Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
TraceAge-DFG Research Unit on Interactions of Essential Trace Elements in Healthy and Diseased Elderly, Potsdam-Berlin-Jena-Wuppertal, Germany.
J Gerontol A Biol Sci Med Sci. 2024 Dec 1;79(12). doi: 10.1093/gerona/glae243.
In older patients, frailty and anemia frequently coexist. However, only few studies have been conducted in older patients with multimorbidity and several overlapping causes of anemia, such as inflammation, inadequate nutrition, or certain pathologies. This analysis aims to decipher potential factors associated with anemia in older hospital patients with frailty.
Patients (n = 208, age: 62-98 years) were categorized as prefrail (n = 68) and frail (n = 140) using the Fried frailty phenotype. We quantified serum concentrations of markers of iron metabolism (iron, ferritin, transferrin, soluble transferrin receptor, and hepcidin), inflammation (interleukin [IL]-6 and IL-10 C-reactive protein), and hematology (hemoglobin). Principal component analysis was conducted to evaluate biomarker patterns and associations with frailty were assessed with logistic regression analysis.
Anemia prevalence was higher in patients with frailty (84.3% vs 70.6%, p = .021). Three principal components (PC1-3) were identified. PC1 was characterized by high factor loadings representing inflammation and factor scores differed between patients with prefrailty and frailty (-0.04 (interquartile range [IQR]: 1.45) vs -0.51 (IQR: 0.87), p < .001]. PC2 represents macrocytic anemia and thus vitamin B12 or folate deficiency, whereas PC3 indicates hematological pathologies. Only PC1 was associated with frailty status when controlled for age, sex, number of drugs, and comorbidities (OR: 2.018, 95% CI: 1.316; 3.094, p = .001). PC2 and PC3 were not associated with frailty.
Our results suggest that anemia in patients with frailty is driven by inflammation rather than being disease-related or solely the result of micronutrient deficiencies.
在老年患者中，衰弱和贫血常常同时存在。然而，只有少数研究针对患有多种合并症和多种贫血病因（如炎症、营养不足或某些疾病）的老年患者进行了研究。本分析旨在探讨与衰弱的老年住院患者贫血相关的潜在因素。
患者（n=208，年龄 62-98 岁）根据 Fried 衰弱表型分为衰弱前期（n=68）和衰弱（n=140）。我们定量检测了血清中铁代谢标志物（铁、铁蛋白、转铁蛋白、可溶性转铁蛋白受体和铁调素）、炎症标志物（白细胞介素[IL]-6 和 IL-10、C 反应蛋白）和血液学标志物（血红蛋白）的浓度。采用主成分分析评估生物标志物模式，并采用逻辑回归分析评估与衰弱的相关性。
衰弱患者贫血的患病率更高（84.3% vs 70.6%，p=0.021）。确定了三个主成分（PC1-3）。PC1 特征是炎症的高因子负荷，衰弱前期和衰弱患者的因子评分存在差异（-0.04（四分位距[IQR]：1.45） vs -0.51（IQR：0.87），p<0.001）。PC2 代表巨幼细胞性贫血，因此可能存在维生素 B12 或叶酸缺乏，而 PC3 表示血液系统疾病。在校正年龄、性别、药物数量和合并症后，只有 PC1 与衰弱状态相关（OR：2.018，95%CI：1.316；3.094，p=0.001）。PC2 和 PC3 与衰弱无关。
我们的结果表明，衰弱患者的贫血是由炎症引起的，而不是由疾病引起的，也不仅仅是由于微量营养素缺乏。
