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Qu S, Zhou M, Jiao S, Zhang Z, Xue K, Long J, Zha F, Chen Y, Li J, Yang Q, Wang Y. Optimizing acute stroke outcome prediction models: Comparison of generalized regression neural networks and logistic regressions. PLoS One 2022; 17:e0267747. [PMID: 35544482 PMCID: PMC9094516 DOI: 10.1371/journal.pone.0267747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Generalized regression neural network (GRNN) and logistic regression (LR) are extensively used in the medical field; however, the better model for predicting stroke outcome has not been established. The primary goal of this study was to compare the accuracies of GRNN and LR models to identify the most optimal model for the prediction of acute stroke outcome, as well as explore useful biomarkers for predicting the prognosis of acute stroke patients. Method In a single-center study, 216 (80% for the training set and 20% for the test set) acute stroke patients admitted to the Shenzhen Second People’s Hospital between December 2019 to June 2021 were retrospectively recruited. The functional outcomes of the patients were measured using Barthel Index (BI) on discharge. A training set was used to optimize the GRNN and LR models. The test set was utilized to validate and compare the performances of GRNN and LR in predicting acute stroke outcome based on the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and the Kappa value. Result The LR analysis showed that age, the National Institute Health Stroke Scale score, BI index, hemoglobin, and albumin were independently associated with stroke outcome. After validating in test set using these variables, we found that the GRNN model showed a better performance based on AUROC (0.931 vs 0.702), sensitivity (0.933 vs 0.700), specificity (0.889 vs 0.722), accuracy (0.896 vs 0.729), and the Kappa value (0.775 vs 0.416) than the LR model. Conclusion Overall, the GRNN model demonstrated superior performance to the LR model in predicting the prognosis of acute stroke patients. In addition to its advantage in not affected by implicit interactions and complex relationship in the data. Thus, we suggested that GRNN could be served as the optimal statistical model for acute stroke outcome prediction. Simultaneously, prospective validation based on more variables of the GRNN model for the prediction is required in future studies.
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Affiliation(s)
- Sheng Qu
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Mingchao Zhou
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Shengxiu Jiao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Zeyu Zhang
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Kaiwen Xue
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Jianjun Long
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Fubing Zha
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Yuan Chen
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Jiehui Li
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Qingqing Yang
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
- * E-mail:
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Couch C, Mallah K, Borucki DM, Bonilha HS, Tomlinson S. State of the science in inflammation and stroke recovery: A systematic review. Ann Phys Rehabil Med 2022; 65:101546. [PMID: 34098132 PMCID: PMC9018463 DOI: 10.1016/j.rehab.2021.101546] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/26/2021] [Accepted: 04/19/2021] [Indexed: 11/20/2022]
Abstract
Stroke is a major cause of mortality worldwide, and survivors often have major life-changing disabilities. Annually in the United States, an estimated 795,000 people experience a new or recurrent stroke. All types of stroke involve an inflammatory reaction that follows the initial phase of incidence. However, investigations into any links between inflammatory markers and recovery processes in the context of post-stroke rehabilitation are lacking. In this systematic review, we searched the literature in PubMed, SCOPUS, and CINAHL databases to gather information on inflammatory biomarkers related to stroke and their association with rehabilitation outcomes, according to PRISMA guidelines. Eleven articles (n=1.773 stroke patients) were selected. Immune markers (interleukin 6 [IL-6], C-reactive protein, IL-1α, tumor necrosis factor α, soluble intercellular adhesion molecule 1) and functional status assessments (Modified Rankin Score, National Institutes of Health Stroke Scale, Functional Independence Measure, etc.) were the primary measures used in the reviewed studies. We found preliminary evidence for the evaluation of inflammatory biomarkers post-stroke, including the role of inflammation in functional recovery and the influence of rehabilitation on inflammation. This is the first systematic review of the topic. The review identifies several gaps in the literature that are critical for understanding the potential use of inflammatory markers to improve post-stroke outcomes.
