Frailty is associated with chronic inflammation and pro-inflammatory monocyte subpopulations

Relationship of Apolipoprotein B to Aortic Aneurysm: Frailty Index as a Partial Mediator - a Mendelian Randomization Study

Aim    Aortic aneurysm is characterized by localized expansion and damage to the vessel wall. While apolipoprotein B (ApoB) has been linked to atherosclerosis, its causal relationship with aortic aneurysm remains unclear. This study used a Mendelian randomization (MR) approach to explore the causal relationships between ApoB, aortic aneurysm, and potential mediators.Material and methods    Single nucleotide polymorphism (SNP) data related to ApoB, apolipoprotein A1 (ApoA1), triglycerides, frailty index, and aortic aneurysm were obtained from large-scale genome-wide association studies. MR analysis was conducted to evaluate causal relationships, using inverse variance weighting (IVW) as the primary statistical method. Additionally, we assessed whether the frailty index mediates the relationship between ApoB and aortic aneurysm.Results    Univariate MR analysis revealed that ApoB is significantly associated with aortic aneurysm (IVW odds ratio (OR) = 1.443, 95 % confidence interval (CI) = 1.273-1.637, p < 0.001). Multivariable MR (MVMR) analysis, adjusted for ApoA1 and triglycerides, confirmed these results. In mediation analysis, the frailty index was found to partially mediate the effect of ApoB on aortic aneurysm (mediation contribution: 20.1 %-23.1 %). The ORs for ApoB and the frailty index with respect to aortic aneurysm were 1.325 (95 % CI = 1.168-1.505) and 4.188 (95 % CI = 1.859-9.435), respectively.Conclusion    ApoB has a causal relationship with aortic aneurysm, with the frailty index acting as a partial mediator in this pathway.

Frailty in Older Adults with Severe Aortic Stenosis: The Role of Systemic Inflammation and Calcium Homeostasis

Background: Frailty and severe aortic stenosis (AoS) are critical conditions in older adults, both of which share pathophysiological mechanisms including chronic inflammation and calcium metabolism dysregulation, potentially influencing the development and progression of these conditions. This study aimed to analyze systemic inflammation and calcium homeostasis biomarkers and their associations with frailty in older adults with severe AoS. Methods: This prospective study included 191 patients aged ≥75 years with severe AoS who were candidates for aortic valve replacement and were evaluated at a Geriatrics Frailty Assessment and Intervention Clinic. Frailty was defined as a score ≤6 on the Short Physical Performance Battery (SPPB). Biomarkers analyzed included aortic valve calcium score, parathyroid hormone (PTH), calcidiol (vitamin D), calcium, phosphate, creatinine, interleukin-6 (IL-6), and the Systemic Immune-Inflammation Index. Multivariate logistic regression was performed to identify independent predictors of frailty. Results: Of the 191 patients studied, 53.9% were women, with a mean age of 84.1 ± 4.1 years. Frailty was identified in 28.3% of patients (mean SPPB score 7.6 ± 2.5). Statistically significant differences between frail and non-frail patients were observed for PTH (87.7 ± 61.1 pg/mL vs. 70 ± 44.4 pg/mL, p = 0.028) and IL-6 (10.4 ± 11.2 pg/mL vs. 7 ± 8.2 pg/mL, p = 0.049). Notably, in the multivariate model, IL-6 emerged as a significant independent predictor of frailty (OR 1.037; CI 1.001-1.074, p = 0.043). Conclusions: IL-6 was identified as a biomarker significantly associated with frailty in older adults with severe AoS. Evaluating IL-6 could enhance the precision of frailty assessments, complement functional measures, and support clinical decision-making in this population.

Predictive potential of pre-procedural cardiac and inflammatory biomarkers regarding mortality following transcatheter aortic valve implantation: A systematic review and meta-analysis

BACKGROUND

Aortic stenosis (AS) is a common heart valve disease, especially in aging populations. While surgical aortic valve replacement (SAVR) is the standard treatment, many patients are ineligible. Transcatheter aortic valve implantation (TAVI) offers an alternative, especially for high-risk patients, but is not without complications. Identifying biomarkers that predict post-TAVI mortality is essential for optimizing outcomes.

