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Bisogno G, Minard-Colin V, Arush MB, Daragjati J, Coppadoro B, Gallego S, Alaggio R, Smeulders N, Mudry P, Zin A, Merks JHM, Slater O. Congenital rhabdomyosarcoma: A report from the European paediatric Soft tissue sarcoma Study Group. Pediatr Blood Cancer 2022; 69:e29376. [PMID: 34582098 DOI: 10.1002/pbc.29376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 11/09/2022]
Abstract
PROCEDURE Congenital rhabdomyosarcoma (RMS) represents a challenging disease due to its characteristics and the difficulties in delivering treatment in this immature population. METHODS We analyzed treatment and outcome of patients with congenital RMS, defined as tumor diagnosed in the first 2 months of life, enrolled in the European paediatric Soft tissue sarcoma Study Group protocols. RESULTS Twenty-four patients with congenital RMS were registered. All, except one patient (PAX3-FOXO1-positive metastatic RMS), had favorable histology and localized disease. Three patients had VGLL2-CITED2/NCOA2 fusion. Complete tumor resection was achieved in 10 patients. No radiotherapy was given. Chemotherapy doses were adjusted to age and weight. Only two patients required further dose reduction for toxicity. The 5-year event-free survival (EFS) and overall survival (OS) were 75.0% (95% confidence interval [CI] 52.6-87.9) and 87.3% (95% CI 65.6-95.7), respectively. Progressive disease was the main cause of treatment failure. CONCLUSION Patients with congenital RMS presented with a favorable disease, allowing weight- and age-adjusted doses of chemotherapy and avoidance of irradiation, without compromising the outcome.
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Affiliation(s)
- Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | | | - Myriam Ben Arush
- Joan and Sanford Weill Pediatric Hematology Oncology and Bone Marrow Transplantation Division, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Julia Daragjati
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Soledad Gallego
- Servicio de Oncología y Hematología Pediatrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rita Alaggio
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Naima Smeulders
- Departments of Paediatric Oncology and Paediatric Urology, Great Ormond Street Hospital for Children, London, UK
| | - Peter Mudry
- Pediatric Oncology Department, Children's Hospital Brno, Brno, Czech Republic
| | - Angelica Zin
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | | | - Olga Slater
- Departments of Paediatric Oncology and Paediatric Urology, Great Ormond Street Hospital for Children, London, UK
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Pilotto A, Veronese N, Daragjati J, Cruz-Jentoft AJ, Polidori MC, Mattace-Raso F, Paccalin M, Topinkova E, Siri G, Greco A, Mangoni AA, Maggi S, Ferrucci L. Using the Multidimensional Prognostic Index to Predict Clinical Outcomes of Hospitalized Older Persons: A Prospective, Multicenter, International Study. J Gerontol A Biol Sci Med Sci 2020; 74:1643-1649. [PMID: 30329033 DOI: 10.1093/gerona/gly239] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multidimensional Prognostic Index (MPI) is useful as a prognostic tool in hospitalized older patients, but our knowledge is derived from retrospective studies. We therefore aimed to evaluate in a multicenter, longitudinal, cohort study whether the MPI at hospital admission is useful to identify groups with different mortality risk and whether MPI at discharge may predict institutionalization, rehospitalization, and use of home care services during 12 months. METHODS This longitudinal study, carried out between February 2015 and August 2017, included nine public hospitals in Europe and Australia. A standardized comprehensive geriatric assessment including information on functional, nutritional, cognitive status, risk of pressure sores, comorbidities, medications, and cohabitation status was used to calculate the MPI and to categorize participants in low, moderate, and severe risk of mortality. Data regarding mortality, institutionalization, rehospitalization, and use of home care services were recorded through administrative information. RESULTS Altogether, 1,140 hospitalized patients (mean age 84.1 years, women = 60.8%) were included. In the multivariable analysis, compared to patients with low risk group at admission, patients in moderate (odds ratio [OR] = 3.32; 95% CI: 1.79-6.17; p < .001) and severe risk (OR = 10.72, 95% CI: 5.70-20.18, p < .0001) groups were at higher risk of overall mortality. Among the 984 older patients with follow-up data available, those in the severe-risk group experienced a higher risk of overall mortality, institutionalization, rehospitalization, and access to home care services. CONCLUSIONS In this cohort of hospitalized older adults, higher MPI values are associated with higher mortality and other negative outcomes. Multidimensional assessment of older people admitted to hospital may facilitate appropriate clinical and postdischarge management.
