Functional measures, inflammatory markers and endothelin-1 as predictors of 360-day survival in centenarians

Abstract

Centenarians represent a rapidly growing population. To better characterize this specific age group, we have performed a cross-sectional study to observe associations between functional measures and a range of biochemical markers, including inflammatory markers and their significance as predictors of 360-day survival. Medical history and physical and functional assessment (Mini-Mental State Examination (MMSE), Katz Index (activities of daily living, ADL) and Barthel Index (Barthel Index) of Activities of Daily Living, and Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)) were conducted on 86 101.9 ± 1.2-year-old (mean ± SD) subjects (70 women, 16 men). Blood tests were performed on 84 subjects of whom 43 also had extended biomarker assessment. As a reference group 30 51.8 ± 5.0-year old healthy subjects (20 women, 10 men) were recruited. The centenarians received follow-up phone calls. Fifty-two centenarians (60 %) survived ≥360 days. Longer survival was associated with higher MMSE (hazard ratio, HR = 0.934, 95 % confidence interval (CI) 0.896–0.975, P = .002), ADL (HR = 0.840, 95 % CI 0.716–0.985, P = .032), Barthel Index (HR = 0.988, 95 % CI 0.977–0.999, P = .026), and albumin level (HR .926, 95 % CI 0.870–0.986, P .016) and with lower white blood cell (WBC) (HR = 1.161, 95 % CI 1.059–1.273, P = .001), C-reactive protein (CRP) (HR = 1.032, 95 % CI 1.014–1.050, P < .001), IL-6 (HR = 1.182, 95 % CI 1.047–1.335, P = .007), and endothelin-1 (ET-1) level (HR = 3.711, 95 % CI 1.233–11.169, P = .020). Centenarians had higher 360-day survival probability with MMSE ≥13 (P < .001), ADL ≥1 (P < .001), Barthel Index ≥15 (P < .001), Lawton IADL ≥10 points (P = .009), WBC <8.3 G/L (P = .039), CRP <10 mg/L (P < .001), IL-6 <6 pg/mL (P .002), and ET-1 <1.1 pg/mL (P .007). Our results indicate that functional measures, inflammatory markers, and endothelin-1 are predictors of 360-day survival in centenarians.

Heterogeneity in functional status among moderately frail older adults: improving predictive performance using a modified approach of subgrouping the Clinical Frailty Scale

“…Findings in this study are consistent with an earlier study which reported that disability in bADLs is a strong predictor of survival amongst centenarians [ 20 ]. A recent study reported an adjusted hazard ratio per disability increment in KI of 1.6 among hospitalised patients aged 83 years and above [ 21 ].…”

Comparing the predictive accuracy of frailty, comorbidity, and disability for mortality: a 1-year follow-up in patients hospitalized in geriatric wards

“…Several different instruments for evaluating frailty, comorbidity, or disability have been developed. 4 , 5 , 20 , 22 , 23 , 49 – 51 , 53 It might be misleading to compare our findings with those obtained using other instruments than were applied in the study presented here for assessing frailty, comorbidity, or disability.…”

“… 50 ADL disability in the items of the Katz index was at least as powerful in predicting 360-day mortality as ADL disability based on the Barthel index in 86 centenarians (102±1 years old). 51 ADL disability according to the Katz index had the highest impact on mortality during a mean follow-up period of 2.8 years, among other parameters, in 1,099 older Swedish persons with an age of 77–100 years from the Kungsholmen Project. 42 …”

“…Among comorbidity instruments, the CIRS-G and, with respect to disability instruments, disability in ADLs that construct the Katz index have been found to be powerful predictors of mortality in previous comparative studies in older people. 49 – 51 The CIRS-G and the Geriatric Index of Comorbidity revealed the largest coefficient of determination for 1-year mortality among six comorbidity indexes including the CIRS-G, the Charlson Comorbidity Index, Index of Coexistent Diseases, Kaplan, Geriatric Index of Comorbidity, and Chronic Disease Score in 444 older patients (mean age of 85 years) discharged from an acute geriatric hospital in Switzerland. 49 The CIRS-G and the Charlson Comorbidity Index revealed a good and comparable ability to predict 3-month mortality in a cohort of older individuals.…”

C‐reactive protein and ageing

“…Physical activity has protective effects on ageing and data have shown that high levels of house work and recreational activity are independently associated with lower CRP levels in the elderly . In an observational study of 360‐day survival in centenarians, higher CRP level was found to be inversely associated with lower survival time . In a 10‐year follow‐up of the Framingham Offspring Study including 934 participants aged ≥60 years, McCabe et al.…”