Cognitive Function, Sarcopenia, and Inflammation Are Strongly Associated with Frailty: A Framingham Cohort Study.
Cognitive Function, Sarcopenia, and Inflammation Are Strongly Associated with Frailty: A Framingham Cohort Study.
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DOI：
10.1016/j.amjmed.2021.07.012
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发表时间：
2021-12
影响因子：
5.9
通讯作者：
Tapper, Elliot B
中科院分区：
文献类型：
--
作者：
Mehta, Manaav;Louissaint, Jeremy;Parikh, Neal S;Long, Michelle T;Tapper, Elliot B
虚弱是慢性肝病发病率和死亡率的重要因素。了解脆弱的贡献者有可能识别出脆弱的风险个体，并可能为脆弱修改干预措施提供目标。我们评估了认知功能、炎症、肌肉减少症和虚弱之间的关系。使用来自心脏脆弱研究（2011-2014）的队列，我们评估了与脆弱相关的因素。暴露包括认知测试（联合试验A/B测试、动物耐受性测试和联合数字跨度向前/向后测试）、炎症（白细胞介素-6和肿瘤坏死因子受体II）和肌肉减少症（肌酐/胱抑素C比值）。我们进行了线性和逻辑回归，以确定这些暴露与肝虚弱指数（LFI）之间的关系。研究人群（N = 1208）的中位年龄为70岁，56%为女性，48.5%有肝病证据。联合Trails A/B试验（β 0.05，P <0.001）、肌酐-半胱氨酸蛋白酶抑制剂C（β −0.17，P = 0.006）以及两种炎症标志物白细胞介素-6水平（β 0.16，P = 0.002）和肿瘤坏死因子受体II（β 0.21，P = 0.04）与LFI独立相关。使用≥4.5的LFI临界值定义虚弱，试验A/B（比值比[OR] 1.21，95%置信区间[CI] 1.07-1.37），动物试验（OR 0.64，95%CI 0.42-0.97）、肌肉减少症（OR 0.10，95%CI 0.01-0.73）和白细胞介素-6（OR 4.99，95%CI 1.03-15.53）均与虚弱相关。虽然肝病并没有改变LFI和Trails A/B试验之间的关系，但白细胞介素-6仅在肝病存在时与LFI显著相关。认知能力、炎症和肌肉减少症在肝硬化中均高度流行，在这项以人群为基础的研究中，无肝硬化的人与LFI相关。进一步的研究是必要的干预措施，旨在防止脆弱的定制他们的方法，以病人的潜在风险因素。
Frailty is an important contributor to morbidity and mortality in chronic liver disease. Understanding the contributors to frailty has the potential to identify individuals at risk for frailty and may potentially provide targets for frailty-modifying interventions. We evaluated the relationship among cognitive function, inflammation, and sarcopenia and frailty. Using cohorts from the Framingham Heart Study (2011-2014), we evaluated for factors associated with frailty. Exposures included cognitive tests (combined Trails A/B test, Animal Naming Test, and combined Digit Span Forward/Backward test), inflammation (interleukin-6 and tumor necrosis factor receptor II), and sarcopenia (creatinine-to-cystatin C ratio). We performed linear and logistic regression to identify the relationship between these exposures and the Liver Frailty Index (LFI). The study population (N = 1208) had a median age of 70 years, was 56% female, and 48.5% had evidence of liver disease. The combined Trails A/B test (β 0.05, P < .001), creatinine-to-cystatin C (β −0.17, P = .006), and both inflammatory markers, interleukin-6 levels (β 0.16, P = .002) and tumor necrosis factor receptor II (β 0.21, P = .04), were independently associated with the LFI. Using an LFI cutoff of ≥4.5 to define frailty, Trails A/B (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.07-1.37), Animal Naming Test (OR 0.64, 95% CI 0.42-0.97), sarcopenia (OR 0.10, 95% CI 0.01-0.73), and interleukin-6 (OR 4.99, 95% CI 1.03-15.53) were all associated with frailty. Although liver disease did not modify the relationship between the LFI and the Trails A/B test, interleukin-6 was significantly associated with the LFI only in the presence of liver disease. Cognitive performance, inflammation, and sarcopenia, each highly prevalent in cirrhosis, are associated with the LFI in this population-based study of persons without cirrhosis. Further research is warranted for interventions aiming to prevent frailty by tailoring their approach to the patient’s underlying risk factors.