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Affiliation(s)
- Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy
| | - Nicola Veronese
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy
| | | | | | | | - Francesco Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc Paccalin
- Geriatrics Department, Poitiers University Hospital, France.,Centre Investigation Clinique 1402, University of Poitiers, France
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Giacomo Siri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy
| | - Antonio Greco
- Geriatrics Unit, IRCCS CSS, San Giovanni Rotondo, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide, Australia
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Cruz-Jentoft AJ, Daragjati J, Fratiglioni L, Maggi S, Mangoni AA, Mattace-Raso F, Paccalin M, Polidori MC, Topinkova E, Ferrucci L, Pilotto A. Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons: results and final recommendations from the MPI_AGE European Project. Aging Clin Exp Res 2020; 32:861-868. [PMID: 32180170 DOI: 10.1007/s40520-020-01516-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
MPI_AGE is a European Union co-funded research project aimed to use the Multidimensional Prognostic Index (MPI), a validated Comprehensive Geriatric Assessment (CGA)-based prognostic tool, to develop predictive rules that guide clinical and management decisions in older people in different European countries. A series of international studies performed in different settings have shown that the MPI is useful to predict mortality and risk of hospitalization in community-dwelling older subjects at population level. Furthermore, studies performed in older people who underwent a CGA before admission to a nursing home or receiving homecare services showed that the MPI successfully identified groups of persons who could benefit, in terms of reduced mortality, of specific therapies such as statins in diabetes mellitus and coronary artery disease, anticoagulants in atrial fibrillation and antidementia drugs in cognitive decline. A prospective trial carried out in nine hospitals in Europe and Australia demonstrated that the MPI was able to predict not only in-hospital and long-term mortality, but also institutionalization, re-hospitalization and receiving homecare services during the one-year follow-up after hospital discharge. The project also explored the association between MPI and mortality in hospitalized older patients in need of complex procedures such as transcatheter aortic valve implantation or enteral tube feeding. Evidence from these studies has prompted the MPI_AGE Investigators to formulate recommendations for healthcare providers, policy makers and the general population which may help to improve the cost-effectiveness of appropriate health care interventions for older patients.
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Veronese N, Cella A, Cruz-Jentoft AJ, Polidori MC, Mattace-Raso F, Paccalin M, Topinkova E, Greco A, Mangoni AA, Daragjati J, Siri G, Pilotto A. Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study. Clin Nutr 2019; 39:1608-1612. [PMID: 31378515 DOI: 10.1016/j.clnu.2019.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/07/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. METHODS Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. RESULTS 1064 patients were included, with 79 (13 in MPI 1-2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19-3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09-3.76), but not in MPI 1-2 class patients (OR = 1.51; 95%CI: 0.44-5.25). The use of propensity score confirmed these findings. CONCLUSIONS ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF.
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Affiliation(s)
- Nicola Veronese
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy; Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy.