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Affiliation(s)
- Christine Couch
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB 204, MSC 504, Charleston, SC, 29425, USA; Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Khalil Mallah
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB 204, MSC 504, Charleston, SC, 29425, USA
| | - Davis M Borucki
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB 204, MSC 504, Charleston, SC, 29425, USA; Medical Scientist Training Program, Medical University of South Carolina, Charleston, SC, USA; Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Heather Shaw Bonilha
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Tomlinson
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB 204, MSC 504, Charleston, SC, 29425, USA; Ralph Johnson VA Medical Center, Charleston, SC, USA.
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Aquilani R, Zuccarelli GC, Maestri R, Boselli M, Dossena M, Baldissarro E, Boschi F, Buonocore D, Verri M. Essential amino acid supplementation is associated with reduced serum C-reactive protein levels and improved circulating lymphocytes in post-acute inflamed elderly patients. Int J Immunopathol Pharmacol 2021; 35:20587384211036823. [PMID: 34387512 PMCID: PMC8366127 DOI: 10.1177/20587384211036823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Persistent systemic inflammation leads to multidistrectual body dysfunctions. Attenuation of inflammation may improve patients’ functional and life prognoses. We hypothesized that essential amino acids (EAAs) given to elderly patients in rehabilitation after acute diseases may be associated with a reduced inflammatory state. Therefore, this retrospective study investigated whether the supplementation of EAAs – modulators of immune competence – was associated with a reduced inflammation rate in elderly patients. Methods The medical records of 282 patients admitted to the rehabilitation (rehab) institute after acute index events (surgery or medical diseases) (age: 81.18 ± 8.58 years; females: 67.9%) were analyzed. Results 46 patients (16.3% of the entire population) had received EAA supplements (S), whereas the remaining 236 patients had not (N-S). Systemic inflammation (I) (serum C-reactive protein (CRP) > 0.5 mg/dL) was present in 67.4% of the I-S group and 57.2% of the I-N-S group. During rehab, the I-S group (but not the I-N-S group) showed a reduction in CRP levels (p = 0.03) and an increase in circulating lymphocytes (p = 0.035), immune cells of the adaptive immune system. C-reactive protein levels remained virtually unchanged in non-inflamed patients who received supplements but increased in non-inflamed patients who did not receive supplements (p = 0.05). Stratified for developed infections, CRP levels reduced in S patients (p = 0.008) but did not in N-S patients. Conclusion EAA supplementation was associated with reduced inflammation in both inflamed and infected patients. In addition, EAA supplementation was associated with increased circulating lymphocytes in inflamed patients.
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Affiliation(s)
- Roberto Aquilani
- Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy
| | - Ginetto C Zuccarelli
- Geriatric Institute P. Redaelli - Reparti di Riabilitazione Geriatrica e di Mantenimento, Vimodrone (Milano), Italy
| | - Roberto Maestri
- Department of Biomedical Engineering of the Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Mirella Boselli
- Neurorehabilitation Unit of the Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Maurizia Dossena
- Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy
| | - Eleonora Baldissarro
- Complex Structure of Recovery and Functional Re-education - ASL 3, Genova, Italy
| | - Federica Boschi
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - Daniela Buonocore
- Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy
| | - Manuela Verri
- Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Pavia, Italy
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The relationship between plasma amino acids and circulating albumin and haemoglobin in postabsorptive stroke patients. PLoS One 2019; 14:e0219756. [PMID: 31412042 PMCID: PMC6693779 DOI: 10.1371/journal.pone.0219756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 07/01/2019] [Indexed: 01/15/2023] Open
Abstract
Background This retrospective study had two main aims: (1) to document possible correlations between plasma Amino Acids (AAs) and circulating Albumin (Alb) and Haemoglobin (Hb); and (2) to identify which AAs were predictors of Alb and Hb. Methods The study considered 125 stroke subjects (ST) (61.6% males; 65.6 +/- 14.9 years) who met the eligibility criteria (absence of co morbidities associated with altered plasma AAs and presence of plasma AAs determined after overnight fasting). Fifteen matched healthy subjects with measured plasma AAs served as controls. Results The best correlations of Alb were with tryptophan (Trp) and histidine (His) (r = + 0.53; p < 0.0001), and those of Hb were with histidine (r = +0.47) and Essential AAs (r = +0.47) (both p<0.0001). In multivariate analysis, Trp (p< 0.0001) and His (p = 0.01) were shown to be the best positive predictors of Alb, whereas glutamine (p = 0.006) was the best positive predictor of Hb. Conclusions The study shows that the majority of plasma AAs were positively correlated with Alb and Hb. The best predictors of circulating Alb and Hb were the levels of tryptophan and glutamine, respectively.
