 17-68%. Applying ESPEN 2015 diagnostic criteria, 15% had malnutrition at baseline and 13% at follow-up. In conclusion, malnutrition, risk of malnutrition and risk factors hereof are prevalent in older medical patients. MNA-SF and NRS-2002 showed the highest agreement at baseline, follow-up, and transitionally.
Collapse
Affiliation(s)
- Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Correspondence: ; Tel.: +45-24-61-61-08
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
| | - Line J. H. Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Psychology & Neuroscience, Duke University, 2020 W Main St., Suite 201, Durham, NC 27707, USA
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Charlotte Treldal
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730 Herlev, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
| |
Collapse
|
10
|
Hansen T, Nielsen RL, Houlind MB, Tavenier J, Rasmussen LJH, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, Petersen J, Andersen AL. Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data. Geriatrics (Basel) 2021; 6:geriatrics6020046. [PMID: 33926079 PMCID: PMC8167602 DOI: 10.3390/geriatrics6020046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/07/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 01/18/2023] Open
Abstract
There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.
Collapse
Affiliation(s)
- Tina Hansen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Correspondence: ; Tel.: +45-29243586
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Psychology and Neuroscience, Duke University, 2020 W Main St, Durham, NC 27705, USA
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650 Hvidovre, Denmark
| | - Charlotte Treldal
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730 Herlev, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650 Hvidovre, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.); (A.L.A.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| |
Collapse
|
11
|
Tavenier J, Andersen O, Nehlin JO, Petersen J. Longitudinal course of GDF15 levels before acute hospitalization and death in the general population. GeroScience 2021; 43:1835-1849. [PMID: 33763774 DOI: 10.1007/s11357-021-00359-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
Growth differentiation 15 (GDF15) is a potential novel biomarker of biological aging. To separate the effects of chronological age and birth cohort from biological age, longitudinal studies investigating the associations of GDF15 levels with adverse health outcomes are needed. We investigated changes in GDF15 levels over 10 years in an age-stratified sample of the general population and their relation to the risk of acute hospitalization and death. Serum levels of GDF15 were measured three times in 5-year intervals in 2176 participants aged 30, 40, 50, or 60 years from the Danish population-based DAN-MONICA cohort. We assessed the association of single and repeated GDF15 measurements with the risk of non-traumatic acute hospitalizations. We tested whether changes in GDF15 levels over 10 years differed according to the frequency of hospitalizations within 2 years or survival within 20 years, after the last GDF15 measurement. The change in GDF15 levels over time was dependent on age and sex. Higher GDF15 levels and a greater increase in GDF15 levels were associated with an increased risk of acute hospitalization in adjusted Cox regression analyses. Participants with more frequent admissions within 2 years, and those who died within 20 years, after the last GDF15 measurement already had elevated GDF15 levels at baseline and experienced greater increases in GDF15 levels during the study. The change in GDF15 levels was associated with changes in C-reactive protein and biomarkers of kidney, liver, and cardiac function. Monitoring of GDF15 starting in middle-aged could be valuable for the prediction of adverse health outcomes.
Collapse
Affiliation(s)
- Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650, Hvidovre, Denmark.
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650, Hvidovre, Denmark.,Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Jan O Nehlin
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650, Hvidovre, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650, Hvidovre, Denmark.,Center for Clinical Research and Prevention, Copenhagen University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| |
Collapse
|
12
|
Tavenier J, Rasmussen LJH, Andersen AL, Houlind MB, Langkilde A, Andersen O, Petersen J, Nehlin JO. Association of GDF15 With Inflammation and Physical Function During Aging and Recovery After Acute Hospitalization: A Longitudinal Study of Older Patients and Age-Matched Controls. J Gerontol A Biol Sci Med Sci 2021; 76:964-974. [DOI: 10.1093/gerona/glab011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
Abstract
Growth differentiation factor 15 (GDF15) is a stress-induced cytokine. Its plasma levels increase during aging and acute illness. In older Patients and age-matched Controls, we evaluated whether GDF15 levels (i) were associated with recovery after acute illness, and (ii) reflected different trajectories of aging and longitudinal changes in health measures. Fifty-two older Patients (≥65 years) were included upon admission to the emergency department (ED). At 30 days after discharge (time of matching), Patients were matched 1:1 on age and sex with Controls who had not been hospitalized within 2 years of inclusion. Both groups were followed up after 1 year. We assessed plasma levels of GDF15 and inflammatory biomarkers, frailty, nutritional status (mini nutritional assessment short-form), physical and cognitive function, and metabolic biomarkers. In Patients, elevated GDF15 levels at ED admission were associated with poorer resolution of inflammation (soluble urokinase plasminogen activator receptor [suPAR]), slowing of gait speed, and declining nutritional status between admission and 30-day follow-up. At time of matching, Patients were frailer and overall less healthy than age-matched Controls. GDF15 levels were significantly associated with participant group, on average Patients had almost 60% higher GDF15 than age-matched Controls, and this difference was partly mediated by reduced physical function. Increases in GDF15 levels between time of matching and 1-year follow-up were associated with increases in levels of interleukin-6 in Patients, and tumor necrosis factor-α and suPAR in age-matched Controls. In older adults, elevated GDF15 levels were associated with signs of accelerated aging and with poorer recovery after acute illness.