OBJECTIVES

The purpose of this systematic review and meta-analysis is to evaluate the role of cardiac and inflammatory biomarkers in predicting short-term and mid to long-term mortality following TAVI.

METHODS

We searched PubMed, Scopus, Embase, and Web of Science for studies examining the impact of inflammatory and cardiac biomarkers on mortality following TAVI. Mean differences (MDs) and 95 % confidence interval (CI) were calculated using a random-effect model.

RESULTS

Twenty-eight studies involving 10,560 patients were included, with 1867 in the mortality group. Mortality was significantly associated with higher pre-procedural levels of creatinine (0.41; 95 % CI: [0.35, 0.48]), brain natriuretic peptide (0.58; 95 % CI: [0.43, 0.73]), C-reactive protein (0.55; 95 % CI: [0.45, 0.64]), and white blood cell count (0.18; 95 % CI: [0.06, 0.31]), and lower pre-procedural levels of hemoglobin (-0.49; 95 % CI: [-0.60, -0.38]) and albumin (-0.18; 95 % CI: [-0.24, -0.13]). These associations remained statistically significant in subgroup analyses for both mid to long-term mortality and short-term mortality, except for WBC levels, which were not significantly associated with short-term mortality, and Hb, for which short-term data were insufficient. Platelet count showed no significant difference.

CONCLUSION

These findings highlight the importance of inflammatory and cardiac biomarkers in risk stratification and patient management in TAVI procedures.

Quantification of perivascular adipose tissue attenuation does not add incremental prognostic value in patients undergoing transcatheter aortic valve implantation

Aims

Perivascular adipose tissue attenuation (PVAT) has emerged as a novel coronary computed tomography angiography (CCTA)-based biomarker predicting cardiovascular events by capturing inflammation around the coronary arteries. We assessed whether PVAT adds incremental prognostic value in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods and results

A total of 510 patients underwent CCTA imaging prior to TAVI between November 2015 and June 2020 at the Medical University of Vienna. PVAT was obtained from CCTA images and was measured around the right coronary artery [PVAT(RCA)] and the aortic valve [PVAT(valve)]. Following application of exclusion criteria, 372 patients [mean age 80.6 ± 6.8 years; 169 (45%) women] were analysed. Over a median follow-up of 3.0 (IQR 2.5-3.6) years, 52 (14%) individuals experienced a major adverse cardiovascular event (MACE, a composite of non-fatal stroke or myocardial infarction, cardiac death, or vascular intervention). Individuals exhibiting elevated PVAT[valve] displayed a heightened surgical risk according to European System for Cardiac Operative Risk Evaluation II, a lower body mass index, reduced left ventricular ejection fraction, prolonged hospitalization following TAVI, and elevated levels of circulating inflammatory markers compared with those in the low PVAT[valve] group (P < 0.05). However, neither PVAT[valve] nor PVAT[RCA] were independently associated with the occurrence of MACE in adjusted multi-variable analyses (PVAT[valve]: sub-distribution hazard ratio [SHR] 1.14, 95% CI:0.63-2.05, P = 0.672); PVAT[RCA]: SHR 1.16 [95% CI: 0.81-1.66], P = 0.417).

Conclusion

Measuring PVAT around either the right coronary artery or the aortic valve does not provide additional prognostic value beyond established risk factors for the prediction of MACE in patients undergoing TAVI.

Risk factors for preoperative frailty in older patients with gastric cancer: a systematic review and meta-analysis

PURPOSE

To summarize the available evidence on risk factors for preoperative frailty in older gastric cancer patients.