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy
| | | | | | - Francesco Mattace-Raso
- Section of Geriatric Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc Paccalin
- Geriatrics Department University Hospital Poitiers, France
| | - Eva Topinkova
- First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Antonio Greco
- Geriatrics Unit, IRCCS CSS, San Giovanni Rotondo, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Julia Daragjati
- Geriatrics Unit, AULSS 6 Euganea, San Antonio Hospital, Padova, Italy
| | - Giacomo Siri
- Scientific Coordination Unit, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy; Department of Interdisciplinary Medicine, 'Aldo Moro' University of Bari, Italy
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Pilotto A, Dini S, Veronese N, Daragjati J, Miolo M, Mion MM, Fontana A, Lo Storto M, Zaninotto M, Bragato G, Cella A, Carraro P, Addante F, Copetti M, Plebani M. Multidimensional Prognostic Index and pro-adrenomedullin plasma levels as mortality risk predictors in older patients hospitalized with community-acquired pneumonia: a prospective study. Panminerva Med 2018; 60:80-85. [DOI: 10.23736/s0031-0808.18.03408-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Volpato S, Custureri R, Puntoni M, Bianchi L, Daragjati J, Garaboldi S, Simonato M, Greco A, Rizzo E, Santo PD, Mangiacotti A, Zigoura E, Siri G, Pilotto A. Effects of oral amino acid supplementation on Multidimensional Prognostic Index in hospitalized older patients: a multicenter randomized, double-blind, placebo-controlled pilot study. Clin Interv Aging 2018; 13:633-640. [PMID: 29713147 PMCID: PMC5908340 DOI: 10.2147/cia.s154998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is not known whether amino acid supplementations may influence health status in hospitalized older acutely ill patients. Aim The aim of this study was to determine whether nutritional supplementation with amino acids (Aminoglutam®) is associated with multidimensional improvement assessed with the Multidimensional Prognostic Index (MPI). Methods In this randomized, double-blind, placebo-controlled pilot clinical trial, 126 patients aged ≥65 years were enrolled from 6 Italian geriatric wards. A multidimensional assessment to calculate the MPI was performed at baseline and after 4 weeks of treatment with nutritional supplementation (96 kcal, 12 g amino acids, 0.18 g fat, 11.6 g carbohydrate, and vitamins B1, B6, and C) or placebo administered twice a day. Logistic regression modeling was applied to determine the effect of treatment on the improvement of MPI (vs no-change/worsening), adjusting for gender, age, and MPI at baseline. Treatment's interactions with age, gender, and MPI at baseline were tested adding the appropriate interaction parameter in the regression models. Results Of the 126 patients included, 117 patients (93%) completed the study. A significant improvement in the MPI score was detected in the overall population (mean difference post-pretreatment: -0.03, p=0.001), with no differences between active and placebo arms. Men in the amino acid supplementation group had a significantly higher rate of improvement in MPI (81%) compared to the placebo group (46%) (Fisher's exact test p=0.03). Adjusting for age, diagnosis, and MPI at baseline, amino acid treatment was shown to be associated with an improvement in MPI in men (OR=4.82, 95% confidence interval [CI]: 0.87-26.7) and not in women (OR=0.70, 95% CI: 0.27-1.81). The interaction effect between active treatment and gender was significant (p=0.04). Conclusion A 4-week amino acid supplementation improved the MPI significantly in hospitalized older male patients but not in female patients. Further studies are needed to confirm the gender effect of amino acid supplementation on MPI in older patients.
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Affiliation(s)
- Stefano Volpato
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Romina Custureri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Matteo Puntoni
- Clinical Trial Unit, Scientific Directorate, E.O. Galliera Hospital, Genoa, Italy
| | - Lara Bianchi
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Julia Daragjati
- Geriatrics Unit, San Antonio Hospital, ULSS 6 Euganea, Padova, Italy
| | - Sara Garaboldi
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Matteo Simonato
- Geriatrics Unit, San Antonio Hospital, ULSS 6 Euganea, Padova, Italy
| | - Antonio Greco
- Geriatrics Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Emanuele Rizzo
- Geriatrics Unit, ULSS 2 Marca Trevigiana, Montebelluna, Italy
| | | | - Antonio Mangiacotti
- Geriatrics Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Ekaterini Zigoura
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Giacomo Siri
- Clinical Trial Unit, Scientific Directorate, E.O. Galliera Hospital, Genoa, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
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Pilotto A, Dini S, Daragjati J, Miolo M, Mion MM, Fontana A, Storto ML, Zaninotto M, Cella A, Carraro P, Addante F, Copetti M, Plebani M. Combined use of the multidimensional prognostic index (MPI) and procalcitonin serum levels in predicting 1-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP): a prospective study. Aging Clin Exp Res 2018; 30:193-197. [PMID: 28417242 DOI: 10.1007/s40520-017-0759-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several scores and biomarkers, i.e., procalcitonin (PCT), were proposed to stratify the mortality risk in community-acquired pneumonia (CAP). AIM Evaluating prognostic accuracy of PCT and Multidimensional Prognostic Index (MPI) for 1-month mortality risk in older patients with CAP. METHODS At hospital admission and at discharge, patients were evaluated by a Comprehensive Geriatric Assessment to calculate MPI. Serum PCT was measured at admission and 1, 3, and 5 days after hospital admission. RESULTS 49 patients were enrolled. The overall 1-month mortality was 44.5 for 100-persons year. Mortality rates were higher with the increasing of MPI. In survived patients, MPI at discharge showed higher predictive accuracy than MPI at admission. Adding PCT levels to admission MPI prognostic accuracy for 1-month mortality significantly increased. CONCLUSION In older patients with CAP, MPI significantly predicted 1 month mortality. PCT levels significantly improved the accuracy of MPI at admission in predicting 1-month mortality.
