ABSTRACT
Objective:To evaluate the effect of procalcitonin(PCT)guiding anti-infection therapy on the prognosis of elderly patients.Methods:By searching PubMed, EMBASE database, Cochrane library, Cochrane clinical trial center registry and SinoMed database in Chinese, we searched for a randomized controlled clinical(RCT)study on the effect of PCT-guided anti-infection treatment on the prognosis of elderly patients, which was conducted according to the PRISMA statement.The main purpose of the study was to evaluate the time of antibiotic application.Results:After retrieval, 9 RCT clinical studies were finally included, involving 2 702 elderly patients, with an average follow-up of 3.5 months(1-12 months). The average age was(71.3±8.9)years old, with 52.8% of males and baseline levels of white blood cell(WBC)was 12.9×10 9/L, C-reactive protein(CRP)was 18.9 mg/L, PCT was 0.38 μg/L.Compared with conventional anti-infective therapy, PCT-guided anti-infective therapy can reduce the antibiotic application time of elderly patients[standard mean difference( SMD)=-2.39 days, 95% CI(-4.03, -0.75)days, P=0.004]. However, PCT-guided anti-infection treatment had no significant effect on the length of hospital stay[ SMD=-0.46 d, 95% CI(-0.05, 0.14)d, P=0.135], the rate of reinfection[ RR=0.87, 95% CI(0.73, 1.03), P=0.105]and the risk of all-cause death[ RR=1.02, 95% CI(0.80, 1.31), P=0.863]. Conclusions:PCT-guided anti-infection treatment can reduce the time of antibiotic application in elderly patients, but other clinical effects need to be verified by more large-scale studies
ABSTRACT
Objective To explore the relationship between the severity of frailty and muscle mass/function in older people,and to determine whether and/or how the results would be influenced by the assessment method for frailty.Methods A total of 106 older adults aged 63-95 years were recruited from individuals undergoing regular health examinations at the Outpatient Department of Beijing Hospital.The characteristics of participants were collected through a questionnaire and subsequently evaluated.Frailty was assessed by both the Fried phenotype and an index of accumulated deficits (FI).Sarcopenia was identified based on the criteria of the Asian Working Group for Sarcopenia (AWGS).Average skeletal muscle mass,appendicular skeletal muscle mass and the appendicular skeletal muscle index (ASMI) were measured by bioelectrical impedance analysis (BIA).Furthermore,grip strength,the 4 m walking test,the timed up and go test (TUGT),the five times sit to stand test (FTSST),and the balance test were performed to investigate the physical performance.Results There were 15 (14.2％) frail and 65 (61.3％) pre-frail cases in this group.Poor grip strength 59 (55.7％) and slow gait speed 33 (31.1％) were more prevalent in frail older people.Meanwhile,when the phenotypic definition of frailty was used,muscle mass and ASMI decreased as the severity of frailty increased (F=6.579,3.969,4.507,respectively;all P＜0.05).Frail older people had significantly slower gait speed and poorer grip strength than those who were not frail (F=23.897,4.583,respectively;both P＜0.05).Moreover,frail older people were more likely to be sarcopenia (53.5％) than those who were pre frail (30.8％) or not frail (3.8％).Participants with frailty performed worse on FTSST,TUGT and the balance test (all P＜0.05) and had markedly lower levels of FI (0.15±0.04,0.18±0.06,and 0.28±0.09,respectively;F=21.764,P＜0.05) than those in the pre-frail and non-frail groups.Appendicular skeletal muscle mass,skeletal muscle mass,grip strength and walking speed were negatively correlated with FI (r =-0.256,-0.321,-0.343,-0.374,respectively;all P＜0.05) while ASMI showed no statistical correlation with FI (P＞0.05).Conclusions Poor grip strength and slow gait speed are very common in frail older people.There is a close correlation between muscle mass/function and frailty.The degree of association of frailty severity with physical performance remains largely unchanged regardless of what assessment method is used.