Magnus Harneshaug1, Lene Kirkhus2, Jūratė Šaltytė Benth3, Bjørn Henning Grønberg4, Sverre Bergh5, Jon Elling Whist6, Siri Rostoft7, Marit S Jordhøy8. 1. The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 4956, Nydalen, 0424 Oslo, Norway. Electronic address: Magnus.Harneshaug@sykehuset-innlandet.no. 2. The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 4956, Nydalen, 0424 Oslo, Norway. Electronic address: Lene.Kirkhus@sykehuset-innlandet.no. 3. The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2313 Ottestad, Norway; HØKH Research Centre, Akershus University Hospital, P.O. Box 1000, 1478 Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, P.O. Box 1171, 0318 Blinderen, Norway. Electronic address: jurate.saltyte-benth@medisin.uio.no. 4. The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, P.O. Box 3250, Sluppen, 7006 Trondheim, Norway; Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway. 5. The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2313 Ottestad, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway. Electronic address: Sverre.Bergh@sykehuset-innlandet.no. 6. The Department of Research, Innlandet Hospital Trust, P.O. Box 104, 2381 Brumunddal, Norway; Laboratory of Medical Biochemistry, Innlandet Hospital Trust, P.O. 2381, Brumunddal, Norway. Electronic address: Jon.Elling.Whist@sykehuset-innlandet.no. 7. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 4956, Nydalen, 0424 Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway. 8. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 4956, Nydalen, 0424 Oslo, Norway; The Cancer Unit, Innlandet Hospital Trust, Hamar Hospital, Skolegata 32, 2326 Hamar, Norway.
Abstract
INTRODUCTION: As frailty is associated with inflammation, biomarkers of inflammation may represent objective measures that could facilitate the identification of frailty. Glasgow prognostic score (GPS), combines C-reactive protein (CRP) and albumin, and is scored from 0 to 2 points. Higher score indicates a higher degree of inflammation. OBJECTIVES: To investigate whether (1) GPS is associated with frailty, (2) GPS could be used to screen for frailty, (3) IL-6 and TNF-α add to the accuracy of GPS as a screening tool, and (4) GPS adds prognostic information in frail older patients with cancer. METHODS: Prospective, observational study of 255 patients ≥70 years with solid malignant tumours referred for medical cancer treatment. At baseline, frail patients were identified by a modified Geriatric Assessment (mGA), and blood samples were collected. RESULTS: Mean age was 76.7 years, 49.8% were frail, and 56.1% had distant metastases. The proportion of frail patients increased with higher GPS (GPS zero: 43.2%, GPS one: 52.7%, GPS two: 94.7%). GPS two was significantly associated with frailty (OR 18.5), independent of cancer type, stage, BMI and the use of anti-inflammatory drugs. The specificity of GPS was high (99%), but the sensitivity was low (14%). Frail patients with GPS two had poorer survival than patients with GPS zero-one. TNF-α and IL-6 did not improve the accuracy of GPS when screening for frailty. CONCLUSION: Frailty and GPS two are strongly associated, and GPS two is a significant prognostic factor in frail, older patients with cancer. The inflammatory biomarkers investigated are not suitable screening tools for frailty.
INTRODUCTION: As frailty is associated with inflammation, biomarkers of inflammation may represent objective measures that could facilitate the identification of frailty. Glasgow prognostic score (GPS), combines C-reactive protein (CRP) and albumin, and is scored from 0 to 2 points. Higher score indicates a higher degree of inflammation. OBJECTIVES: To investigate whether (1) GPS is associated with frailty, (2) GPS could be used to screen for frailty, (3) IL-6 and TNF-α add to the accuracy of GPS as a screening tool, and (4) GPS adds prognostic information in frail older patients with cancer. METHODS: Prospective, observational study of 255 patients ≥70 years with solid malignant tumours referred for medical cancer treatment. At baseline, frail patients were identified by a modified Geriatric Assessment (mGA), and blood samples were collected. RESULTS: Mean age was 76.7 years, 49.8% were frail, and 56.1% had distant metastases. The proportion of frail patients increased with higher GPS (GPS zero: 43.2%, GPS one: 52.7%, GPS two: 94.7%). GPS two was significantly associated with frailty (OR 18.5), independent of cancer type, stage, BMI and the use of anti-inflammatory drugs. The specificity of GPS was high (99%), but the sensitivity was low (14%). Frail patients with GPS two had poorer survival than patients with GPS zero-one. TNF-α and IL-6 did not improve the accuracy of GPS when screening for frailty. CONCLUSION: Frailty and GPS two are strongly associated, and GPS two is a significant prognostic factor in frail, older patients with cancer. The inflammatory biomarkers investigated are not suitable screening tools for frailty.