Association of serum biomarkers with frailty in elderly hospitalized patients / 中华老年医学杂志

Objective:To evaluate the association of different biomarkers with frailty in elderly hospitalized patients.Methods:In this cross-sectional study, a total of 319 elderly patients aged 65 years or older hospitalized in Beijing Hospital between September 2018 and February 2019 were enrolled.Patients had a mean age of(75.0±6.6)years and 151(47.3%)were women.Based on the Fried phenotype, patients were divided into a non-frail group(244 cases, 76.5%)and a frail group(75 cases, 23.5%). The clinical characteristics and biomarker levels of the two groups were compared.The association of different biomarkers with frailty was evaluated by using the receiver operating characteristic(ROC)curve.The Youden index was used for the optimal cutoff values and the area under the curve(AUC)were calculated.AUCs of different biomarkers were compared to assess their correlations with frailty.Results:Hemoglobin, lipid levels(triglycerides, total cholesterol and low-density lipoprotein cholesterol), and prealbumin were significantly lower in the frail group than in the non-frail group( P<0.05), while N-terminal pro-B type natriuretic peptide(NT-proBNP)and high-sensitivity C reactive protein(hsCRP)levels were significantly higher than in the non-frail group( P<0.05). Thyrotropin(TSH)and free triiodothyronine(FT3)levels were significantly lower( P<0.05)and trans-triiodothyronine(rT3)was significantly higher( P<0.05)in the frail group.The combination of six biomarkers[hemoglobin, prealbumin, hsCRP, 25-dihydroxy vitamin D3[25(OH)D3], rT3 and NT-pro BNP]had the most powerful correlation with frailty(AUC=0.705, 95% CI: 0.652-0.755), but the correlation was not significantly different from that of the combination of 3 markers(hemoglobin, rT3 and hsCRP)(ROC=0.010, 95% CI: -0.0106-0.0306, P>0.05). Either of the two combinations was significantly better than the combination of 2 markers(hemoglobin and rT3)(ROC=0.143, 95% CI: 0.0406-0.245; ROC=0.153, 95% CI: 0.0498-0.256; all P<0.01). Conclusions:Hemoglobin, lipids, prealbumin, TSH and FT3 levels decrease while NT-proBNP and hsCRP levels increase in elderly hospitalized frail patients.The 6-biomarker combination[hemoglobin, prealbumin, hsCRP, 25(OH)D3, rT3 and NT-pro BNP]and 3-biomarker combination(hemoglobin, rT3 and hsCRP)have better correlation with frailty than the 2-biomarker combination(hemoglobin and rT3).

The correlation between frailty and cardiac autonomic nervous function in elderly patients / 中华老年医学杂志

