scholarly journals P054: Do biomarkers need clinical attention among pre-frail injured seniors seen in the ED

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S96
Author(s):  
M. Blouin ◽  
M. Sirois ◽  
M. Aubertin-Leheudre ◽  
L.E. Griffith ◽  
L. Nadeau ◽  
...  
Keyword(s):  
Functional Decline ◽  
Cross Sectional Study ◽  
Serum Biomarkers ◽  
Clinical Frailty Scale ◽  
Cross Sectional ◽  
Insulin Growth Factor ◽  
Frailty Status ◽  
Reactive Protein ◽  
Minor Injuries ◽  
A Minor

Introduction: Frailty is associated with functional decline and physiological impairments in seniors with minor injuries. Serum biomarkers have also been suggested as potential markers of these impairments in clinical studies. However, no study has addressed the usefulness of serum biomarkers among pre-frail seniors consulting emergency departments (ED) in order to detect these impairments.Objectives: The purpose of the present study was to explore the association between several serum biomarkers and the frailty status of seniors seen in ED for a minor injury who are at risk of functional decline and 2) assist professionals in clinical decisions while identifying frail seniors in whom interventions should be started in order to prevent potential functional decline. Methods: This cross-sectional study includes 190 seniors retrieved from the larger CETI cohort and discharged home from 4 EDs after treatment of minor injuries. Their frailty status was measured by the Canadian Study of Health & Aging-Clinical Frailty Scale (CSHA-CFS). Then, patients were classified as “Robust” (CHSA-CFS levels 1 and 2) vs. “Pre-frail/Frail” (CHSA-CFS levels ≥3). Biomarkers (Albumin, Creatinine, C-reactive protein (CRP), Vitamin D, Ferritin, Glucose and Insulin-Growth Factor (IGF-1)) were obtained from blood samples. “Normal” vs. “Impaired” (low and/or high) clinical threshold values were used for statistical analyses. Results: The proportion of patients with clinically high creatinine levels (>105 µmol/L for male and >85 µmol/L for female) was higher in Pre-frails/Frails when compared to Robusts (P-value=0.01). Also, regarding IGF-1, we observed that the proportion of patients with lower IGF-1 levels (<50 µg/L) was higher in patients showing Pre-frail/Frail status (P-value=0.01). Finally, a significant correlation was found between frailty status and blood glucose (r=0.22; P-value=0.02) whereas a tendency was noted for CRP level (r=0.14; P-value=0.1). Conclusion: When compared to Robust seniors, Pre-frail/Frail individuals presenting to EDs tend to have physiological dysregulations that may help detect pre-frail status in community-dwellers. Larger prospective studies are needed to specify the usefulness and clinical implications of frailty biomarkers in the continuum of acute elder care.

scholarly journals LO14: In emergency department, do serum biomarkers are useful to screen independent frail seniors exposed to functional or mobility impairments after a minor injury?

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S11-S11
Author(s):  
M. Emond ◽  
M. Blouin ◽  
M. Sirois ◽  
M. Aubertin-Leheudre ◽  
L. Griffith ◽  
...  
Keyword(s):  
Emergency Department ◽  
Functional Decline ◽  
Serum Biomarkers ◽  
Community Dwelling ◽  
Geriatric Syndrome ◽  
Mobility Impairments ◽  
Frailty Status ◽  
Minor Injury ◽  
Minor Injuries ◽  
A Minor

Introduction: Frailty is a geriatric syndrome conferring a high risk of declining functional capacities. Some serum biomarkers were associated with frailty, but no study has investigated this possible association among community-dwelling seniors with minor injuries in the emergency department (ED). The aim was to determine if ED serum biomarker assay combined with frailty status improve the prediction of 3-months functional or mobility impairments in this population, beyond frailty status alone. Methods: This prospective sub-study of the CETI cohort includes 190 participants (age 65 years, ED consultation within 2 weeks of a minor injury, independent in daily activities 4 weeks prior to injury, and discharged home from EDs). Biomarkers were obtained from blood samples at baseline (ED visit). Normal vs. at risk physiological states were defined according to clinical threshold values. Also, the patients were screened for frailty at baseline) while their functional (OARS scale) and mobility characteristics were assessed at the ED visit and 3 months later. Patients were classified as robust or pre-frail/frail according of the CHSA-CFS and SOF scales. Simple generalized linear models with a binomial distribution and a log link function were used to explore the differences in functional and mobility outcomes at three months across sub-groups (RR). Results: When compared to robust ones, ED pre-frail/frail patients were less functional in their instrumental activities of day living (p=0.004), slower walkers (p=0.02), more frequent users of walking aids (p=0.03), more fearful of falling (p=0.006), went outside their home less often weekly (p=0.004) and had higher abnormal creatinine levels (p=0.02). We observed an overall 3-month functional decline in around 10% of patients combined with worsened mobility characteristics. We found that vitamin D [RR: 0.51 (0.07-3.9)], glucose (RR: 0.27 [(0.03-2.16)]) and creatinine (RR: [1.10 [(0.40-2.97]) modulate the prediction of 3-months mobility impairments. However, ED frailty status with CHSA-CFS and SOF scales clearly remained the stronger predictor of mobility impairments [vitamin DRR: 2.93 (1.12-7.65); glucoseRR: 2.36 (0.85-6.55); creatinine: RR2.06 (1.21-3.53)]. Conclusion: Since they do not improve the prediction of 3-months functional or mobility impairments associated with frailty status, ED biomarker assays are not useful in adequately screening for frailty among independent seniors with minor injuries.