Collapse
Affiliation(s)
- Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | | | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Denmark
| | - Anne Langkilde
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Jan O Nehlin
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
| |
Collapse
|
13
|
Kimer N, Gluud LL, Pedersen JS, Tavenier J, Møller S, Bendtsen F. The Psychometric Hepatic Encephalopathy Syndrome score does not correlate with blood ammonia, endotoxins or markers of inflammation in patients with cirrhosis. Transl Gastroenterol Hepatol 2021; 6:8. [PMID: 33409402 DOI: 10.21037/tgh.2020.02.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 10/11/2019] [Accepted: 02/10/2020] [Indexed: 12/18/2022] Open
Abstract
Background The pathogenesis of hepatic encephalopathy (HE) remains unclear but impaired clearance of gut-derived neurotoxins and increased systemic inflammation are thought to play key roles. The diagnosis is based on detection of neurophysiological and neuropsychometric abnormalities. The Psychometric Hepatic Encephalopathy Score (PHES) have been found to correlate with markers of systematic inflammation including interleukin 6, C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α). This study explores the associations between the PHES score and systemic inflammation, endotoxins and disease severity using baseline data from a trial involving patients with cirrhosis and minimal or no HE (NCT01769040). Methods Arterial blood was obtained during hepatic vein catheterization, from 54 patients [median age 55 (range, 33-70) years; 83% men] with decompensated but stable cirrhosis. None had clinical evidence of HE but 34 (55.6%) had an abnormal PHES score indicating the presence of minimal HE. Relationships were sought between the PHES score and markers of systemic inflammation, high sensitivity-CRP, cytokines (SDF-1α, TGF-b1, IP-10, IL-6, 10 and 18, and TNF-α; lipopolysaccharide (LPS), the lipopolysaccharide binding protein (LBP) and soluble CD14 (sCD14); and the blood ammonia. Results No significant relationships were found between the PHES score and any of the variables tested with the single exception of the correlation with serum IL-6 (r=-0.29, 95% confidence interval, -0.53 to -0.02, P=0.031). No independent predictors of the PHES score were identified in regression analyses. Conclusions No predictive associations were identified between the PHES scores and circulating blood ammonia, endotoxins, or markers of systemic inflammation in this patient population.
Collapse
Affiliation(s)
- Nina Kimer
- Gastrounit, Medical Division, University Hospital Hvidovre, Hvidovre, Denmark.,Centre of Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, University Hospital Hvidovre, Hvidovre, Denmark
| | - Lise Lotte Gluud
- Gastrounit, Medical Division, University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Juliette Tavenier
- Clinical Research Centre, University Hospital Hvidovre, Hvidovre, Denmark
| | - Søren Møller
- Centre of Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, University Hospital Hvidovre, Hvidovre, Denmark
| | - Flemming Bendtsen
- Gastrounit, Medical Division, University Hospital Hvidovre, Hvidovre, Denmark
| |
Collapse
|
14
|
Tavenier J, Rasmussen LJH, Houlind MB, Andersen AL, Panum I, Andersen O, Petersen J, Langkilde A, Nehlin JO. Alterations of monocyte NF-κB p65/RelA signaling in a cohort of older medical patients, age-matched controls, and healthy young adults. Immun Ageing 2020; 17:25. [PMID: 33685482 PMCID: PMC7938715 DOI: 10.1186/s12979-020-00197-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered monocyte NF-κB signaling is a possible cause of inflammaging and driver of aging, however, evidence from human aging studies is sparse. We assessed monocyte NF-κB signaling across different aging trajectories by comparing healthy older adults to older adults with a recent emergency department (ED) admission and to young adults. METHODS We used data from: 52 older (≥65 years) Patients collected upon ED admission and at follow-up 30-days after discharge; 52 age- and sex-matched Older Controls without recent hospitalization; and 60 healthy Young Controls (20-35 years). Using flow cytometry, we assessed basal NF-κB phosphorylation (pNF-κB p65/RelA; Ser529) and induction of pNF-κB following stimulation with LPS or TNF-α