Altered immune system in frailty: Genetics and diet may influence inflammation

Pansarasa, Orietta; Pistono, Cristiana; Davin, Annalisa; Bordoni, Matteo; Mimmi, Maria Chiara; Guaita, Antonio; Cereda, Cristina

doi:10.1016/j.arr.2019.100935

Cited by 82 publications

(58 citation statements)

References 142 publications

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“…There is lack of corresponding consensus despite the wide range of tools that are available to diagnose frailty and its dimensions in clinical practice [26,27]. Thus, the tool needs to be validated and simple to use, and provide results that is easy to interpret for appropriately guiding goal setting and care planning such that identification of frailty is able to meaningfully impact the management of the individual in a contextual and appropriate way [27].…”

Section: Discussionmentioning

confidence: 99%

Psoas Muscle Area Measured with Computed Tomography at Admission to Intensive Care Unit: Prediction of In-Hospital Mortality in Patients with Pulmonary Embolism

Akkoç

Toptaş

Yalcin

et al. 2020

BioMed Research International

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Aim. Sarcopenia, a core component of physical frailty, is an independent risk factor for suboptimal health outcomes in hospitalized patients, especially in the intensive care patients. Psoas muscle areas can be assessed to identify sarcopenia. The aim of this study was to determine the prognostic value of psoas muscle area measured with CT for the prediction of in-hospital mortality in patients with pulmonary embolism at admission to the intensive care unit. Methods. Patients with an admission abdominal computed tomography scan and requiring intensive care unit (ICU) stay were reviewed. Selected clinical data of patients admitted to intensive care unit for the management of pulmonary embolism were collected. Using CT scan images at the level of L3 vertebra, the psoas muscle area value was obtained by dividing the sum of the right and left psoas muscle areas into the body surface area. Results. In-hospital mortality rate was 22.5% in 89 patients. The pulmonary embolism patients with in-hospital mortality had higher PESI and lower value of psoas muscle area, in addition to the lower systolic blood pressure and arterial oxygen saturation at admission. The increase in the value of psoas muscle area is associated with a decrease in the rate of in-hospital mortality. In patients with in-hospital mortality related to pulmonary embolism, the higher PESI and the lower value of psoas muscle area were considered in accordance with the outcome of patients. Conclusions. For the prediction of in-hospital mortality risk in patients with pulmonary embolism managed in intensive care unit, the psoas muscle area value has a merit to be used among the routine diagnostic procedures after further studies conducted with different severity of pulmonary embolism.

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Section: Discussionmentioning

confidence: 99%

Psoas Muscle Area Measured with Computed Tomography at Admission to Intensive Care Unit: Prediction of In-Hospital Mortality in Patients with Pulmonary Embolism

Akkoç

Toptaş

Yalcin

et al. 2020

BioMed Research International

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“…The aging process is characterized by enhanced catabolism and reduced anabolism, thus elderly patients would benefit from increased protein intake, especially in severe systemic conditions, such as wasting syndromes also associated with COVID-19 (Deutz et al 2014). Of note, nutritional support has been shown to improve immune responses in older malnourished patients (Pansarasa et al 2019;Aiello et al 2019).…”

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confidence: 99%

Elderly at time of COronaVIrus disease 2019 (COVID-19): possible role of immunosenescence and malnutrition

2020

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The unprecedented COVID-19 pandemic is rapidly and unpredictably evolving and the majority of deaths are occurring in older people. A partial description of the magnitude of the scenario is provided by numbers and statistics, which probably underestimate the ongoing tragedy. In the present opinion paper, we have focused our attention on the evidence of the relationship among malnutrition, immunosenescence, and the higher morbidity and mortality in elderly patients. In particular, we propose the intriguing hypothesis that correction of nutritional deficits may attenuate the age-dependent alterations of the innate and adaptive immune system which participate in the increased susceptibility and worse outcome observed in the elderly COVID-19 patients.

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“…Some studies have reported that frailty was associated with chronic changes in the immune response, including the imbalance of decline in immune function and increased in ammation. 26,27 Other studies have reported that aging was related to changes in the acute immune response, 28,29 due to dysfunction of immune cells or decreased cytokines working as a part of innate and adaptive immunity. 28 Both frailty and aging may be involved in weakening the acute in ammatory response.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Frail Patients with Suspected Infection in Intensive Care Units: A Descriptive Analysis From A Multicenter Cohort Study

Komori

Abe²,

Ogura³

et al. 2020

Preprint

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Background: Frailty is associated with morbidity and mortality in patients in intensive care units (ICUs). However, the characteristics of frail patients with suspected infection, including sepsis, remain unclear. We aimed to investigate the characteristics and outcomes of frail patients with suspected infection in ICUs. Methods: This is a secondary analysis of a multicenter cohort study conducted by 22 ICUs in Japan. Adult patients (≥16 years) with newly suspected infection from December 2017 to May 2018 were included. We compared baseline patient characteristics and outcomes between three frailty groups based on the Clinical Frailty Scale (CFS) score: fit (score 1–3), vulnerable (score 4), and frail (score 5–9). We conducted subgroup analysis of patients with sepsis defined based on Sepsis-3 criteria. We also produced Kaplan–Meier survival curves for 90-day survival.Results: We enrolled 650 patients with suspected infection, including 599 (92.2%) patients with sepsis. Patients with a median rating of 3 (3–5) on the CFS were included: 337 (51.8%) were fit, 109 (16.8%) were vulnerable, and 204 were (31.4%) frail. Comorbidities were more common in frail and vulnerable patients than in fit patients. The Sequential Organ Failure Assessment scores for fit, vulnerable, and frail patients were 7 (4–10), 8 (5–11), and 7 (5–10), respectively (p = 0.59). The patients' median body temperatures were as follows: fit 37.5 (36.5–38.5)℃; vulnerable 37.5 (36.4–38.6)℃; and frail 37.0 (36.3–38.1)℃ (p < 0.01). C-reactive protein levels of fit, vulnerable, and frail patients were 13.6 (4.6–24.5), 12.1 (3.9–24.9), 10.5 (3.0–21.0) mg/dL, respectively (p < 0.01). In-hospital mortality did not statistically differ according to frailty (p = 0.19). Kaplan–Meier survival curves showed little difference in the mortality rate during the acute phase. However, more vulnerable and frail patients died after the acute phase than fit patients; this difference was not statistically significant (p = 0.25). Compared with fit or vulnerable patients, fewer frail patients were discharged.Conclusion: Frail and vulnerable patients with suspected infection, including sepsis, tend to have poor disease outcomes after the acute phase of infection.

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Altered immune system in frailty: Genetics and diet may influence inflammation

Cited by 82 publications

References 142 publications

Psoas Muscle Area Measured with Computed Tomography at Admission to Intensive Care Unit: Prediction of In-Hospital Mortality in Patients with Pulmonary Embolism

Psoas Muscle Area Measured with Computed Tomography at Admission to Intensive Care Unit: Prediction of In-Hospital Mortality in Patients with Pulmonary Embolism

Elderly at time of COronaVIrus disease 2019 (COVID-19): possible role of immunosenescence and malnutrition

Characteristics and Outcomes of Frail Patients with Suspected Infection in Intensive Care Units: A Descriptive Analysis From A Multicenter Cohort Study

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