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Boselli M, Aquilani R, Maestri R, Achilli MP, Arrigoni N, Pasini E, Condino AM, Boschi F, Dossena M, Buonocore D, Verri M. Inflammation and rehabilitation outcomes in patients with nontraumatic intracranial haemorrhage. NeuroRehabilitation 2018; 42:449-456. [PMID: 29966209 DOI: 10.3233/nre-172362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Systemic inflammation and its impact on rehabilitation for patients with non-traumatic haemorrhagic injury (HBI) sequelae has not yet been adequately documented. OBJECTIVE AND METHODS We therefore considered 31 patients with HBI, to determine the serum levels of inflammatory markers (C-Reactive Protein, CRP and or interleukine-6, IL-6) to establish their impact on functional status (Functional Independence Measure, FIM: 18 indicating the worst performance and 126, a normal score). RESULTS The results showed an inflammation prevalence (CRP >0.5 mg/dl and/or IL 6 >7 pg/ml) of 74.2% at admission to Rehab. FIM reduction was more pronounced in inflamed compared to non-inflamed subjects (p < 0.05) and significantly correlated with blood variables sensitive to inflammation, such as alpha 1 globulin (r = - 0.565) and neutrophil/ lymphocyte ratio (r = - 0.52), CRP (r = - 0.365). At discharge from Rehab, the inflammation rate diminished. Inflamed patients showed similar gains in FIM score as their controls. In the entire population, the FIM gain was significantly associated with a gain in serum albumin, only (r = +0.56). CONCLUSIONS We conclude that systemic inflammation is prevalent in HBI patients and contributes to reduce patient functional status. However, during the Rehab stage, inflammation does not hinder the improvement rate of functional capacity.
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Affiliation(s)
- Mirella Boselli
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Roberto Maestri
- Dipartimento di Ingegneria Biomedica, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Maria Pia Achilli
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Nadia Arrigoni
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Evasio Pasini
- Divisione di Riabilitazione Cardiaca, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Brescia, Italy
| | - Anna Maria Condino
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - Maurizia Dossena
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Daniela Buonocore
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Manuela Verri
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
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Boselli M, Aquilani R, Maestri R, Achilli MP, Arrigoni N, Pasini E, Condino AM, Boschi F, Dossena M, Buonocore D, Verri M. Inflammation and rehabilitation outcomes in patients with nontraumatic intracranial haemorrhage. NeuroRehabilitation 2018:NRE182362. [PMID: 29660970 DOI: 10.3233/nre-182362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Systemic inflammation and its impact on rehabilitation for patients with non-traumatic haemorrhagic injury (HBI) sequelae has not yet been adequately documented. OBJECTIVE AND METHODS We therefore considered 31 patients with HBI, to determine the serum levels of inflammatory markers (C-Reactive Protein, CRP and or interleukine-6, IL-6) to establish their impact on functional status (Functional Independence Measure, FIM: 18 indicating the worst performance and 126, a normal score). RESULTS The results showed an inflammation prevalence (CRP >0.5 mg/dl and/or IL 6 >7 pg/ml) of 74.2% at admission to Rehab. FIM reduction was more pronounced in inflamed compared to non-inflamed subjects (p < 0.05) and significantly correlated with blood variables sensitive to inflammation, such as alpha 1 globulin (r = - 0.565) and neutrophil/ lymphocyte ratio (r = - 0.52), CRP (r = - 0.365). At discharge from Rehab, the inflammation rate diminished. Inflamed patients showed similar gains in FIM score as their controls. In the entire population, the FIM gain was significantly associated with a gain in serum albumin, only (r = +0.56). CONCLUSIONS We conclude that systemic inflammation is prevalent in HBI patients and contributes to reduce patient functional status. However, during the Rehab stage, inflammation does not hinder the improvement rate of functional capacity.