Objective:To assess the correlation between frailty and cardiac autonomic nervous system function in elderly patients.Methods:Elderly hospitalized patients aged 65 years and over were enrolled and assessed for frailty by using the clinical frailty scale.Cardiac autonomic modulation was evaluated by heart rate variability analysis through 24 h electrocardiogram recording.Results:A total of 180 elderly patients were enrolled in this study, including 66 patients with frailty and 114 patients without frailty.The mean age of the frailty group was higher than that of the non-frailty group(79.8±6.0 vs.75.0±6.3, t=5.030, P<0.001). The proportions of patients with hypertension, stroke/transient cerebral ischemia attack(TIA), heart failure and osteoarthritis were higher in the frailty group than in the non-frailty group(all P<0.05). Compared with the non-frailty group, the standard deviation of normal-to-normal intervals(SDNN)[103.0(76.0, 121.2) vs.107.5(92.0, 136.0), Z=-2.108, P=0.035], the standard deviation of the averages of NN intervals in all 5-min segments(SDANN)[86.0(67.7, 106.5) vs.97.5(78.0, 126.0), Z=-2.694, P=0.007], normalized low frequency(LFnorm)(53.1±13.0 vs.59.3±13.9, t=-3.024, P=0.003)and low frequency/high frequency(LF/HF)ratio[1.2(1.0, 1.4) vs.1.4(1.1, 1.7), Z=-3.041, P=0.002]were decreased and normalized high frequency(HFnorm)(36.8±9.2 vs.32.2±10.7, t=3.033, P=0.003)was increased in the frailty group.HFnorm in the frailty group was significantly higher than that in the non-frailty group.The incidents of SDANN<92 ms, LFnorm<50 nU, HFnorm>32 nU and LF/HF ratio<1.5 were higher in the frailty group than in the non-frailty group(59.1% or 39/66 vs.41.2% or 47/114, 42.4% or 28/66 vs.22.8% or 26/114, 72.7% or 48/66 vs.49.1% or 56/114, 84.8% or 56/66 vs.65.8% or 75/114, χ2=5.346, 7.660, 9.547, 7.664, P=0.021, 0.006, 0.002, 0.006). Logistic multivariate regression analysis showed that LFnorm, HFnorm and LF/HF ratio were correlated with frailty( OR=0.971, 1.039 and 0.333, all P<0.05), and HFnorm>32 nU and LF/HF ratio<1.5 were risk factors for frailty( OR=2.401 and 2.773, both P<0.05). Conclusions:Cardiac autonomic nerve system function is impaired in elderly frail patients, with the imbalance between the sympathetic and vagus nerves.Therefore particular attention should be paid to heart rate variability in elderly patients with frailty.

Cardiac autonomic nerve function in elderly patients with frailty / 中华全科医师杂志

Objective:To assess the cardiac autonomic nervous function in elderly patients with frailty.Methods:Patients aged ≥ 65 years old admitted in Beijing Hospital from September 2018 to August 2019 were enrolled in this study. Clinical frailty score was used to assess the frailty. The cardiac autonomic modulation was evaluated by sinus heart rate turbulence analysis through 24 h electrocardiogram recording.Results:A total of 129 elderly patients were finally enrolled in this study with a mean age of (77.5±6.4) years, 58.1% of them were male. There were 53 patients in frail group and 76 patients in non-frail group. The age of the frailty group was significantly higher than that of the non-frailty group [(80.5±5.5) vs.(75.3±6.2)]; the prevalence of hypertension [84.9%(45/53)], heart failure [32.1%(17/53)] and peripheral vascular diseases [32.1%(17/53)] in the frailty group was significantly higher than that in the non-frailty group [65.8%(50/76), 1.3%(1/76), 17.1%(13/76); t=5.001, χ 2=5.879, 24.606, 3.921; all P<0.05]. Compared with non-frailty group, turbulence onset (TO) [-0.05(-0.92, 0.82)% vs. -0.74(-1.58, 0)%; Z=2.616, P=0.009] was significantly higher in frailty group, while turbulence slope (TS) [2.34(1.30, 5.00)ms/RR vs. 4.34(2.66, 6.39)ms/RR; Z=-3.048, P=0.002] was significantly lower. The rate of TO abnormality [49.1% (26/53) vs. 26.3%(20/76), χ 2=7.038, P=0.008] and TS abnormality [34.7%(29/53) vs. 21.0%(16/76); χ 2=15.579, P<0.001] in the frailty group was significantly higher than that in the non-frailty group. Multivariate logistic regression analysis showed that TO abnormality( OR=2.970, P=0.010, 95 %CI:1.300-6.785) and TS abnormality( OR=3.618, P=0.003, 95 %CI:1.565-8.364) were correlated with frailty. Conclusion:Cardiac autonomic nerve function may be impaired in elderly frail patients, and decreased vagal nerve tension may be presented.