scholarly journals P007: Association between serum biomarkers and frailty level in seniors with minor injurys

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S80-S81
Author(s):  
N. Allain-Boulé ◽  
J. Lebon ◽  
M. Sirois ◽  
M. Aubertin-Leheudre ◽  
M. Émond
Keyword(s):  
Vitamin D ◽  
Thyroid Stimulating Hormone ◽  
Serum Biomarkers ◽  
Sexual Hormones ◽  
Clinical Frailty Scale ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Vitamin D Levels ◽  
Minor Injuries ◽  
Age And Sex

Introduction: Frailty is associated with mobility & physical impairment in seniors with minor injuries. Serum biomarkers have also been suggested as potential markers of these impairments in clinical studies. No study has examined if serum biomarkers could contribute to the diagnosis of frailty in seniors with minor injuries. Objectives: To explore the association between several serum biomarkers (Ferritin, Creatinine, Vitamin D, Albumin, Glucose, Estradiol, Testosterone, Thyroid Stimulating Hormone (TSH), Insulin-Growth Factor (IGF-1) C-reactive protein (CRP)) and frailty level in seniors treated in emergency department (ED) for minor injuries. Methods: Cross-sectional study within the larger CETI cohort. It includes 142 seniors discharged home from 4 EDs after treatment of minor injuries. Their frailty status was measured by the Canadian Study of Health & Aging-Clinical Frailty Scale (CSHA-CFS). Biomarkers were obtained from blood samples. Pearson’s correlations (r) were performed to examine the relation between serum biomarkers and frailty levels. Partial correlation controlled for age and sex, were also performed. Results: Due to inclusion criteria, no patient was severely frail. Overall, these preliminary analyses seem to indicate that robust patients tended to have lower Glucose & Vitamin D levels (-0.264 ≤ r ≤ -0.230; p < 0.05), higher Estradiol (r = 0,230; p < 0.05) & Testosterone (r = 0,295; p < 0.05), while prefrail/frail patients tended to have higher Glucose & Vitamin D levels (0,235 ≤ r ≤ 0,238; p < 0.05), lower Estradiol levels (r = -0,235; p < 0.05) & more elevated Ferritin levels. Due to the small number of patients, controlling for age and sex lead to non-significant results of the most associations. Conclusion: Pre-frail/frail seniors presenting to EDs with minor injuries tend to have higher Ferritin, Glucose & Vitamin D levels as well as lower sexual hormones levels than robust individuals. Larger samples are needed in order to elucidate which biomarkers could be most useful to identify frail seniors needing clinical attention and to assess a possible association with mobility impairments in this population.

scholarly journals The Convergent Validity of the electronic Frailty Index (eFI) with the Clinical Frailty Scale (CFS)

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 88 ◽  
Author(s):  
Antoinette Broad ◽  
Ben Carter ◽  
Sara Mckelvie ◽  
Jonathan Hewitt
Keyword(s):  
Convergent Validity ◽  
Frailty Index ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Paired Data ◽  
Clinical Frailty Scale ◽  
Cross Sectional ◽  
Frailty Status ◽  
Regional Community ◽  
Community Dwelling Older People