in monocytes. We assessed frailty (FI-OutRef), physical and cognitive function, and plasma levels of IL-6, IL-18, TNF-α, and soluble urokinase plasminogen activator receptor. RESULTS Patients at follow-up were frailer, had higher levels of inflammatory markers and decreased physical and cognitive function than Older Controls. Patients at follow-up had higher basal pNF-κB levels than Older Controls (median fluorescence intensity (MFI): 125, IQR: 105-153 vs. MFI: 80, IQR: 71-90, p < 0.0001), and reduced pNF-κB induction in response to LPS (mean pNF-κB MFI fold change calculated as the log10 ratio of LPS-stimulation to the PBS-control: 0.10, 95% CI: 0.08 to 0.12 vs. 0.13, 95% CI: 0.10 to 0.15, p = 0.05) and TNF-α stimulation (0.02, 95% CI: - 0.00 to 0.05 vs. 0.10, 95% CI: 0.08 to 0.12, p < 0.0001). Older Controls had higher levels of inflammatory markers than Young Controls, but basal pNF-κB MFI did not differ between Older and Young Controls (MFI: 81, IQR: 70-86; p = 0.72). Older Controls had reduced pNF-κB induction in response to LPS and TNF-α compared to Young Controls (LPS: 0.40, 95% CI: 0.35 to 0.44, p < 0.0001; and TNF-α: 0.33, 95% CI: 0.27 to 0.40, p < 0.0001). In Older Controls, basal pNF-κB MFI was associated with FI-OutRef (p = 0.02). CONCLUSIONS Increased basal pNF-κB activity in monocytes could be involved in the processes of frailty and accelerated aging. Furthermore, we show that monocyte NF-κB activation upon stimulation was impaired in frail older adults, which could result in reduced immune responses and vaccine effectiveness.
Collapse
Affiliation(s)
- Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Department of Psychology and Neuroscience, Duke University, Durham, NC, 27708, USA
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- The Capital Region Pharmacy, 2730, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Inge Panum
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650, Hvidovre, Denmark.
- Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen, Denmark.
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital, 2000, Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1014, Copenhagen, Denmark
| | - Anne Langkilde
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Jan O Nehlin
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| |
Collapse
|
15
|
Houlind MB, Andersen AL, Treldal C, Jørgensen LM, Kannegaard PN, Castillo LS, Christensen LD, Tavenier J, Rasmussen LJH, Ankarfeldt MZ, Andersen O, Petersen J. A Collaborative Medication Review Including Deprescribing for Older Patients in an Emergency Department: A Longitudinal Feasibility Study. J Clin Med 2020; 9:jcm9020348. [PMID: 32012721 PMCID: PMC7074203 DOI: 10.3390/jcm9020348] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 12/27/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
Medication review for older patients with polypharmacy in the emergency department (ED) is crucial to prevent inappropriate prescribing. Our objective was to assess the feasibility of a collaborative medication review in older medical patients (≥65 years) using polypharmacy (≥5 long-term medications). A pharmacist performed the medication review using the tools: Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, a drug–drug interaction database (SFINX), and Renbase® (renal dosing database). A geriatrician received the medication review and decided which recommendations should be implemented. The outcomes were: differences in Medication Appropriateness Index (MAI) and Assessment of Underutilization Index (AOU) scores between admission and 30 days after discharge and the percentage of patients for which the intervention was completed before discharge. Sixty patients were included from the ED, the intervention was completed before discharge for 50 patients (83%), and 39 (61.5% male; median age 80 years) completed the follow-up 30 days after discharge. The median MAI score decreased from 14 (IQR 8-20) at admission to 8 (IQR 2-13) 30 days after discharge (p < 0.001). The number of patients with an AOU score ≥1 was reduced from 36% to 10% (p < 0.001). Thirty days after discharge, 83% of the changes were sustained and for 28 patients (72%), 1≥ medication had been deprescribed. In conclusion, a collaborative medication review and deprescribing intervention is feasible to perform in the ED.