Efficacy and safety of statin combined with ezetimibe for elderly patients with coronary heart disease and dyslipidemia / 中华全科医师杂志

Objective:To evaluate the efficacy and safety of statin combined with ezetimibe for elderly patients with coronary heart disease (CHD) and dyslipiclemia.Methods:Clinical data of 293 patients with CHD and dyslipidemia treated with statins and ezetimibe in the outpatient clinic of Beijing Hospital from November 2009 to June 2019 were retrospectively analyzed. There were 153 patients aged ≥65 years (elderly group) and 140 patients aged<60 year (control group). The low density lipid cholesterol reduction (ΔLDL-C), LDL-C compliance rate and safety were compared between the two groups.Results:The longest follow-up time was 9 months, the average follow-up time was 5.3 months in the elderly group, and 5.2 months in the control group. After treatment the TC, LDL-C, and TG levels were lower than those before treatment in both groups ( P<0.05), and there was no significant changed in HDL-C levels. After treatment there were no significant differences in TC [3.50(3.15,4.01) vs.3.49(3.14,4.00) mmol/L], LDL-C [1.85(1.56,2.23) vs.1.85(1.56,2.40) mmol/L], and TG [1.23(0.94,1.57) vs.1.32(0.84,1.70)mmol/L] between two groups (all P>0.05). There were also no significant differences in ΔLDL-C [-0.85(1.14,-0.55) vs.-0.81 (-1.34, -0.50) mmol/L], LDL-C decline rate (29.3% vs. 28.5%), and LDL-C compliance rate [44.4%(68/153) vs.45.0%(63/140)] between two group (all P>0.05). After combined treatment, AST and ALT increased in both groups, but they were still in the normal range. The difference of AST and ALT before and after treatment in the two groups was not statistically significant. There were no significant changes in CK in both groups ( P>0.05). Conclusion:The combined administration of ezetimibe and statin can significantly reduce LDL-C level and increase LDL-C compliance rate in treatment of elderly patients with coronary heart disease and dyslipidemia safety.

The correlation between frailty and N-terminal pro-B-type natriuretic peptide in elderly hospitalized patients / 中华老年医学杂志

Objective:To investigate the relationship between N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels and frailty in elderly hospitalized patients.Methods:A total of 604 patients aged 65 years or older(with a mean age of 74.9±6.5)admitted to Beijing Hospital from September 2018 to February 2019 were consecutively enrolled in this cross-sectional study.Patients with clinical diagnosis of heart failure or left ventricular ejection fraction(LVEF)>50% were excluded.Participants were divided into the non-frail(n=130, 21.5%), pre-frail(n=327, 54.1%)and frail(n=147, 24.3%)groups based on the Fried phenotype.Clinical data, laboratory test results and echocardiographic data were collected.Blood levels NT-proBNP were measured.The ability of daily living activities was evaluated.The relationship of NT-proBNP levels with frailty and the diagnostic value of NT-proBNP levels for frailty screening were analyzed.Results:As the severity of frailty increased, elevated NT-proBNP levels were observed( P<0.01). NT-proBNP levels were higher in the frail group than in the pre-frail group [235.7(104.1, 650.3)ng/L vs. 123.2(67.7, 281.7)ng/L, P<0.01] and higher in the pre-frail group than in the non-frail group [123.2(67.7, 281.7)ng/L vs.88.2(49.9, 203.1)ng/L, P<0.01]. With increased severity of frailty, the anterior and posterior diameter of the left atrium increased( P<0.05), while LVEF decreased( P<0.05). Logistic regression analysis showed that NT-proBNP levels were independently associated with frailty( P<0.01). The level of NT-proBNP had a certain diagnostic value for frailty, and the area under the receiver-operating characteristics(ROC)curve was 0.688( P<0.01). Conclusions:The level of NT-proBNP is elevated in elderly frail inpatients, it is an independent factor for frailty.Measuring NT-proBNP levels in frail groups can help clinicians pay attention to patients' cardiac function and give appropriate interventions as early as possible.