METHODS

We comprehensively searched the CNKI, Wanfang, VIP, CBM, PubMed, Embase, The Cochrane Library, Web of Science, and CINAHL databases for preoperative articles on risk factors for frailty in older gastric cancer patients. The search was conducted from the time of construction of the library to January 27, 2024, with no language restrictions. The quality of the included studies was rated by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality tool.

RESULTS

A total of 20 studies were included, including 16 cohort studies and 4 cross-sectional studies, with a total sample size of 51,717 individuals. The results of the meta-analysis showed that age, albumin, hemoglobin, cancer stage III-IV, Charlson Comorbidity Index score ≥ 3, Eastern Cooperative Oncology Group score > 2, American Society of Anesthesiologists score > 2, smoking, nutritional risk, high school degree or above, and sleep disorders are the main influencing factors for the occurrence of preoperative frailty in older gastric cancer patients. Among them, high school degree or above was a protective factor.

CONCLUSIONS

Our study provides valid evidence of risk factors for preoperative frailty in older patients with gastric cancer and informs clinical healthcare professionals to make targeted interventions.

Aging and putative frailty biomarkers are altered by spaceflight

Human space exploration poses inherent risks to astronauts' health, leading to molecular changes that can significantly impact their well-being. These alterations encompass genomic instability, mitochondrial dysfunction, increased inflammation, homeostatic dysregulation, and various epigenomic changes. Remarkably, these changes bear similarities to those observed during the aging process on Earth. However, our understanding of the connection between these molecular shifts and disease development in space remains limited. Frailty syndrome, a clinical syndrome associated with biological aging, has not been comprehensively investigated during spaceflight. To bridge this knowledge gap, we leveraged murine data obtained from NASA's GeneLab, along with astronaut data gathered from the JAXA and Inspiration4 missions. Our objective was to assess the presence of biological markers and pathways related to frailty, aging, and sarcopenia within the spaceflight context. Through our analysis, we identified notable changes in gene expression patterns that may be indicative of the development of a frailty-like condition during space missions. These findings suggest that the parallels between spaceflight and the aging process may extend to encompass frailty as well. Consequently, further investigations exploring the utility of a frailty index in monitoring astronaut health appear to be warranted.

Frailty phenotype as mediator between systemic inflammation and osteoporosis and fracture risks: A prospective study

BACKGROUND

Systemic inflammation and frailty have been implicated in osteoporosis (OP) and fracture risks; however, existing evidence remains limited and inconclusive. This study aimed to assess the associations of systemic inflammation and frailty phenotype with incident OP and fracture and to evaluate the mediating role of frailty phenotype.

METHODS

The present study analysed data from the UK Biobank, a comprehensive and representative dataset encompassing over 500 000 individuals from the general population. Baseline peripheral blood cell counts were employed to calculate the systemic inflammation markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII). Frailty phenotype was assessed using five criteria, defined as frail (≥3 items met), pre-frail (1-2 items met) and non-frail (0 items met). OP and fracture events were confirmed through participants' health-related records. Multivariable linear and Cox regression models were utilized, along with mediation analysis.

RESULTS

Increased systemic inflammation was associated with increased risks of OP and fracture. The corresponding hazard ratios and 95% confidence intervals (CIs) for OP risk per standard deviation increase in the log-transformed NLR, PLR and SII were 1.113 (1.093-1.132), 1.098 (1.079-1.118) and 1.092 (1.073-1.111), and for fracture risk, they were 1.066 (1.051-1.082), 1.059 (1.044-1.075) and 1.073 (1.058-1.089), respectively. Compared with the non-frail individuals, the pre-frail and frail ones showed an elevated OP risk by 21.2% (95% CI: 16.5-26.2%) and 111.0% (95% CI: 98.1-124.8%), respectively, and an elevated fracture risk by 6.1% (95% CI: 2.8-9.5%) and 38.2% (95% CI: 30.7-46.2%), respectively. The systemic inflammation level demonstrated a positive association with frailty, with β (95% CI) of 0.034 (0.031-0.037), 0.026 (0.023-0.029) and 0.008 (0.005-0.011) in response to per standard deviation increment in log-transformed SII, NLR and PLR, respectively. The frailty phenotype mediated the association between systemic inflammation and OP/fracture risk. Subgroup and sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS

Systemic inflammation and frailty phenotype are independently linked to increased risks of OP and fracture. The frailty phenotype partially mediates the association between systemic inflammation and osteoporotic traits. These results highlight the significance of interventions targeting systemic inflammation and frailty in OP and fracture prevention and management.