Collapse
Affiliation(s)
- Morten Baltzer Houlind
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence: ; Tel.: + 45-28-85-85-63
| | - Aino Leegaard Andersen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Charlotte Treldal
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Lillian Mørch Jørgensen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Pia Nimann Kannegaard
- Department of Geriatric Medicine, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark
| | - Luana Sandoval Castillo
- Department of Geriatrics, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark
| | - Line Due Christensen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Research Unit for General Practice, 8000 Aarhus, Denmark
| | - Juliette Tavenier
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Line Jee Hartmann Rasmussen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA
| | - Mikkel. Zöllner Ankarfeldt
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Copenhagen Phase IV unit (Phase4CPH), Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
| | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Janne Petersen
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Copenhagen Phase IV unit (Phase4CPH), Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| |
Collapse
|
16
|
Tavenier J, Ouyang M, Li H, Leng SX. EFFECT OF INFLUENZA VACCINE ON TWEAK LEVELS IN THE ELDERLY: IMPLICATION IN CARDIOVASCULAR PROTECTION. Innov Aging 2019. [PMCID: PMC6845704 DOI: 10.1093/geroni/igz038.2392] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Substantial evidence suggests a protective effect of annual influenza immunization on cardiovascular diseases (CVD). The inflammatory mediator TNF-related weak inducer of apoptosis (TWEAK) is thought to be involved in the pathogenesis of CVD. We previously showed that administration of a standard-dose influenza vaccine reduced circulating TWEAK levels. This study aimed to test the hypothesis that a high-dose vaccine would have greater impact on TWEAK levels than the standard-dose. Two groups of participants matched on age and sex were included in the study. One group (n=25) received standard-dose vaccine during 2008-2009 season, the other group (n=25) received high-dose vaccine during 2014-2015 season. Soluble TWEAK (sTWEAK) levels were assessed using ELISA in serum samples collected immediately before vaccination and during the 4th week after vaccination. Vaccine-induced strain specific antibody titers were measured by hemagglutination inhibition assay. The participants had a mean age 86 years and 68% were women. Our preliminary results thus far demonstrated no statistically significant change in sTWEAK levels after vaccination in either group (Wilcoxon matched-pairs signed rank test: standard-dose group: median change [interquartile range]=11.2 [-92.2–197.1] pg/mL, p=0.72; high-dose group: -24.8 [-58.9–87.3] pg/mL, p=0.70). Pre-vaccination sTWEAK levels tended to be negatively associated with age (unadjusted linear regression of log2(x) transformed TWEAK levels on age: estimate [±SE]=-4.6% [±2.7%] change in TWEAK level per year, p=0.08). We continue to evaluate more pre- and post-vaccination samples. We have also begun exploring TWEAK expression by circulating immune cells (T and B lymphocytes and monocytes) and potential impact of influenza immunization in older adults.
Collapse
Affiliation(s)
- Juliette Tavenier
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Min Ouyang
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huifen Li
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sean X Leng
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| |
Collapse
|
17
|
Tavenier J, Rasmussen LJH, Houlind MB, Andersen AL, Langkilde A, Nehlin J, Petersen J, Andersen O. BIOLOGICAL AGING IS ASSOCIATED WITH INCREASED MONOCYTE INFLAMMATORY ACTIVITY IN OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6845097 DOI: 10.1093/geroni/igz038.3315] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Chronic inflammation is thought to play a central role in biological aging. However, the causes of chronic inflammation are not fully elucidated. We hypothesized that a dysregulation in monocyte inflammatory activity may contribute to chronic inflammation and biological aging. There are no validated methods for Biological Age (BA) estimation. Therefore, we also hypothesized that older adults with a recent ED (Emergency Department) admission had a higher BA compared to age-matched older adults without a recent ED admission. Two groups of older adults were enrolled: a “high BA”-group who were discharged from the ED four weeks preceding data collection (n=52), and a “low BA”-group consisting of age and sex matched participants without ED admission within the two years preceding data collection (n=52). We assessed NF-κB phosphorylation (Ser529) and NLRP3 inflammasome levels in monocytes using flow cytometry staining of whole blood. Preliminary analyses showed that participants had a median age of 74.8 (IQR: 70.7–82.0) years, 48% were women. Participants in the high-BA group had reduced lower body strength (30 seconds chair stand test p=0.02 and 4 meters gait speed p=0.001) and cognitive function (Digit Symbol Substitution Test p=0.001 and Trail Making Test p=0.002) compared to the low-BA group. Monocytes of participants in the low BA group had lower constitutive p-NF-κB (p< 0.0001) and NLRP3 (p=0.0001) median fluorescence intensity compared to the high BA group. Increased monocyte inflammatory activity assessed by p-NF-κB and NLRP3 was associated with a higher BA. We will investigate associations between monocyte inflammatory activity and markers of chronic inflammation.