Background: Different scales are being used to measure frailty. This study examined the convergent validity of the electronic Frailty Index (eFI) with the Clinical Frailty Scale (CFS). Method: The cross-sectional study recruited patients from three regional community nursing teams in the South East of England. The CFS was rated at recruitment, and the eFI was extracted from electronic health records (EHRs). A McNemar test of paired data was used to compare discordant pairs between the eFI and the CFS, and an exact McNemar Odds Ratio (OR) was calculated. Findings: Of 265 eligible patients consented, 150 (57%) were female, with a mean age of 85.6 years (SD = 7.8), and 78% were 80 years and older. Using the CFS, 68% were estimated to be moderate to severely frail, compared to 91% using the eFI. The eFI recorded a greater degree of frailty than the CFS (OR = 5.43, 95%CI 3.05 to 10.40; p < 0.001). This increased to 7.8 times more likely in men, and 9.5 times in those aged over 80 years. Conclusions: This study found that the eFI overestimates the frailty status of community dwelling older people. Overestimating frailty may impact on the demand of resources required for further management and treatment of those identified as being frail.

scholarly journals MP016: Measuring frailty can help emergency departments identify seniors at risk of functional decline after minor injuries

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S71-S72
Author(s):  
N. Allain-Boulé ◽  
M. Sirois ◽  
L.E. Griffith ◽  
M. Émond ◽  
B. Batomen Kuimi
Keyword(s):  
At Risk ◽  
Emergency Departments ◽  
Predictive Accuracy ◽  
Characteristic Curve ◽  
Functional Decline ◽  
Community Dwelling ◽  
Post Injury ◽  
Clinical Frailty Scale ◽  
Minor Injuries ◽  
A Minor

Introduction: The CETI team has shown that around 18% of otherwise independent seniors remain in a state functional decline up to six months after a minor injury. In that context, frailty may be associated with increased likelihood of decline. As most seniors consult Emergency Departments (EDs) when injured, measuring frailty may help identify those at risk of functional decline. Objectives: This study aims to 1) describe frailty in the sub-group of independent community-dwelling seniors consulting Emergency Departments (ED) for minor injuries, 2) examine the association between frailty and functional decline three months post-injury, 3) ascertain the predictive accuracy of frailty measures and Emergency Physicians’ (EPs) for functional decline. Methods: Prospective cohort in 2011-2013 among 1072 seniors aged ≥ 65, independent in basic daily activities, evaluated in Canadian EDs for minor injuries and discharged home. Frailty was assessed at EDs using the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) and the Study of Osteoporotic Fracture index (SOF). Functional decline was defined as a loss ≥ 2/28 on the Older American Resources Services scale three months post-injury. Generalized mixed models were used to explore differences in functional decline across frailty levels. Areas Under the Receiver operating characteristic curve (AUC) were used to ascertain the predictive accuracy of frailty measures and EPs’ clinical judgement. Results: The SOF and CSHA-CFS were available in 342 and 1058 participants, respectively. The SOF identified 55.6%, 32.7%, 11.7% patients as robust, prefrail and frail. These CSHA-CFS (n=1058) proportions were 51.9%, 38.3% and 9.9%. The 3-month incidence of functional decline was 12.1% (10.0%-14.6%). The AUCs of the CSHA-CFS and the EPs’ were similar (0.548 - 0.777), while the SOF was somewhat higher (0.704 - 0.859). Conclusion: Measuring frailty in community-dwelling seniors with minor injuries in EDs may enhance current risk screening for functional decline. However, before implementation in usual care, feasibility issues such as inter-rater reliability and acceptability of frailty tools in the EDs have to be addressed.

scholarly journals The Association between Frailty Indicators and Blood-Based Biomarkers in Early-Old Community Dwellers of Thailand

2019 ◽  
Vol 16 (18) ◽  
pp. 3457 ◽  
Author(s):  
Warathit Semmarath ◽  
Mathuramat Seesen ◽  
Supachai Yodkeeree ◽  
Ratana Sapbamrer ◽  
Pisittawoot Ayood ◽  
...  
Keyword(s):  
Healthy Aging ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
Frailty Phenotype ◽  
Cross Sectional ◽  
Frailty Status ◽  
Reactive Protein ◽  
Hand Grip ◽  
The Status ◽  
Community Dwellers

Thailand has officially reached the status of an “aged society” and become the developing country with the 2nd largest proportion of senior citizens in Southeast Asia. A cross-sectional study of 526 early-old community dwellers was conducted for the Fried frailty phenotype assessment, This included five indicators: Weakness, slowness, physical activity, exhaustion, and weight loss. C-reactive protein (CRP), interleukin-6 (IL-6), insulin-like growth factor-1, and CD4+:CD8+ Ratio which serve as blood-based biomarkers of frailty. The prevalence of frailty and pre-frail in this population was found to be 15% and 69.6% respectively and was higher among women than men. Frail (n = 58) and non-frail (n = 60) participants were evaluated for the associations between the frail indicators and the blood-based biomarkers. Serum levels of IL-6 and CRP from frail group were significantly elevated when compared with the non-frail counterparts (p = 0.044 and 0.033, respectively), and were significantly associated with the frailty status with an Odd RatioIL-6 [OR] of 1.554-fold (95% confidence interval [CI], 1.229–1.966) and an ORCRP of 1.011-fold (95 CI, 1.006–1.016). Decreased hand-grip strength was the only frailty indicator that was significantly associated with both inflammatory biomarkers, (ORIL-6 of 1.470-fold and ORCRP of 1.008-fold). Our study is the first to assess the frailty status among the early-old population in Thailand. These findings will encourage general practitioners to combine frailty indicators and serum biomarkers as early detection tools for at-risk older adults to achieve the goal of healthy aging.

