Is frailty a prognostic factor for critically ill elderly patients?

AIM: The study aimed to investigate the effects of frailty on clinical outcomes of patients in an intensive care unit (ICU). METHODS: In this prospective study, 122 patients (59 frail, 37 pre-frail and 26 robust) were included. A frailty index (FI) derived from comprehensive geriatric assessment parameters was used for the evaluation. The FI score of ≤0.25 was considered as robust, 0.25-0.40 as pre-frail and >0.40 as frail. The prognostic effects of FI were investigated and FI and APACHE II and SOFA scores, the prognostic scores using in ICU, were compared. RESULTS: Median age of the patients was 71 years old and 50.8 % were male. ICU mortality rate and median length of stay (LOS) were 51.6 % and 8 days (min-max: 1-148), respectively. ICU mortality was higher (69.2, 56.8 and 40.7 %, respectively, p = 0.040) and median overall survival was lower in frail group compared to pre-frail and robust subjects (23, 31 and 140 days, p = 0.013, respectively). Long term mortality over 3 and 6 months in frail patients were 80.8 and 84.6 %, respectively and significantly higher than others. Multivariate analysis showed that LOS in ICU (HR 1.067, 95 % CI 1.021-1.114), SOFA score (HR 1.272, 95 % CI 1.096-1.476) and FI (HR 39.019, 95 % CI 1.235-1232.537) were the independent correlates for ICU mortality (p = 0.004, p = 0.002 and 0.038, respectively). There was a weak but statistically significant positive correlation between APACHE II and FI scores (r = 0.190, p = 0.036). CONCLUSIONS: FI may be used as a predictor for the evaluation of elderly patients' clinical outcomes in ICUs.

Serum markers of inflammation and oxidative stress in sarcopenia.

BACKGROUND: Sarcopenia is a geriatric syndrome characterized by the presence of low muscle mass and function. Possible mechanisms underlying sarcopenia include oxidative stress and elevation of inflammatory cytokines. AIMS: The aim of the study was to evaluate the relationship between sarcopenia and biomarkers that may be involved in its pathogenesis and hence early detection. METHODS: A total of 72 patients (36 sarcopenic and 36 non-sarcopenic) were included in the study. An experienced geriatric team applied comprehensive geriatric assessment to all patients. Anthropometric measures, gait speed and handgrip strength were recorded. Bioelectrical impedance analysis was used to assess skeletal muscle mass. In addition to routine clinical laboratory tests, serum adiponectin, thioredoxin-1 and pentraxin-3 levels were measured. Sarcopenia was defined according to the European Working Group on Sarcopenia in older Adults as the presence of low muscle mass and low muscle function or muscle performance. RESULTS: Sarcopenic patients were more likely to be functionally dependent and had lower scores on comprehensive geriatric assessment tools. Erythrocyte sedimentation rate (ESR) and C-reactive protein levels were significantly higher in the sarcopenic group. There was no significant difference in serum levels of thioredoxin-1 and pentraxin-3. Sarcopenic patients had lower levels of hemoglobin, albumin, total protein, calcium, triglycerides, uric acid and adiponectin (p < 0.05). Hypertension and body mass index were inversely correlated with sarcopenia whereas ESR was positively correlated. DISCUSSION AND CONCLUSION: The present study demonstrated an association of sarcopenia with inflammatory markers CRP, ESR and adiponectin. Long-term prospective studies are warranted to confirm the relationship between markers oxidative stress and age related muscle decline.

Secondary acute myeloid leukemia arising early after cyclophosphamide treatment.

BACKGROUND: Acute myeloid leukemia (AML) can develop secondary to drug treatment. This phenomenon has been placed under the title "Therapy Related Acute Myeloid Leukemias and Myelodysplastic Syndromes" in the WHO classification of AML. Cyclophosphamide, which is used in various malignancies and rheumatological diseases, is an alkylating agent that plays a significant role in therapy related AML. CASE DESCRIPTION: A patient treated with cyclophosphamide due to vasculitis, subsequently developed AML months after treatment. CONCLUSION: Cyclophosphamide related AML is seen, in most cases, many years after exposure to the drug. The significance of this report lies in the fact that, to our knowledge, this is the most rapidly arising case of cyclophosphamide related AML.