Collapse
Affiliation(s)
- Juliette Tavenier
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Line J H Rasmussen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Morten B Houlind
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Aino L Andersen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Anne Langkilde
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Jan Nehlin
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Janne Petersen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| |
Collapse
|
18
|
Langkilde A, Tavenier J, Danielsen AV, Eugen-Olsen J, Therkildsen C, Jensen FK, Henriksen JH, Langberg H, Steiniche T, Petersen J, Holck S, Andersen O. Histological and Molecular Adipose Tissue Changes Are Related to Metabolic Syndrome Rather Than Lipodystrophy in Human Immunodeficiency Virus-Infected Patients: A Cross-Sectional Study. J Infect Dis 2019; 218:1090-1098. [PMID: 29788076 DOI: 10.1093/infdis/jiy284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/13/2018] [Indexed: 01/23/2023] Open
Abstract
Background In human immunodeficiency virus (HIV)-infected patients on combination antiretroviral therapy (cART), lipodystrophy shares many similarities with metabolic syndrome, but only metabolic syndrome has objective classification criteria. We examined adipose tissue changes related to lipodystrophy and metabolic syndrome to clarify whether it may be acceptable to focus diagnosis on metabolic syndrome rather than lipodystrophy. Methods This is a cross-sectional study of 60 HIV-infected men on cART and 15 healthy men. We evaluated lipodystrophy (clinical assessment) and metabolic syndrome (JIS-2009). We compared adipocyte size, leukocyte infiltration, and gene expression in abdominal subcutaneous adipose tissue biopsies of patients with and without lipodystrophy and with and without metabolic syndrome. Results Lipodystrophy was only associated with increased macrophage infiltration (P = .04) and adiponectin messenger ribonucleic acid ([mRNA] P = .008), whereas metabolic syndrome was associated with larger adipocytes (P < .0001), decreased expression of genes related to adipogenesis and adipocyte function (P values between <.0001 and .08), increased leptin mRNA (P = .04), and a trend towards increased expression of inflammatory genes (P values between .08 and .6). Conclusions Metabolic syndrome rather than lipodystrophy was associated with major unfavorable abdominal subcutaneous adipose tissue changes. In a clinical setting, it may be more relevant to focus on metabolic syndrome diagnosis in HIV-infected patients on cART with regards to adipose tissue dysfunction and risk of cardiometabolic complications.
Collapse
Affiliation(s)
- Anne Langkilde
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Juliette Tavenier
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Jesper Eugen-Olsen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | | | | | - Jens Henrik Henriksen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henning Langberg
- CopenRehab, Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark
| | | | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Biostatistics, University of Copenhagen, Denmark
| | - Susanne Holck
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
19
|
Clemmesen CG, Tavenier J, Andersen O, Palm H, Foss NB. Methylprednisolone and inflammatory stress response in older people undergoing surgery for hip fracture: a secondary analysis of a randomized controlled trial. Eur Geriatr Med 2019; 10:913-921. [DOI: 10.1007/s41999-019-00231-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 08/21/2019] [Indexed: 01/13/2023]
|
20
|
Abstract
Anemia is a common, yet often overlooked, geriatric syndrome characterized by reduced hemoglobin levels and associated with adverse health outcomes and early mortality. Evidence suggests that anemia is an independent risk factor for frailty in older adults. In this article, the authors review the evidence for the role of chronic inflammation in the pathogenesis of anemia in the frail elderly. Understanding the relationships between anemia, frailty, and chronic inflammation will pave the way for the development of novel interventional strategies for the treatment and prevention of anemia and, likely, also frailty in older adults.
Collapse
Affiliation(s)
- Juliette Tavenier
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, Hvidovre 2650, Denmark
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle - Room 1A.38A, Baltimore, MD 21224, USA.
| |
Collapse
|
21
|
Polzik P, Grøndal O, Tavenier J, Madsen MB, Andersen O, Hedetoft M, Hyldegaard O. SuPAR correlates with mortality and clinical severity in patients with necrotizing soft-tissue infections: results from a prospective, observational cohort study. Sci Rep 2019; 9:5098. [PMID: 30911053 PMCID: PMC6434142 DOI: 10.1038/s41598-019-41688-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/06/2018] [Accepted: 03/13/2019] [Indexed: 01/12/2023] Open
Abstract
Necrotizing soft tissue infections (NSTI) have a 90-day mortality rate of 18–22%. Tools are needed for estimating the prognosis and severity of NSTI upon admission. We evaluated soluble urokinase-type plasminogen activator receptor (suPAR) levels at admission as a prognostic marker of NSTI severity and mortality. In a prospective, observational cohort study, suPAR was measured in 200 NSTI patients. We compared admission suPAR levels in survivors and non-survivors, patients with septic shock and non-shock, amputation and non-amputation, correlations with Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score. Admission suPAR levels were higher in septic shock vs. non-septic shock patients (9.2 vs. 5.8 ng/mL, p-value < 0.001) and non-survivors vs. survivors (11 vs. 6.1 ng/mL, p-value < 0.001) and correlated with SAPS II (r = 0.52, p < 0.001) and SOFA score (r = 0.64, p < 0.001). Elevated suPAR upon admission was associated with 90-day mortality (log-rank test p < 0.001), however not after adjustment for age, sex, and SOFA score. The AUC for suPAR and 90-day mortality was 0.77. We found that suPAR is a promising candidate for prognosis and severity in patients with NSTI.