scholarly journals Ethnicity-Specific Normative Models of Quadruple Test as a Screening Test for Down Syndrome

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 651
Author(s):  
Praetip Praikaew ◽  
Kuntharee Traisrisilp ◽  
Chanane Wanapirak ◽  
Ratanaporn Sekararithi ◽  
Theera Tongsong
Keyword(s):  
Quantile Regression ◽  
Gestational Age ◽  
Cross Sectional Study ◽  
Serum Biomarkers ◽  
Rank Test ◽  
Maternal Weight ◽  
Cross Sectional ◽  
Inhibin A ◽  
Thai Women ◽  
Normative Models

Background and Objectives: To establish normative models for median levels of serum biomarkers of the second trimester quad test (alpha-fetoprotein: AFP; free beta-human gonadotropins: hCG; inhibin-A; and unconjugated estriol: uE3) specific to Thai women and to compare multiples of the median (MoMs) derived from ethnicity-specific models and those derived from Caucasian models with ethnic correction. Materials and Methods: A cross-sectional study was undertaken in a tertiary, medical teaching center among low-risk pregnant Thai women between 14 and 21 weeks of gestation to measure the levels of the four serum biomarkers. The measured values of each biomarker were analyzed using the multivariable factorial polynomial technique for quantile regression as a function of gestational age and maternal weight. Results: The Thai-specific normative models for the four biomarkers were generated and available for use. The MoMs of all individuals generated from our models were significantly different from conventional (Caucasian) models with ethnic correction (Wilcoxon signed-rank test; p < 0.0001 for all biomarkers). The MoMs of AFP and hCG from both methods were in agreement, but those from Thai-specific models were significantly higher. However, those of inhibin-A and uE3 were markedly different and ethnic correction was unlikely to be useful. Conclusions: The Thai-specific normative models of the quad test as a function of gestational age and maternal weight were constructed using multivariable factorial polynomial models, better than simple quantile regression or log-linear regression used in earlier decades. The analysis of MoMs supports the use of ethnicity-specific models instead of Caucasian models with ethnic correction.

scholarly journals Interleukin-37 as an anti-inflammatory cytokine: does its relation to disease activity suggest its potential role in rheumatoid arthritis therapy?

2021 ◽  
Vol 48 (1) ◽  
Author(s):  
Eman A. Baraka ◽  
Mona G. Balata ◽  
Shereen H. Ahmed ◽  
Afaf F. Khamis ◽  
Enas A. Elattar
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Cross Sectional Study ◽  
Healthy Controls ◽  
Tender Joint ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Significant Difference ◽  
The Mean ◽  
Anti Inflammatory

Abstract Background This study aimed to measure the serum and synovial interleukin (IL)-37 levels in rheumatoid arthritis (RA) patients compared to patients with primary knee osteoarthritis (PKOA) and healthy controls and to detect its relation to RA disease activity. Results This cross-sectional study included 50 RA patients with a mean age of 40.24 ± 8.62 years, 50 patients with PKOA with a mean age of 56.69 ± 4.21, and 40 healthy controls with a mean age of 41.75 ± 7.38 years. The mean serum IL-37 level in the RA patients (382.6 ± 73.97 pg/ml) was statistically significantly (P < 0.001) the highest among the studied groups; however, it showed a non-significant difference between the PKOA patients (70.38 ± 27.49 pg/ml) and the healthy controls (69.97 ± 25.12 pg/ml) (P > 0.94). Both serum and synovial IL-37 levels were significantly positively correlated with disease activity scores (r = 0.92, P< 0.001 and r = 0.85, P < 0.001), tender joint counts (r = 0.83, P < 0.001 and r = 0.82, P < 0.001 ), swollen joint counts (r = 0.72, P < 0.001 and r = 0.60, P < 0.001), visual analog scale (r = 0.82, P < 0.001 and r = 0.82, P < 0.001), erythrocyte sedimentation rate (r = 0.75, P < 0.001 and r = 0.65, P < 0.001), and C-reactive protein (r = 0.93, P < 0.001 and r = 0.79, P < 0.001), respectively. Conclusion Serum and synovial IL-37 were significantly elevated in the RA patients, and they were closely correlated. Being less invasive, the serum IL-37 could be a marker of disease activity and could reflect the effective disease control by drugs. Having an anti-inflammatory effect could not suggest IL-37 as the key player to control inflammation alone, but its combination with other anti-proinflammatory cytokines could be investigated.

