Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities - Results from the Cardiovascular Health Study
Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities - Results from the Cardiovascular Health Study
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DOI：
10.1001/archinte.162.20.2333
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发表时间：
2002-11-11
影响因子：
--
通讯作者：
Fried, LP
中科院分区：
文献类型：
--
作者：
Walston, J;McBurnie, MA;Fried, LP
背景：由于缺乏标准定义、其复杂性以及经常与疾病共存，衰弱的生物学基础一直难以确定。目的：确定是否存在并发心血管疾病和糖尿病时衰弱的生物学相关性。方法：参与者为 4735 名 65 岁及以上的社区居民。通过经过验证的筛查工具和排除标准来识别体弱、中等和非体弱受试者。通过分类变量的 Pearson chi(2) 检验和连续变量的方差 F 检验分析来评估虚弱水平和生理测量之间的双变量关系。采用多项逻辑回归来评估虚弱状态和生理测量之间的多变量关系。结果：在 4735 名心血管健康研究参与者中，299 名 (6.3%) 被确定为虚弱，2147 名 (45.3%) 为中等虚弱，2289 名 (48.3%) 为不虚弱。与非虚弱参与者相比，C反应蛋白（5.5 +/- 9.8 vs 2.7 +/- 4.0 mg/L）、因子VIII（13790 +/- 4480 Vs 11860 +/- 3460 mg/dL）以及较小亚组中的D二聚体（647 +/- 1033 Vs 224 +/- 258）的平均+/- SD水平增加 ng/mL）（所有 P 值小于或等于 0.001，chi(2) 趋势检验）。当排除患有心血管疾病和糖尿病的个体并在调整年龄、性别和种族后，这些差异仍然存在。结论：这些发现支持这样的假设，即老年衰弱综合征存在特定的生理学基础，其部分特征是炎症增加和凝血标记物升高，并且当患有糖尿病和心血管疾病的患者处于健康状态时，这些生理差异仍然存在。 排除。
Background: The biological basis of frailty has been difficult to establish owing to the lack of a standard definition, its complexity, arid its frequent coexistence with illness.Objective: To establish the biological correlates of frailty in the presence and absence of concurrent cardiovascular disease and diabetes mellitus.Methods: Participants were 4735 community-dwelling adults 65 years and older. Frail, intermediate, and nonfrail subjects were identified by a validated screening tool and exclusion criteria. Bivariate relationships between frailty level and physiological measures were evaluated by Pearson chi(2) tests for categorical variables and analysis of variance F tests for continuous variables. Multinomial logistic regression was performed to evaluate multivariable relationships between frailty status and physiological measures.Results: Of 4735 Cardiovascular Health Study participants, 299 (6.3%) were identified as frail, 2147 (45.3%) as intermediate, and 2289 (48.3%) as not frail. Frail Vs nonfrail participants had increased mean +/- SD levels of C-reactive protein (5.5 +/- 9.8 vs 2.7 +/- 4.0 mg/L), factor VIII (13790 +/- 4480 Vs 11860 +/- 3460 mg/dL), and, in a smaller subset, D dimer (647 +/- 1033 Vs 224 +/- 258 ng/mL) (P less than or equal to .001 for all, chi(2) test for trend). These differences persisted when individuals with cardiovascular disease and diabetes were excluded and after adjustment for age, sex, and race.Conclusions: These findings support the hypothesis that there is a specific physiological basis to the geriatric syndrome of frailty that is characterized in part by increased inflammation and elevated markers of blood clotting and that these physiological differences persist when those with diabetes and cardiovascular disease are excluded.