Collapse
Affiliation(s)
- Peter Polzik
- Department of Anesthesiology, Center of Head and Orthopedics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark.
| | - Olav Grøndal
- Department of Anesthesiology, Center of Head and Orthopedics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
| | - Juliette Tavenier
- Clinical Research Center, Copenhagen University Hospital (Hvidovre), Hvidovre, Denmark
| | - Martin B Madsen
- Department of Intensive Care, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ove Andersen
- Clinical Research Center, Copenhagen University Hospital (Hvidovre), Hvidovre, Denmark.,The Emergency Department, Copenhagen University Hospital (Hvidovre), Hvidovre, Denmark
| | - Morten Hedetoft
- Hyperbaric Medicine Center, Department of Anesthesiology, Center of Head and Orthopedics, University Hospital of Copenhagen (Rigshospitalet), Copenhagen, Denmark
| | - Ole Hyldegaard
- Department of Anesthesiology, Center of Head and Orthopedics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
| |
Collapse
|
22
|
Kimer N, Pedersen JS, Tavenier J, Christensen JE, Busk TM, Hobolth L, Krag A, Al-Soud WA, Mortensen MS, Sørensen SJ, Møller S, Bendtsen F. Rifaximin has minor effects on bacterial composition, inflammation, and bacterial translocation in cirrhosis: A randomized trial. J Gastroenterol Hepatol 2018; 33:307-314. [PMID: 28671712 DOI: 10.1111/jgh.13852] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Received: 03/22/2017] [Revised: 05/30/2017] [Accepted: 06/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Decompensated cirrhosis is characterized by disturbed hemodynamics, immune dysfunction, and high risk of infections. Translocation of viable bacteria and bacterial products from the gut to the blood is considered a key driver in this process. Intestinal decontamination with rifaximin may reduce bacterial translocation (BT) and decrease inflammation. A randomized, placebo-controlled trial investigated the effects of rifaximin on inflammation and BT in decompensated cirrhosis. METHODS Fifty-four out-patients with cirrhosis and ascites were randomized, mean age 56 years (± 8.4), and model for end-stage liver disease score 12 (± 3.9). Patients received rifaximin 550-mg BD (n = 36) or placebo BD (n = 18). Blood and fecal (n = 15) sampling were conducted at baseline and after 4 weeks. Bacterial DNA in blood was determined by real-time qPCR 16S rRNA gene quantification. Bacterial composition in feces was analyzed by 16S rRNA gene sequencing. RESULTS Circulating markers of inflammation, including tumor necrosis factor alpha, interleukins 6, 10, and 18, stromal cell-derived factor 1-α, transforming growth factor β-1, and high sensitivity C-reactive protein, were unaltered by rifaximin treatment. Rifaximin altered abundance of bacterial taxa in blood marginally, only a decrease in Pseudomonadales was observed. In feces, rifaximin decreased bacterial richness, but effect on particular species was not observed. Subgroup analyses on patients with severely disturbed hemodynamics (n = 34) or activated lipopolysaccharide binding protein (n = 37) revealed no effect of rifaximin. CONCLUSION Four weeks of treatment with rifaximin had no impact on the inflammatory state and only minor effects on BT and intestinal bacterial composition in stable, decompensated cirrhosis (NCT01769040).