Serum biomarkers related to frailty predict negative outcomes in older adults with hip fracture

PURPOSE

Hip fracture is a public health problem worldwide. Traditional prognostic models do not include blood biomarkers, such as those obtained by proteomics. This study aimed to investigate the relationships between serum inflammatory biomarkers and frailty in older adults with hip fracture as well as adverse outcomes at one and three months after discharge.

METHODS

A total of 45 patients aged 75 or older who were admitted for hip fracture were recruited. At admission, a Comprehensive Geriatric Assessment (CGA) was conducted, which included a frailty assessment using the Clinical Frailty Scale (CFS). Blood samples were collected before surgery. Participants were followed up at one and three months after discharge. The levels of 45 cytokines were analyzed using a high-throughput proteomic approach. Binary logistic regression was used to determine independent associations with outcomes, such as functional recovery, polypharmacy, hospital readmission, and mortality.

RESULTS

The results showed that IL-7 (OR 0.66 95% CI 0.46-0.94, p = 0.022) and CXCL-12 (OR 0.97 95% CI 0.95-0.99, p = 0.011) were associated with better functional recovery at three months after discharge, while CXCL-8 (OR 1.07 95% CI 1.01-1.14, p = 0.019) was associated with an increased risk of readmission.

CONCLUSIONS

These findings suggest that immunology biomarkers may represent useful predictors of clinical outcomes in hip fracture patients.

Genetic predisposition to white blood cells in relation to the risk of frailty

BACKGROUND

Observational studies have suggested an association between white blood cells (WBCs) and frailty, but considering the susceptibility to reverse causality and confounding, the causal direction and magnitude of this association remain ambiguous. Our aim was to investigate the causal effect of WBCs on frailty by means of a Mendelian randomization (MR) analysis.

METHODS

Based on the genome-wide association study (GWAS) summary statistics data provided by the European Bioinformatics Institute (EBI), we carried out a two-sample MR study. We applied the genetically predicted independent WBCs from GWAS as a measure of exposure data. The Rockwood Frailty Index (FI) was used as outcome measure, which was derived from a meta-analysis from GWAS in UK Biobank European ancestry participants and Swedish TwinGene participants. Our study applied inverse variance weighted (IVW), weighted median, Mendelian randomization-Egger (MR-Egger) and outlier test (MR-PRESSO) methods to explore relationships between various WBCs and frailty.

RESULTS

In our study, a possible causal relationship between eosinophil levels and frailty was demonstrated by two-sample MR analysis. Eosinophils were associated with FI (beta:0.0609; 95% CI 0.0382, 0.0836; P = 1.38E-07). Our results suggest that as the level of eosinophils increases, so does the risk of frailty. No meaningful causal relationship between neutrophils, lymphocytes, monocytes or basophils and FI was found in the MR results (P > 0.05).

CONCLUSIONS

According to this MR study, higher eosinophil counts are related to an increased risk of frailty. To validate these findings and investigate the mechanisms underlying these connections, future studies are warranted.

Preoperative prognostic nutritional index is an independent indicator for perioperative prognosis in coronary artery bypass grafting patients

OBJECTIVES

The prognostic nutritional index is widely used for surgery prognosis, but the association between preoperative prognostic nutritional index and short-term prognosis for coronary artery bypass grafting surgery and the profiles of perioperative prognostic nutritional index remain unclear.

