Identification of a metabolic signature for multidimensional impairment and mortality risk in hospitalized older patients

Aging Cell

Luigi Fontana¹  Filomena Addante²  Massimiliano Copetti⁴  Giulia Paroni²  Andrea Fontana⁴  Daniele Sancarlo²  Fabio Pellegrini⁴  Luigi Ferrucci³ 

[1] Department of Medicine, Salerno University Medical School, Salerno, Italy;Department of Medical Sciences, Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy;National Institute on Aging, Longitudinal Studies Section, Harbor Hospital Center, Baltimore, MD, USA;Unit of Biostatistics, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy

关键词: comprehensive geriatric assessment;    IGF‐1;    inflammation;    mortality;    multidimensional prognostic index;    testosterone;   

DOI  :  10.1111/acel.12068

来源: Wiley

【 摘 要 】

Summary

A combination of several metabolic and hormonal adaptations has been proposed to control aging. Little is known regarding the effects of multiple deregulations of these metabolic and hormonal systems in modulating frailty and mortality in hospitalized elderly patients. We measured 17 biological serum parameters from different metabolic/hormonal pathways in 594 hospitalized elderly patients followed up to 1 year who were stratified into three groups according to their multidimensional impairment, evaluated by a Comprehensive Geriatric Assessment (CGA)-based Multidimensional Prognostic Index (MPI). The mortality incidence rates were 7% at 1 month and 21% at 1 year. Our data show that frailty and mortality rate were positively associated with chronic inflammation and with a down-regulation of multiple endocrine factors. Of the 17 biomarkers examined, blood levels of IGF-1, triiodothyronine, C-reactive protein, erythrocyte sedimentation rate, white blood cell and lymphocyte counts, iron, albumin, total cholesterol, and LDL-c were significantly associated with both MPI severity grade and mortality. In multivariate Cox proportional hazard model, the following biomarkers most strongly predicted the risk of mortality (adjusted hazard ratio (HR) per 1 quintile increment in predictor distribution): IGF-1 HR = 0.71 (95% CI: 0.63–0.80), CRP HR = 1.48 (95% CI: 1.32–1.65), hemoglobin HR = 0.82 (95% CI: 0.73–0.92), and glucose HR = 1.17 (95% CI: 1.04–1.30). Multidimensional impairment assessed by MPI is associated with a distinctive metabolic ‘signature’. The concomitant elevation of markers of inflammation, associated with a simultaneous reduction in multiple metabolic and hormonal factors, predicts mortality in hospitalized elderly patients.

【 授权许可】

Unknown   
© 2013 John Wiley & Sons Ltd and the Anatomical Society