scholarly journals HUBUNGAN ANTARA PERUBAHAN KADAR HS-CRP DENGAN FUNGSI KOGNITIF PADA STROKE ISKEMIK

2018 ◽  
Vol 35 (2) ◽  
Author(s):  
Betsi Sumanti ◽  
Hexanto Hexanto ◽  
Widiastuti Widiastuti
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Function ◽  
Acute Ischemic Stroke ◽  
Inflammatory Marker ◽  
Cross Sectional Study ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Hs Crp ◽  
Relationship Of

   ASSOCIATION BETWEEN ALTERED HS-CRP LEVELS AND  COGNITIVE FUNCTION OF ISCHEMIC STROKE PATIENTSABSTRACTIntroduction: The incidence of cognitive impairment in acute ischemic stroke patients is increasing. The mechanism of the inflammatory effect, such as  elevated hs-CRP level, a  non-specific inflammatory marker  sensitive to chronic inflammation due to hypoperfusion as well other vascular risk, is thought to have an effect on cognitive function.Aims: To determine the relationship of cognitive function changes in acute phase of ischemic stroke with hs-CRP level changes on day 3 and day 7 after onset.Methods: This was a cross sectional study of 31 first-timer ischemic stroke patients who met inclusion and exclusion criteria. The level of hs-CRP was checked on the 3rd day and 7th day after onset, while MoCA-Ina was assessed on the 7th day after onset. Cognitive disturbance was considered if MoCA <26. Analyses was done using SPSS 2.0Results: The average onset of day 3 Hs-CRP concentration was 0.66 (0.12-16.67)mg/dl and the onset of day 7 was 5.455 (0.14-17.34)mg/dl. The mean change of hs-CRP level between 3 day and 7 day after onset was -0,16 (-3.32-4.95). There was a significant correlation between elevated hs-CRP levels on day 3 and day 7 after onset with cognitive function of acute ischemic stroke patients.Discussion: There was a significant correlation between elevated hs-CRP levels on day 3 and day 7 after onset with cognitive function of acute ischemic stroke patients.Keyword: Acute ischemic stroke, hs-CRP, MoCA-Ina scoresABSTRAKPendahuluan: Insidens penurunan fungsi kognitif pada pasien stroke iskemik akut semakin meningkat. Hal ini diduga dipengaruhi oleh mekanisme efek inflamasi, meliputi peningkatan kadar high sensitive-C reactive protein (hs-CRP), salah satu penanda inflamasi non-spesifik yang sangat sensitif pada inflamasi kronis, akibat hipoperfusi maupun karena risiko vaskuler lainnya.Tujuan: Mengetahui hubungan perubahan fungsi kognitif pasien stroke iskemik fase akut dengan perubahan kadar hs-CRP hari ke-3 dan hari ke-7 setelah awitan.Metode: Studi potong lintang terhadap penderita stroke iskemik pertama kali yang memenuhi kriteria inklusi dan eksklusi. Dilakukan pemeriksaan kadar hs-CRP hari ke-3 dan hari ke-7 setelah awitan dan MoCA-Ina pada hari ke-7 setelah awitan. Fungsi kognitif dinyatakan terganggu jika MoCA-Ina <26. Analisis data menggunakan program SPSS 22.0.Hasil: Didapatkan rerata kadar Hs-CRP hari ke-3 setelah awitan adalah 0,66 (0,12-16,67)mg/dl dan hari ke-7 setelah awitan adalah 5,455 (0,14-17,34)mg/dl. Dengan rerata perubahan kadar hs-CRP awitan hari ke-3 dan awitan hari ke-7 adalah -0,16 (-3,32-4,95). Didapatkan hubungan yang bermakna antara perubahan kadar hs-CRP hari ke-3 setelah awitan dan hari ke-7 setelah awitan dengan fungsi kognitif pasien stroke iskemik akut.Kesimpulan: Didapatkan hubungan yang bermakna antara peningkatan kadar hs-CRP pada hari ke-7 dan kadar hari ke-3 dengan fungsi kognitif pasien stroke iskemik akut.Kata kunci: hs-CRP, MoCA-Ina, stroke iskemik akut 

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