METHODS

This study retrospectively enrolled a total of 879 adult patients undergoing coronary artery bypass grafting surgery in the Shanghai Chest Hospital from 2006 to 2022. The prognostic nutritional index was calculated based on serum albumin and peripheral lymphocyte count. In-hospital mortality, demographic characteristics, blood biochemistry parameters, cardiovascular medical history, and physical examination results were collected from the hospital information system. The propensity score matching method and multivariate logistic regression were used to detect the association between preoperative prognostic nutritional index and in-hospital mortality.

RESULTS

Patients were divided into a high-prognostic nutritional index group (n = 500) and a low-prognostic nutritional index group (n = 379), using a cutoff value of 48.1 according to receiver operating characteristic curve analysis. The propensity score matching-adjusted mean prognostic nutritional index levels decreased from 48.35 before the operation to 34.04 an in ≤24 h after the operation and rebounded to 43.36 before discharge. High preoperative prognostic nutritional index was inversely associated with in-hospital mortality for coronary artery bypass grafting surgery (odds ratio = 0.86; 95% CI, 0.77-0.97) in propensity score matching-adjusted multivariate logistic regression.

CONCLUSIONS

Preoperative prognostic nutritional index is an independent indicator for in-hospital mortality of for coronary artery bypass grafting surgery, and the variation trend of prognostic nutritional index during perioperation tends to be U-shaped.

Adverse outcomes and health-ecological influencing factors of preoperative frailty among elderly patients with gastric cancer

PURPOSE

Frailty is defined as a state of decreased physiologic reserves arising from cumulative deficits in multiple homeostatic systems, which is important in the field of clinical oncology. We aimed to explore the relationship between preoperative frailty and adverse outcomes, and systematically analyze the factors influencing frailty based on the health ecology model among elderly gastric cancer patients.

METHODS

A observational study was conducted to select 406 elderly patients who would undergo gastric cancer surgery at a tertiary hospital. The logistic regression model was used to examine the relationship between preoperative frailty and adverse outcomes, including total complications, prolonged length of stay (PLOS), and 90-day hospital readmission. Based on the health ecology model, the factors which may influence frailty were collected from four levels. Univariate and multivariate analysis were utilized to determine the factors influencing preoperative frailty.

RESULTS

Preoperative frailty was associated with total complications (odds ratio [OR] 2.776, 95% confidence interval [CI] 1.588-4.852), PLOS (OR 2.338, 95%CI 1.342-4.073), and 90-day hospital readmission (OR 2.640, 95% CI 1.275-5.469). Besides, nutritional risk (OR 4.759, 95% CI 2.409-9.403), anemia (OR 3.160, 95% CI 1.751-5.701), number of comorbidity ≥ 2 (OR 2.318, 95% CI 1.253-4.291), low physical activity level (OR 3.069, 95% CI 1.164-8.092), apathetic attachment (OR 2.656, 95% CI 1.457-4.839), personal monthly income ≤ 1000 yuan (OR 2.033, 95% CI 1.137-3.635) and anxiety (OR 2.574, 95% CI 1.311-5.053) were independent risk factors for frailty. High physical activity level (OR 0.413, 95% CI 0.208-0.820) and improved objective support (OR 0.818, 95% CI 0.683-0.978) were independent protective factors for frailty.

CONCLUSIONS

Preoperative frailty was associated with multiple adverse outcomes and could be affected by factors of different dimensions from the health ecology perspective, including nutrition, anemia, comorbidity, physical activity, attachment style, objective support, anxiety, and income, which can guide the formation of a comprehensive prehabilitation for frailty among elderly gastric cancer patients.