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Affiliation(s)
- Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance & High Specialization Hospital, Mura delle Cappuccine 14, Genova, 16128, Italy.
| | - Simone Dini
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance & High Specialization Hospital, Mura delle Cappuccine 14, Genova, 16128, Italy
| | | | - Manuela Miolo
- Department of Laboratory Medicine, Azienda ULSS 16 and Azienda Ospedaliera, Padova, Italy
| | - Monica Maria Mion
- Department of Laboratory Medicine, Azienda ULSS 16 and Azienda Ospedaliera, Padova, Italy
| | - Andrea Fontana
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Martina Zaninotto
- Department of Laboratory Medicine, Azienda ULSS 16 and Azienda Ospedaliera, Padova, Italy
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance & High Specialization Hospital, Mura delle Cappuccine 14, Genova, 16128, Italy
| | - Paolo Carraro
- Department of Laboratory Medicine, Azienda ULSS 16 and Azienda Ospedaliera, Padova, Italy
| | - Filomena Addante
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Mario Plebani
- Department of Laboratory Medicine, Azienda ULSS 16 and Azienda Ospedaliera, Padova, Italy
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Pilotto A, Cella A, Pilotto A, Daragjati J, Veronese N, Musacchio C, Mello AM, Logroscino G, Padovani A, Prete C, Panza F. Three Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions. J Am Med Dir Assoc 2017; 18:192.e1-192.e11. [DOI: 10.1016/j.jamda.2016.11.004] [Citation(s) in RCA: 225] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 12/27/2022]
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Pilotto A, Gallina P, Panza F, Copetti M, Cella A, Cruz-Jentoft A, Daragjati J, Ferrucci L, Maggi S, Mattace-Raso F, Paccalin M, Polidori MC, Topinkova E, Trifirò G, Welmer AK, Strandberg T, Marchionni N. Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease. Am J Cardiol 2016; 118:1624-1630. [PMID: 27670793 DOI: 10.1016/j.amjcard.2016.08.042] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 01/14/2023]
Abstract
Clinical decision-making for statin treatment in older patients with coronary artery disease (CAD) is under debate, particularly in community-dwelling frail patients at high risk of death. In this retrospective observational study on 2,597 community-dwelling patients aged ≥65 years with a previous hospitalization for CAD, we estimated mortality risk assessed with the Multidimensional Prognostic Index (MPI), based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA), used to determine accessibility to homecare services/nursing home admission in 2005 to 2013 in the Padua Health District, Veneto, Italy. Participants were categorized as having mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) baseline mortality risk, and propensity score-adjusted hazard ratios (HRs) of 3-year mortality rate were calculated according to statin treatment in these subgroups. Greater MPI-SVaMA scores were associated with lower rates of statin treatment and higher 3-year mortality rate (MPI-SVaMA-1 = 23.4%; MPI-SVaMA-2 = 39.1%; MPI-SVaMA-3 = 76.2%). After adjusting for propensity score quintiles, statin treatment was associated with lower 3-year mortality risk irrespective of MPI-SVaMA group (HRs [95% confidence intervals] 0.45 [0.37 to 0.55], 0.44 [0.36 to 0.53], and 0.28 [0.21 to 0.39] in MPI-SVaMA-1, -2, and -3 groups, respectively [interaction test p = 0.202]). Subgroup analyses showed that statin treatment was also beneficial irrespective of age (HRs [95% confidence intervals] 0.38 [0.27 to 0.53], 0.45 [0.38 to 0.54], and 0.44 [0.37 to 0.54] in 65 to 74, 75 to 84, and ≥85 year age groups, respectively [interaction test p = 0.597]). In conclusion, in community-dwelling frail older patients with CAD, statin treatment was significantly associated with reduced 3-year mortality rate irrespective of age and multidimensional impairment, although the frailest patients were less likely to be treated with statins.