Collapse
Affiliation(s)
- Nina Kimer
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Centre of Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Julie S Pedersen
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Juliette Tavenier
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jeffrey E Christensen
- Vaiomer SAS, Toulouse, France.,Institute of Cardiovascular and Metabolic Diseases (I2MC), INSERM U1048, Toulouse, France
| | - Troels M Busk
- Centre of Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Lise Hobolth
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Gastroenterology and Hepatology, Copenhagen University Hospital Bispebjerg, Bispebjerg, Denmark
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Waleed Abu Al-Soud
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Martin S Mortensen
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Søren J Sørensen
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Søren Møller
- Centre of Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | |
Collapse
|
23
|
Tavenier J, Haupt TH, Andersen AL, Buhl SF, Langkilde A, Andersen JR, Jensen JEB, Pedersen MM, Petersen J, Andersen O. A high-protein diet during hospitalization is associated with an accelerated decrease in soluble urokinase plasminogen activator receptor levels in acutely ill elderly medical patients with SIRS. Nutr Res 2017; 41:56-64. [PMID: 28477944 DOI: 10.1016/j.nutres.2017.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/06/2017] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022]
Abstract
Acute illness and hospitalization in elderly individuals are often accompanied by the systemic inflammatory response syndrome (SIRS) and malnutrition, both associated with wasting and mortality. Nutritional support and resistance training were shown to increase muscle anabolism and reduce inflammation in healthy elderly. We hypothesized that nutritional support and resistance training would accelerate the resolution of inflammation in hospitalized elderly patients with SIRS. Acutely admitted patients aged >65 years with SIRS were randomized to an intervention consisting of a high-protein diet (1.7 g/kg per day) during hospitalization, and daily protein supplement (18.8 g) and 3 weekly resistance training sessions for 12 weeks after discharge (Intervention, n=14), or to standard-care (Control, n=15). Plasma levels of the inflammatory biomarkers soluble urokinase plasminogen activator receptor (suPAR), interleukin-6, C-reactive protein (CRP), and albumin were measured at admission, discharge, and 4 and 13 weeks after discharge. The Intervention group had an earlier decrease in suPAR levels than the Control group: -15.4% vs. +14.5%, P=.007 during hospitalization, and -2.4% vs. -28.6%, P=.007 between discharge and 4 weeks. There were no significant effects of the intervention on the other biomarkers. All biomarkers improved significantly between admission and 13 weeks, although with different kinetics (suPAR: -22%, interleukin-6: -86%, CRP: -89%, albumin: +11%). Nutritional support during hospitalization was associated with an accelerated decrease in suPAR levels, whereas the combined nutrition and resistance training intervention after discharge did not appear to affect the inflammatory state. Our results indicate that improved nutritional care during hospitalization may accelerate recovery in acutely ill elderly medical patients.
Collapse
Affiliation(s)
- Juliette Tavenier
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, DK-2650 Hvidovre, Denmark.
| | - Thomas H Haupt
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, DK-2650 Hvidovre, Denmark
| | - Aino L Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, DK-2650 Hvidovre, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, DK-1958 Frederiksberg C, Denmark
| | - Sussi F Buhl
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, DK-2650 Hvidovre, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, DK-1958 Frederiksberg C, Denmark
| | - Anne Langkilde
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, DK-2650 Hvidovre, Denmark
| | - Jens R Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, DK-1958 Frederiksberg C, Denmark; Nutrition Unit 5711, Rigshospitalet, DK-2100 Copenhagen Ø, Denmark
| | - Jens-Erik B Jensen
- Department of Endocrinology, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, DK-2650 Hvidovre, Denmark
| | - Mette M Pedersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, DK-2650 Hvidovre, Denmark
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, DK-2650 Hvidovre, Denmark; Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen K. Denmark
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, DK-2650 Hvidovre, Denmark
| |
Collapse
|
24
|
Klausen HH, Petersen J, Bandholm T, Juul-Larsen HG, Tavenier J, Eugen-Olsen J, Andersen O. Erratum to: Association between routine laboratory tests and long-term mortality among acutely admitted older medical patients: a cohort study. BMC Geriatr 2017; 17:67. [PMID: 28298200 PMCID: PMC5353888 DOI: 10.1186/s12877-017-0463-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 01/24/2023] Open
Affiliation(s)
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bandholm
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Physical Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Juliette Tavenier
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,The Emergency Department, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
25
|
Klausen HH, Petersen J, Bandholm T, Juul-Larsen HG, Tavenier J, Eugen-Olsen J, Andersen O. Association between routine laboratory tests and long-term mortality among acutely admitted older medical patients: a cohort study. BMC Geriatr 2017; 17:62. [PMID: 28249621 PMCID: PMC5333426 DOI: 10.1186/s12877-017-0434-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/25/2017] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Older people have the highest incidence of acute medical admissions. Old age and acute hospital admissions are associated with a high risk of adverse health outcomes after discharge, such as reduced physical performance, readmissions and mortality. Hospitalisations in this population are often by acute admission and through the emergency department. This, along with the rapidly increasing proportion of older people, warrants the need for clinically feasible tools that can systematically assess vulnerability in older medical patients upon acute hospital admission. These are essential for prioritising treatment during hospitalisation and after discharge. Here we explore whether an abbreviated form of the FI-Lab frailty index, calculated as the number of admission laboratory test results outside of the reference interval (FI-OutRef) was associated with long term mortality among acutely admitted older medical patients. Secondly, we investigate other markers of aging (age, total number of chronic diagnoses, new chronic diagnoses, and new acute admissions) and their associations with long-term mortality. METHODS A cohort study of acutely admitted medical patients aged 65 or older. Survival time within a 3 years post-discharge follow up period was used as the outcome. The associations between the markers and survival time were investigated by Cox regression analyses. For analyses, all markers were grouped by quartiles. RESULTS A total of 4,005 patients were included. Among the 3,172 patients without a cancer diagnosis, mortality within 3 years was 39.9%. Univariate and multiple regression analyses for each marker showed that all were significantly associated with post-discharge survival. The changes between the estimates for the FI-OutRef quartiles in the univariate- and the multiple analyses were negligible. Among all the markers investigated, FI-OutRef had the highest hazard ratio of the fourth quartile versus the first quartile: 3.45 (95% CI: 2.83-s4.22, P < 0.001). CONCLUSION Among acutely admitted older medical patients, FI-OutRef was strongly associated with long-term mortality. This association was independent of age, sex, and number of chronic diagnoses, new chronic diagnoses, and new acute admissions. Hence FI-OutRef could be a biomarker of advancement of aging within the acute care setting.