The Prognostic Significance of Uric Acid/Albumin Ratio in Patients with Aortic Stenosis Following Transcatheter Aortic Valve Implantation for Major Adverse Cardiac and Cerebral Events

Background: The goal of this study was to examine if the uric acid/albumin ratio (UAR) could predict major adverse cardiac and cerebral events (MACCEs) such as stroke, readmission, and short-term all-cause death in aortic stenosis (AS) patients, after transcatheter aortic valve implantation (TAVI). Material and Methods: A total of 150 patients who had TAVI for AS between 2013 and 2022 were included in our study, retrospectively. Before the TAVI, each patient’s baseline uric acid/albumin was determined. The study’s major endpoint was MACCEs, which included stroke, re-hospitalization, and 12-month all-cause death. Results: The UAR was found to be higher in TAVI patients who developed MACCEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the UAR (HR: 95% CI; 2.478 (1.779–3.453) p < 0.01), was an independent predictor of MACCEs in AS patients after TAVI. The optimal value of the UAR for MACCEs in AS patients following TAVI was >1.68 with 88% sensitivity and 66% specificity (AUC (the area under the curve): 0.899, p < 0.01). We noted that the AUC of UAR in predicting MACCEs was significantly higher than the AUC of albumin (AUC: 0.823) and uric acid (AUC: 0.805, respectively). Conclusion: MACCEs in AS patients who received TAVI may be predicted by high pre-procedural uric acid/albumin levels. The uric acid/albumin ratio (UAR) can be used to determine MACCEs in such patients following TAVI because it is inexpensive and straightforward to calculate inflammatory parameters.

Chronic Coronary Syndrome in Frail Old Population

The demographic trend of aging is associated with an increased prevalence of comorbidities among the elderly. Physical, immunological, emotional and cognitive impairment, in the context of the advanced biological age segment, leads to the maintenance and precipitation of cardiovascular diseases. Thus, more and more data are focused on understanding the pathophysiological mechanisms underlying each fragility phenotype and how they potentiate each other. The implications of inflammation, sarcopenia, vitamin D deficiency and albumin, as dimensions inherent in fragility, in the development and setting of chronic coronary syndromes (CCSs) have proven their patent significance but are still open to research. At the same time, the literature speculates on the interdependent relationship between frailty and CCSs, revealing the role of the first one in the development of the second. In this sense, depression, disabilities, polypharmacy and even cognitive disorders in the elderly with ischemic cardiovascular disease mean a gradual and complex progression of frailty. The battery of tests necessary for the evaluation of the elderly with CCSs requires a permanent update, according to the latest guidelines, but also an individualized approach related to the degree of frailty and the conditions imposed by it. By summation, the knowledge of frailty screening methods, through the use of sensitive and individualized tools, is the foundation of secondary prevention and prognosis in the elderly with CCSs. Moreover, a comprehensive geriatric assessment remains the gold standard of the medical approach of these patients. The management of the frail elderly, with CCSs, brings new challenges, also from the perspective of the treatment particularities. Sometimes the risk–benefit balance is difficult to achieve. Therefore, the holistic, individualized and updated approach of these patients remains a desired objective, by understanding and permanently acquiring knowledge on the complexity of the frailty syndrome.

Frailty and cytokines in preclinical models: Comparisons with humans

Chronic low-grade elevations of blood-borne cytokines/chemokines in older age tend to associate with frailty in humans. This persistent inflammation is often called "inflammageing" and likely contributes to frailty progression. Preclinical models such as ageing and/or genetically modified mice offer a unique opportunity to mechanistically study how these inflammatory mediators affect frailty. In this review, we summarize and contrast evidence relating cytokines/chemokines to frailty in humans and in mouse models of frailty. In humans and mice, higher levels of the pro-inflammatory cytokine interleukin-6 regularly increased in proportion to the degree of frailty. Evidence linking other cytokines/chemokines to frailty in humans and mice is less certain. The chemokines CXCL-10 and monocyte chemoattractant protein-1 related to frailty across both species, but evidence is limited and inconsistent. Several other cytokines/chemokines, including tumour necrosis factor-α relate to frailty in humans or in mice, but evidence to date is species- and tissue-dependent. It is important for future studies to validate common mechanistic inflammatory biomarkers of frailty between humans and mice. Achieving this goal will accelerate the search for drugs to treat frailty.

