Disentangling Anemia in Frailty: Exploring the role of Inflammation.

Catrin Herpich, Lea Göger, Lea Faust, Magdalena Kalymon, Christiane Ott, Sophia Walter, Elke Lehmkuhl, Tilman Grune, Varvara Moskiou, Ursula Müller-Werdan, Kristina Norman
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Abstract

Background: 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.

Methods: Patients (n=208, age: 62-98 years) were categorized as pre-frail (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, hepcidin), inflammation (interleukin (IL) 6, IL-10 C-reactive protein) and haematology (hemoglobin). Principal component analysis was conducted to evaluate biomarker patterns and associations with frailty were assessed with logistic regression analysis.

Results: Anemia prevalence was higher in patients with frailty (84.3% versus 70.6%, p=0.021). Three principal components (PC1-3) were identified. PC1 was characterized by high factor loadings representing inflammation and factor scores differed between patients with pre-frailty and frailty [-0.04 (IQR:1.45) versus -0.51 (IQR:0.87), p<0.001]. 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=0.001). PC2 and PC3 were not associated with frailty.

Conclusion: 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.

厘清虚弱中的贫血:探索炎症的作用
背景:在老年患者中,虚弱和贫血经常同时存在。然而,针对老年患者的研究却寥寥无几,这些患者多病共存,而且贫血的原因也相互重叠,如炎症、营养不足或某些病症。本分析旨在解读与老年虚弱住院患者贫血相关的潜在因素:采用弗里德虚弱表型将患者(208 人,年龄 62-98 岁)分为虚弱前期(68 人)和虚弱期(140 人)。我们对血清中铁代谢标记物(铁、铁蛋白、转铁蛋白、可溶性转铁蛋白受体、血红细胞生成素)、炎症(白细胞介素(IL)6、IL-10 C-反应蛋白)和血液学(血红蛋白)的浓度进行了量化。通过主成分分析评估了生物标志物的模式,并通过逻辑回归分析评估了与虚弱的关系:结果:虚弱患者的贫血发生率更高(84.3% 对 70.6%,P=0.021)。确定了三个主成分(PC1-3)。PC1 的特点是代表炎症的因子载荷较高,且虚弱前期和虚弱期患者的因子得分不同[-0.04 (IQR:1.45) 对 -0.51 (IQR:0.87), p结论:我们的研究结果表明,虚弱患者的贫血是由炎症引起的,而不是与疾病相关或仅仅是微量元素缺乏的结果。
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