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Affiliation(s)
- Mirella Boselli
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Roberto Maestri
- Dipartimento di Ingegneria Biomedica, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Maria Pia Achilli
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Nadia Arrigoni
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Evasio Pasini
- Divisione di Riabilitazione Cardiaca, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Brescia, Italy
| | - Anna Maria Condino
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - Maurizia Dossena
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Daniela Buonocore
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Manuela Verri
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
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Verri M, Aquilani R, Ricevuti G, Rondanelli M, Ghitti M, Bongiorno AI, Venturini L, Buonocore D, Boschi F, Dossena M. Plasma energy substrates at two stages of Alzheimer’s disease in humans. Int J Immunopathol Pharmacol 2018. [PMCID: PMC6309029 DOI: 10.1177/2058738418817707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In Alzheimer’s disease (AD), the presence of amyloid-β peptide may impair cell
energy formation by altering both anaerobic and aerobic metabolism. This study
aimed to estimate possible alterations in circulating energy substrates. In 54
community-dwelling AD subjects, fasting peripheral venous blood samples were
drawn in the morning to determine the energy substrates lactate, pyruvate and
ketone bodies (KBs, β-hydroxybutyrate and acetoacetate). Plasma lactate levels
in the entire AD population were significantly lower than in healthy controls
(P < 0.01), whereas pyruvate concentrations were
similar. This is particularly evident in AD subjects with diagnosis time
>5 years. Moreover, both plasma lactate and pyruvate were lower in subjects
with AD >5 years than in subjects with AD ⩽5 years
(P < 0.001 for lactate; P = 0.04 for
pyruvate). KB concentrations were normal in both subgroups. Lactate was
inversely related to diagnosis time (r = −0.42; P = 0.002). In
conclusion, subjects with AD, particularly those with a longer diagnosis time,
show considerable reductions in circulating lactate and pyruvate as an
expression of altered muscular metabolic pathways that generate energy.
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Affiliation(s)
- Manuela Verri
- Dipartimento di Biologia e Biotecnologie ‘Lazzaro Spallanzani’, Università degli Studi di Pavia, Pavia, Italy
| | - Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie ‘Lazzaro Spallanzani’, Università degli Studi di Pavia, Pavia, Italy
| | - Giovanni Ricevuti
- Dipartimento di Medicina Interna e Terapia Medica, Università degli Studi di Pavia, Pavia, Italy
| | - Mariangela Rondanelli
- Dipartimento di Sanità Pubblica, Medicina Sperimentale e Forense, ASP–IDR S. Margherita, Università degli Studi di Pavia, Pavia, Italy
| | - Michele Ghitti
- Dipartimento di Scienze della Terra e dell’Ambiente, Università degli Studi di Pavia, Pavia, Italy
| | - Andria Innocenza Bongiorno
- Dipartimento di Biologia e Biotecnologie ‘Lazzaro Spallanzani’, Università degli Studi di Pavia, Pavia, Italy
| | - Letizia Venturini
- Dipartimento di Medicina Interna e Terapia Medica, Università degli Studi di Pavia, Pavia, Italy
| | - Daniela Buonocore
- Dipartimento di Biologia e Biotecnologie ‘Lazzaro Spallanzani’, Università degli Studi di Pavia, Pavia, Italy
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - Maurizia Dossena
- Dipartimento di Biologia e Biotecnologie ‘Lazzaro Spallanzani’, Università degli Studi di Pavia, Pavia, Italy
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Payne MA, Morley JE. Dysphagia: A New Geriatric Syndrome. J Am Med Dir Assoc 2017; 18:555-557. [DOI: 10.1016/j.jamda.2017.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/28/2017] [Indexed: 01/28/2023]