Macrophages and monocytes mediated activation of oxidative phosphorylation implicated the prognosis and clinical therapeutic strategy of Wilms tumour

Wilms tumour is the fourth leading cause of paediatric malignancy, but the detailed relationship between the tumour microenvironment and prognosis remains largely unclear. In this research, gene expression profile and clinical information from TARGET and the First Affiliated Hospital of Anhui Medical University were collected. After comparing the prognostic value of the associated immune cells, we established a nomogram to predict the prognosis of Wilms tumour based on monocyte infiltration, macrophage infiltration, stage, and sex. Further results showed that the most significant relationship between matrix metallopeptidase 9 and prognosis or macrophage infiltration. Meanwhile, by gene set enrichment or variation analyses and immunohistochemistry staining, we demonstrated that the most highly enriched hub genes were closely related to the activated oxidative phosphorylation pathway. Finally, through tumour immune dysfunction and an exclusion algorithm, the satisfactory discriminative performance of our nomogram was revealed for predicting the response to clinical therapy. Anti-PD1 therapy is more suitable for Wilms tumour patients with high nomogram points, and chemotherapies are more effective for patients with low nomogram score.

Circulating Monocyte Subsets and Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR), as an alternative to open heart surgery, has revolutionized the treatment of severe aortic valve stenosis (AVS), the most common valvular disorder in the elderly. AVS is now considered a form of atherosclerosis and, like the latter, partly of inflammatory origin. Patients with high-grade AVS have a highly disturbed blood flow associated with high levels of shear stress. The immediate reopening of the valve during TAVR leads to a sudden restoration of a normal blood flow hemodynamic. Despite its good prognosis for patients, TAVR remains associated with bleeding or thrombotic postprocedural complications, involving mechanisms that are still poorly understood. Many studies report the close link between blood coagulation and inflammation, termed thromboinflammation, including monocytes as a major actor. The TAVR procedure represents a unique opportunity to study the influence of shear stress on human monocytes, key mediators of inflammation and hemostasis processes. The purpose of this study was to conduct a review of the literature to provide a comprehensive overview of the impact of TAVR on monocyte phenotype and subset repartition and the association of these parameters with the clinical outcomes of patients with severe AVS who underwent TAVR.

Inflammatory biomarkers in older adults with frailty: a systematic review and meta-analysis of cross-sectional studies

BACKGROUND

Systemic chronic inflammation has been proposed as an essential mediating factor in frailty, and several studies tested its relationship with frailty. However, the issue is still controversial.

OBJECTIVES

We identified observational studies and pooled their results to assess whether abnormal expression of inflammatory biomarkers is present in the blood of older adults with frailty.

METHODS

We conducted a systematic search on the Medline, Embase, and Web of Science database from inception to 1st September 2021. The quality of included studies was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies (JBI-MAStARI). Study heterogeneity was assessed with the Cochran Q test and I² statistic. Pooled estimates were obtained through random-effect models. Sensitivity analyses were conducted by excluding one of the studies. Egger's regression test and observation of funnel plots were used to detect small-study effects and publication bias. PROSPERO registration: CRD42020172853.

RESULT

A total of 53 cross-sectional studies corresponding to 56 independent study populations were included in this analysis. There were 31 study populations with three frailty categories (3144 frailty, 14,023 pre-frailty, 10,989 robust) and 25 study populations with two frailty categories (2576 frailty, 8368 non-frailty). This meta-analysis performed pooled analyses for the inflammatory biomarker leukocyte, lymphocytes, CRP, IL-6, IL-10, and TNF-α. Older adults with frailty had lower lymphocytes and higher interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) levels compared with the control group. However, there was no significant difference in leukocyte and IL-10 levels in the two groups.

CONCLUSIONS

These findings suggest that peripheral inflammatory biomarkers lymphocytes, IL-6, CRP, and TNF-α are related to frailty status. Our findings are not conclusive regarding the causal relationship between chronic inflammation and frailty, so the development of further longitudinal and well-designed studies focused on this is necessary.