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Affiliation(s)
- Alberto Pilotto
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy; Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padua, Italy
| | | | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Cella
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy
| | | | - Julia Daragjati
- Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padua, Italy
| | | | - Stefania Maggi
- National Research Council, Neuroscience Section, Padua, Italy
| | | | | | - Maria Cristina Polidori
- Unit for Aging Clinical Research, Department of Medicine II, University of Cologne, Cologne, Germany
| | | | - Gianluca Trifirò
- Erasmus Medical Center, Rotterdam, The Netherlands; University of Messina, Messina, Italy
| | | | - Timo Strandberg
- Geriatric Clinic, Department of Medicine, University of Helsinki, Helsinki, Finland; Institute of Health Sciences/Geriatrics, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Niccolò Marchionni
- Division of Geriatric Cardiology and Medicine, University of Florence, Florence, Italy
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Abstract
Studies on populations at different ages have shown that after birth, the gastrointestinal (GI) microbiota composition keeps evolving, and this seems to occur especially in old age. Significant changes in GI microbiota composition in older subjects have been reported in relation to diet, drug use and the settings where the older subjects are living, that is, in community nursing homes or in a hospital. Moreover, changes in microbiota composition in the old age have been related to immunosenescence and inflammatory processes that are pathophysiological mechanisms involved in the pathways of frailty. Frailty is an age-related condition of increased vulnerability to stresses due to the impairment in multiple inter-related physiologic systems that are associated with an increased risk of adverse outcomes, such as falls, delirium, institutionalization, hospitalization and death. Preliminary data suggest that changes in microbiota composition may contribute to the variations in the biological, clinical, functional and psycho-social domains that occur in the frail older subjects. Multidimensional evaluation tools based on a Comprehensive Geriatric Assessment (CGA) have demonstrated to be useful in identifying and measuring the severity of frailty in older subjects. Thus, a CGA approach should be used more widely in clinical practice to evaluate the multidimensional effects potentially related to GI microbiota composition of the older subjects. Probiotics have been shown to be effective in restoring the microbiota changes of older subjects, promoting different aspects of health in elderly people as improving immune function and reducing inflammation. Whether modulation of GI microbiota composition, with multi-targeted interventions, could have an effect on the prevention of frailty remains to be further investigated in the perspective of improving the health status of frail 'high risk' older individuals.
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Affiliation(s)
- Anna Maria Mello
- Department of Orthogeriatrics, Rehabilitation and Stabilization, Frailty Area, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genova, Italy
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Volpato S, Daragjati J, Simonato M, Fontana A, Ferrucci L, Pilotto A. Change in the Multidimensional Prognostic Index Score During Hospitalization in Older Patients. Rejuvenation Res 2016; 19:244-51. [PMID: 26905632 DOI: 10.1089/rej.2015.1715] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We investigated and describe change in the Multidimensional Prognostic Index (MPI) score between admission and discharge in 960 older patients admitted to 20 geriatric units for an acute disease or a relapse of a chronic disease. The MPI was calculated at admission and at discharge. Subjects were divided into three groups of MPI score, low risk (MPI-1 value ≤0.33), moderate risk (MPI-2 value 0.34-0.66), and severe risk of mortality (MPI-3 value ≥0.67), on the basis of previously established cutoffs. Variation of MPI values over length of hospital stay (LOS) was analyzed with a multivariable longitudinal linear model for repeated measurements. At admission, 23.5% subjects had an MPI-1 score, 33.3% had an MPI-2 score, and 43.0% had an MPI-3 score. Overall, for almost 60% of the patients, MPI score at hospital discharge was different compared with the score at admission, although the difference was not statistically significant (-0.003; p = 0.708). Patients with high and intermediate MPI scores at admission had a decrease of MPI score at discharge (delta-MPI -0.026, p < 0.001, and delta-MPI -0.066, p = 0.569, respectively), whereas patients in the MPI-low group, experienced a significant increase in MPI score (delta-MPI 0.041, p < 0.001). The evolution of MPI score as a function of LOS had a curvilinear shape because it significantly decreased for patients with short hospitalization (1-6 days) and tended to increase for those with longer LOS. The MPI, a well-established prognostic tool, is sensitive to change of patient's health status and might be used to objectively track and monitor the clinical evolution of acutely ill geriatric patients admitted to the hospital.