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Aquilani R, Zuccarelli GC, Condino AM, Catani M, Rutili C, Del Vecchio C, Pisano P, Verri M, Iadarola P, Viglio S, Boschi F. Despite Inflammation, Supplemented Essential Amino Acids May Improve Circulating Levels of Albumin and Haemoglobin in Patients after Hip Fractures. Nutrients 2017. [PMID: 28635634 PMCID: PMC5490616 DOI: 10.3390/nu9060637] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Essential amino acids (EAAs) are nutritional substrates that promote body protein synthesis; thus we hypothesised that their supplementation may improve circulating albumin (Alb) and haemoglobin (Hb) in rehabilitative elderly patients following hip fractures (HF). Out of the 145 HF patients originally enrolled in our study, 112 completed the protocol. These subjects were divided into two randomised groups, each containing 56 patients. For a period of two months, one group (age 81.4 ± 8.1 years; male/female 27/29) received a placebo, and the other (age 83.1 ± 7.5 years; male/female 25/31) received 4 + 4 g/day oral EAAs. At admission, the prevalence of both hypoAlb (<3.5 g/dL) and hypoHb (<13 g/dL male, <12 g/dL female) was similar in the placebo group (64.3% hypoAlb, 66% hypoHb) and the treated group of patients (73.2% hypoAlb, 67.8% hypoHb). At discharge, however, the prevalence of hypoAlb had reduced more in EAAs than in placebo subjects (31.7% in EAAs vs. 77.8% in placebo; p < 0.001). There was a 34.2% reduction of anaemia in hypoHb in EAA subjects and 18.9% in placebo subjects, but the difference was not statistically significant. Oral supplementation of EAAs improves hypoAlb and, to a lesser extent, Hb in elderly rehabilitative subjects with hip fractures. Anaemia was reduced in more than one third of patients, which, despite not being statistically significant, may be clinically relevant.
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Affiliation(s)
- Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1. I-27100 Pavia, Italy.
| | - Ginetto Carlo Zuccarelli
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Anna Maria Condino
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Viale Taramelli, 14. I-27100 Pavia, Italy.
| | - Michele Catani
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Carla Rutili
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Consiglia Del Vecchio
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Pietro Pisano
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Manuela Verri
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1. I-27100 Pavia, Italy.
| | - Paolo Iadarola
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1. I-27100 Pavia, Italy.
| | - Simona Viglio
- Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Viale Taramelli, 3/B. I-27100 Pavia, Italy.
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Viale Taramelli, 14. I-27100 Pavia, Italy.
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Unaffected arm muscle hypercatabolism in dysphagic subacute stroke patients: the effects of essential amino acid supplementation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:964365. [PMID: 25431770 PMCID: PMC4241696 DOI: 10.1155/2014/964365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 09/04/2014] [Accepted: 09/07/2014] [Indexed: 11/17/2022]
Abstract
Alterations in muscle protein turnover of the unaffected side of stroke patients could contribute to physical disability. We investigated whether hypercatabolic activity occurred in unaffected arm muscle and whether supplemented essential amino acids (EAAs) could limit muscle hypercatabolism (MH). Thirty-eight dysphagic subacute stroke subjects (<3 months after acute event) (29 males+9 females; 69.7±11.4 yrs) were enrolled and randomized to receive 8 g/day EAAs (n=19; EAA group) or isocaloric placebo (maltodextrin; n=19, Plac group). Before randomization, all patients had their arterial (A) and venous (V) amino acids measured and muscle (A-V) differences calculated in the unaffected arm. Eight matched and healthy subjects served as controls. When compared to healthy controls, the entire stroke population showed significant muscle release (=negative value A-V) of the amino acid phenylalanine (phenyl-) indicating a prevalence of MH. Moreover, randomized EAA and Plac groups had similar rates of MH. After 38 days from the start of the protocol, the EAA group but not the Plac group had MH converted to balanced protein turnover or anabolic activity. We concluded that muscle protein metabolism of the unaffected arm of dysphagic subacute stroke individuals could be characterized by MH which can be corrected by supplemented EAAs.
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