Prognostic values of blood parameters on mortality in octogenarian population: a nine-year-follow-up study / 中华老年医学杂志

Objective To evaluate the prognostic values of leukocyte count,hemoglobin,biochemical parameters,erythrocyte sedimentation rate and immunoglobulin on mortality in patients aged 80 years and over.Methods Totally 342 patients(aged 85.6±4.0 years)were followed up for (82.0±36.9) months,and the cause and time of death were recorded.Results During the period of follow up,198 patients suffered from death.Compared with the survival group (132 cases),the death group had older age [ (86.5±4.4)years vs.(84.5±3.2)years,t=-4.86,P＜0.01 ],higher white blood cell [ (6.2± 1.7) ＞ 109/L vs.(5.5±1.3) × 109/L,t=-3.93,P＜0.01 ],lower hemoglobin [(134.4±14.4)g/L vs.(140.0± 12.6)g/L,t= 3.65,P＜0.01 ],slightly faster erythrocyte sedimentation rate [ 11 mm/h(15 mm/h) vs.9 mm/h (10 mm/h),U=- 3.31,P＜0.01 ],lower immunoglobulin M [ (0.9±0.5)mg/L vs.(1.1±0.8)mg/L,t =2.55,P＜0.05 ],slightly higher urea nitrogen [ (7.5±2.6) mmol/L vs.(6.8±1.6) mmol/L,t=2.81,P＜0.01]and creatinine [(113.0±32.5) μmol/L vs.(100.5±15.8) μmol/L,t=-4.65,P＜0.01 ].Cox multivariate analysis revealed that older age (RR=1.083,95％CI:1.040 1.127,P＜0.01),white blood cell count (RR=1.134,95％CI:1.021-1.260,P＜0.05),creatinine (RR=1.011,95％CI=1.0021.020,P＜0.05),hemoglobin(RR=0.835,95％CI:0.714-0.975,P＜0.05)andimmunoglobulin M(RR=0.710,95％CI:0.521-0.966,P＜0.03),aorticaneurysm(RR=2.144,95％CI:1.163-3.951,P ＜ 0.05 ) were the independent risk factors for death.Conclusions Aging,increased WBC count,decreased hemoglobin and immunoglobulin M,elevated creatinine and aortic aneurysm are the independent risk factors for death,which are powerful parameters for the prognostic evaluation in the elderly aged 80 years and over.

Diagnostic value of the electrocardiogram in detecting left ventricular hypertrophy in the elderly men / 中华老年医学杂志

Objective To investigate the correlation between QRS amplitudes and left ventricular wall thickness in autopsy specimens of elderly men.Methods The data of autopsy cases in our hospital since 1990 were retrospectively analyzed.The cases with QRS duration≥0.12 s and the pacing electrocardiogram were excluded.QRS amplitudes of standard 12-lead electrocardiography in 3 months before death were measured and the correlation between QRS amplitudes and left ventricular wall thickness was analyzed in the elderly men.Results Correlations were found between the amplitudes of the R waves in leads V5 ,V6, Ⅰ ,aVL[(1.1±0.7) mV, (0.95±0.6) mV, (0.44±0.3)mV and(0.35±0.3)mV] and left ventricular wall thickness[(13.6±5.4)mm;r=0.22,0.14,0.22,0.23,all P<0.05], and between the combination of QRS amplitudes SV1 +RV5 or RV6(1.9±1.2) mV] and left ventrieular wall thickness [(13.8± 5.4) mm; r = 0.23, P < 0.05].The correlationbetween the combination of QRS amplitudes (SV1 + RV5 or RV6 ) and left ventricular wall thickness was the strongest in 60-79 years old cases (r=0.48, P<0.01) ,and was decreased in 80-89 years old cases (r= 0.23, P<0.05).There was no correlation between the combination of QRS amplitudes (SV1+RV5or RV6) and left ventricular wall thickness in 90-101 years old cases (r= 0.03, P> 0.05).Conclusions Electrocardiogram is a reliable method for diagnosis of left ventricular hypertrophy in elderly men aged < 90 years.