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Affiliation(s)
- Stefano Volpato
- 1 Internal Medicine Section, Department of Medical Science, University of Ferrara , Italy
| | - Julia Daragjati
- 2 Geriatric Unit, Azienda ULSS 16 Padova , Padova, Italy .,3 Geriatric-Gerontology Research Unit, Scientific Institute for Research and Care , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Andrea Fontana
- 4 Unit of Biostatistics, Scientific Institute for Research and Care , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Luigi Ferrucci
- 5 Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging , Baltimore, Maryland
| | - Alberto Pilotto
- 2 Geriatric Unit, Azienda ULSS 16 Padova , Padova, Italy .,3 Geriatric-Gerontology Research Unit, Scientific Institute for Research and Care , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy .,6 Department of Geriatric Care, OrthoGeriatrics and Rehabilitation-Frailty Area, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genova, Italy
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Pilotto A, Arboretti Giancristofaro R, Panza F, Daragjati J, Prete C, Polidori M, Cella A, Maggi S. O-053: Role of anti-dementia drugs and multidimensional impairment on mortality rates in frail multimorbid older patients with dementia: results from the European MPI_AGE project. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30066-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Daragjati J, Pilotto A. P-400: The Multidimensional Prognostic Index (MPI) predicts central nervous system-related adverse drug events (CNS-ADRs) in older patients admitted to hospital: a prospective 3-year observational study. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
INTRODUCTION The cytochrome P450 (CYP) enzymes oxidize about 80% of the most commonly used drugs. Older patients form a very interesting clinical group in which an increased prevalence of adverse drug reactions (ADRs) and therapeutic failures (TFs) is observed. Might CYP drug metabolism change with age, and justify the differences in drug response observed in a geriatric setting? AREAS COVERED A complete overview of the CYP pharmacogenetics with a focus on the epigenetic CYP gene regulation by DNA methylation in the context of advancing age, in which DNA methylation might change. EXPERT OPINION Responder phenotypes consist of a continuum spanning from ADRs to TFs, with the best responders at the midpoint. CYP genetics is the basis of this continuum on which environmental and physiological factors act, modeling the phenotype observed in clinical practice. Physiological age-related changes in DNA methylation, the main epigenetic mechanisms regulating gene expression in humans, results in a physiological decrease in CYP gene expression with advancing age. This may be one of the physiological changes that, together with increased drug use, contributed to the higher prevalence of ADRs and TFs observed in the geriatric setting, thus, making geriatrics a special group for pharmacogenetics.
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Affiliation(s)
- Davide Seripa
- IRCCS Casa Sollievo della Sofferenza, Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences , San Giovanni Rotondo, Foggia , Italy
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Pilotto A, Sancarlo D, Daragjati J, Panza F. Perspective: the challenge of clinical decision-making for drug treatment in older people. The role of multidimensional assessment and prognosis. Front Med (Lausanne) 2015; 1:61. [PMID: 25593930 PMCID: PMC4294213 DOI: 10.3389/fmed.2014.00061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/24/2014] [Indexed: 01/10/2023] Open
Abstract
A complex decision path with a careful evaluation of the risk-benefit ratio is mandatory for drug treatment in advanced age. Enrollment biases in randomized clinical trials (RCTs) cause an under-representation of older individuals. In high-risk frail older subjects, the lack of RCTs makes clinical decision-making particularly difficult. Frail individuals are markedly susceptible to adverse drug reactions, and frailty may result in reduced treatment efficacy. Life expectancy should be included in clinical decision-making paths to better assess the benefits and risks of different drug treatments in advanced age. We performed a scoping review of principal hospital- and community-based prognostic indices in older age. Mortality prognostic tools could help clinical decision-making in diagnostics and therapeutics, tailoring appropriate intervention for older patients. The effectiveness of drug treatments may be significantly different in older patients with different risk of mortality. Clinicians need to consider the prognostic information obtained through well-validated, accurate, and calibrated predictive tools to identify those patients who may benefit from drug treatments given with the aim of increasing survival.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Azienda ULSS 16 Padova, Hospital S. Antonio , Padova , Italy ; Geriatric Unit, Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Daniele Sancarlo
- Geriatric Unit, Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Julia Daragjati
- Geriatrics Unit, Azienda ULSS 16 Padova, Hospital S. Antonio , Padova , Italy ; Geriatric Unit, Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Francesco Panza
- Geriatric Unit, Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy ; Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari , Italy
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