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重组促红细胞生成素对住院老年人贫血、身体功能及认知评估的影响

Impact of recombinant erythropoietin on anemia, physical function, and cognitive assessment in hospitalized older adults.

作者信息

Castelli Roberto, Mannucci Pier Mannuccio, Delitala Alessandro Palmerio, Atzori Sebastiana, Bergamaschini Luigi, Sechi Gemma Lisa, Manetti Roberto, Budroni Chiara, Gidaro Antonio

机构信息

Dipartimento di Medicina, Chirurgia e Farmacia, Università degli Studi di Sassari e Azienda Ospedaliera Universitaria di Sassari, Viale San Pietro 8, Sassari, Italy.

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.

出版信息

Intern Emerg Med. 2025 Sep 2. doi: 10.1007/s11739-025-04038-7.


DOI:10.1007/s11739-025-04038-7
PMID:40897956
Abstract

Anemia is frequent in older adults. The essential mechanisms underlying its pathogenesis and relationship with clinical outcomes have been investigated. Erythroid-stimulating agents, particularly recombinant erythropoietin (EPO), corrected anemia in older adults and improved their clinical outcomes. Notwithstanding, many questions remain unanswered. The aim of this study was to correlate a few components of the comprehensive geriatric assessment, such as frailty index, time to up and go test, and mini mental state examination with hemoglobin levels (Hb) after treatment with EPO and blood transfusion, and to determine improvements in outcomes after treatment. 256 patients with anemia aged 65 or older were evaluated, but only 101 hospitalized cases completed the follow-up. They were allocated to three groups: group 1 received recombinant EPO 40,000 U/week, group 2 EPO 4000 U three times a week, and group 3 transfusions as needed. No statistically significant difference was observed between group 1 and group 2. All patients underwent a geriatric evaluation based on the time up and go test (TUGT), the mini mental test, the frailty index, and the occurrence of events such as delirium and falls. EPO resulted in erythroid response in nearly 70% of the treated cases and increased Hb (p < 0.001). There was no correlation between anemia and mortality or adverse events, except for such cardiovascular events as heart failure, angina, and syncope. There was a correlation of Hb levels with less frailty and falls (p < 0.001). EPO treatment was also associated with functional improvement, as indicated by TUGT. These findings indirectly support the view that anemia is an independent risk factor for executive function impairment in hospitalized older adults.

摘要

贫血在老年人中很常见。其发病机制的基本原理以及与临床结局的关系已得到研究。促红细胞生成剂,特别是重组促红细胞生成素(EPO),可纠正老年人的贫血并改善其临床结局。尽管如此,许多问题仍未得到解答。本研究的目的是将综合老年评估的一些组成部分,如衰弱指数、从坐到站测试时间和简易精神状态检查,与EPO和输血治疗后的血红蛋白水平(Hb)相关联,并确定治疗后结局的改善情况。对256名65岁及以上的贫血患者进行了评估,但只有101例住院病例完成了随访。他们被分为三组:第1组每周接受重组EPO 40,000单位,第2组每周三次接受EPO 4000单位,第3组根据需要进行输血。第1组和第2组之间未观察到统计学上的显著差异。所有患者均根据从坐到站测试(TUGT)、简易精神测试、衰弱指数以及谵妄和跌倒等事件的发生情况进行了老年评估。EPO在近70%的治疗病例中导致了红细胞反应,并提高了Hb水平(p < 0.001)。除了心力衰竭、心绞痛和晕厥等心血管事件外,贫血与死亡率或不良事件之间没有相关性。Hb水平与较少的衰弱和跌倒相关(p < 0.001)。如TUGT所示,EPO治疗也与功能改善相关。这些发现间接支持了贫血是住院老年人执行功能障碍独立危险因素的观点。

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[1]
Impact of recombinant erythropoietin on anemia, physical function, and cognitive assessment in hospitalized older adults.

Intern Emerg Med. 2025-9-2

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本文引用的文献

[1]
Inhibition of alternative complement system and prolyl hydroxylase ameliorates anaemia of inflammation.

Inflammopharmacology. 2025-2

[2]
Challenges and recent advances in erythropoietin stability.

Pharm Dev Technol. 2024-11

[3]
Unwarranted clinical practice variation and resource overutilization in medical care: The example of transfusion practices in elderly hospital patients.

Eur J Intern Med. 2023-9

[4]
The Role of Inflammation in Age-Associated Changes in Red Blood System.

Int J Mol Sci. 2023-5-18

[5]
Role of Erythropoiesis-Stimulating Agents in Cardiovascular Protection in CKD Patients: Reappraisal of Their Impact and Mechanisms.

Cardiovasc Drugs Ther. 2023-12

[6]
Evaluation of the use of erythropoietin-stimulating agents in a hospital setting to assess the necessity of a protocol-driven anemia management service.

Proc (Bayl Univ Med Cent). 2020-2-27

[7]
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Blood Adv. 2019-4-23

[8]
Management of Cancer-Associated Anemia With Erythropoiesis-Stimulating Agents: ASCO/ASH Clinical Practice Guideline Update.

J Clin Oncol. 2019-4-10

[9]
Anemia of inflammation.

Blood. 2018-11-6

[10]
Management of anemia in low-risk myelodysplastic syndromes treated with erythropoiesis-stimulating agents newer and older agents.

Med Oncol. 2018-4-19

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