Collapse
Affiliation(s)
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bandholm
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Physical Therapy, Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Juliette Tavenier
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
- The Emergency Department, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
26
|
Tavenier J, Haupt T, Andersen A, Buhl S, Langkilde A, Andersen J, Jensen JE, Pedersen M, Petersen J, Andersen O. MON-P041: Nutritional Support During Hospitalization is Associated with an Earlier Decrease in Inflammation in Acutely Ill Older Medical Patients with SIRS. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30675-6] [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] [Indexed: 10/21/2022]
|
27
|
Tavenier J, Langkilde A, Haupt TH, Henriksen JH, Jensen FK, Petersen J, Andersen O. Immunosenescence of the CD8(+) T cell compartment is associated with HIV-infection, but only weakly reflects age-related processes of adipose tissue, metabolism, and muscle in antiretroviral therapy-treated HIV-infected patients and controls. BMC Immunol 2015; 16:72. [PMID: 26611787 PMCID: PMC4661963 DOI: 10.1186/s12865-015-0136-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 08/06/2015] [Accepted: 11/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background Despite effective antiretroviral therapy (ART), HIV-infected patients exhibit systemic inflammation, early onset of age-related diseases, and features of immunosenescence. The role of inflammation in the development of age-related diseases is widely recognized. However, the role of immunosenescence is not well established. Studying immunosenescence in HIV-infection could give insight into its role in ageing processes. In this cross-sectional study, we aimed to investigate whether ART-treated HIV-infected patients exhibit immunosenescence; and whether immunosenescence is associated with age-related processes of inflammation, metabolism, adipose tissue, and muscle. T cell immunosenescence and exhaustion were assessed by flow cytometry analysis of CD8+ cells from 43 ART-treated HIV-infected patients (HIV+) and ten Controls using markers of differentiation: CD27/CD28; maturation: CD27/CD45RA; senescence: killer cell lectin-like receptor G1 (KLRG1); and exhaustion: programmed death-1 (PD-1). Relationships between CD8+ T cell immunosenescence, exhaustion, and age-related processes were assessed using linear regressions. Results HIV-infection was strongly associated with more highly differentiated and mature CD8+ T cell phenotypes. PD-1 and KLRG1 expression did not differ between HIV+ and Controls, but depended on differentiation and maturation stages of the cells. CD8+ T cell maturation was associated with age. KLRG1 expression was associated with age, metabolic syndrome, visceral adipose tissue, and high muscle mass. PD-1 expression was not associated with age-related parameters. Conclusions HIV-infection strongly affected CD8+ T cell differentiation and maturation, whereas age-related processes were only weakly associated with immune parameters. Our findings suggest that, in contrast to inflammation, immunosenescence appears to be highly dependent on HIV-infection and is only to a small extent associated with age-related parameters in well-treated HIV-infection. Electronic supplementary material The online version of this article (doi:10.1186/s12865-015-0136-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Juliette Tavenier
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, DK-2650, Hvidovre, Denmark.
| | - Anne Langkilde
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, DK-2650, Hvidovre, Denmark.
| | - Thomas Huneck Haupt
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, DK-2650, Hvidovre, Denmark.
| | - Jens Henrik Henriksen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, DK-2650, Hvidovre, Denmark.
| | - Frank Krieger Jensen
- Department of Radiology, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, DK-2650, Hvidovre, Denmark.
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, DK-2650, Hvidovre, Denmark. .,Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K., Denmark.
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, DK-2650, Hvidovre, Denmark. .,Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegård Alle 30, DK-2650, Hvidovre, Denmark.
| |
Collapse
|