The effect of the estimated glomerular filtration rate on prognosis of elderly patients with coronary artery disease / 中华老年医学杂志

ObjectiveTo study the effect of different renal functions on the prognosis of elderly patients with coronary neart disease (CHD). MethodsAll 383 patients with CHD were divided into elderly group and non-elderly group. Then patients in the elderly group were assigned to 4 groups according to the quartile of the estimated glomerular filtration rate (eGFR): GFR1 group (eGFR:1.73 m-2). All patients were followed up for 2 years, and the cumulative death rate of cardiovascular diseases and the relative risk for cardiovascular death were analyzed. Results(1)The cumulative death rate of cardiovascular diseases in elderly group was higher than that in non-elderly group (9.4vs. 1.3%, P=0. 019). (2)The cumulative death rate of cardiovascular diseases in GFR1,GFR2,GFR3 group were 6.8% ,6.3% ,4.6%, respectively, and there were no statistical differences among the three groups (P>0. 05). The cumulative death rate of cardiovascular diseases was 19.4% in GFR4 group, which was higher than that in other three groups (19.4% vs. 6.8%, P=0.038;19.4% vs. 6.3%, P=0.025 ;19.4% vs. 4.6%, P=0.009) . (3)Multivariate regression analysis revealed that eGFR was an independent prognosis factor for elderly patients with CHD, and the hazard ratio for cardiovascular death was 0. 965(95% CI: 0. 946～0. 985, P=0. 001). ConclusionseGFR is an important predictor for cardiovascular death in elderly patients with CHD.

Prognostic value of adenosine tri phosphate myocardial perfusion tomography in octogenarians / 中华内科杂志

Objective To evaluate the prognostic value of ~(99m)Tc-MIBI myocardial perfusion single-photon emission computed tomography (MPS) with adenosine triphosphate in patients aged 80 years or older. Methods A total of 265 patients [ mean age (84. 2 ±3.6) years old ] who underwent adenosine triphosphate and rest ~(99m)Tc-MIBI myocardial SPECT imaging were followed-up for (36. 7 ± 22. 8 ) months. Results During the period of follow-up, 57 patients (20. 4% ) suffered from cardiac events, including 20 major events: 5 cardiac death and 15 acule non-fatal myocardial infarction, 14 unstable angina pectoris,7 heart failure and 16 cases undergoing PCI. The cardiac event rate in patients with fixed or mixed perfusion defects (n = 54) was 50%, which was significantly higher lhan that in patients with reversible perfusion defects(n=67, 31. 3% ,P<0. 05) and normal perfusion imaging( n = 144, 6. 2% ,P <0. 01 ) . The major cardiac event rate in patients with fixed or mixed perfusion defects was 27. 8% , which was significantly higher than that in those with reversible perfusion defects ( 6. 0% , P < 0. 05) and normal perfusion imaging (0.7%, P < 0. 01 ) . Cox multivariate analysis revealed that an abnormal MPS was the most important independent predictor of major or total cardiac events. Conclusions ~(99m) Tc-MIBI MPS with ATP is demonstrated to be a powerful tool for the prognostic evaluation in octogenarian population. Octogenarians with a normal MPS have a low risk of major or total cardiac events, but when an abnormal MPS is present, the risk is significantly higher, being highest in patients with fixed or mixed perfusion defects.

Platelet function and endothelial cell disturbance in older non-valve cardiac patients with atrial fibrillation / 中华老年医学杂志

Objective To investigate platelet function with special regard to the role of platelet membrane glycoproteins (GPIIb/IIIa?GPIb) and endothelial cell disturbance in the older non valve cardiac patients with atrial fibrillation and their clinical implications. Methods 22 older patients with non valve cardiac atrial fibrillation were studied. There were two age and sex matched control groups, one with 18 patients in sinus rhythm with cardiovascular disease, called the normal sinus rhythm group; the other with 16 health subjects named the health control group. The expression of activated GPIIb/IIIa and GPIb on platelet was analyzed with flow cytometry. Mean platelet volume (MPV) was measured by automatic hematologic analyzer, the plasma vWF was assayed using ELISA. Results The non valve atrial fibrillation group had markedly activated platelet, indicated by increased expression of activated GPIIb/IIIa ( P