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.

中文翻译：

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解开虚弱中的贫血：探索炎症的作用


背景 在老年患者中，虚弱和贫血经常共存。然而，只有少数研究是在患有多病共存和几种重叠的贫血原因（如炎症、营养不足或某些病症）的老年患者中进行的。该分析旨在破译与老年医院虚弱患者贫血相关的潜在因素。方法 使用 Fried 衰弱表型将患者 （n=208，年龄： 62-98 岁） 分为衰弱前期 （n=68） 和虚弱 （n=140）。我们量化了铁代谢标志物 （铁、铁蛋白、转铁蛋白、可溶性转铁蛋白受体、铁调素） 、炎症 （白细胞介素 （IL） 6、IL-10 C 反应蛋白） 和血液学 （血红蛋白） 标志物的血清浓度。进行主成分分析以评估生物标志物模式，并通过 logistic 回归分析评估与衰弱的关联。结果 衰弱患者贫血患病率较高 （84.3% vs 70.6%，p=0.021）。确定了 3 个主要成分 （PC1-3）。PC1 的特征是代表炎症的高因子负荷，衰弱前期和衰弱患者之间的因子评分不同 [-0.04 （IQR：1.45） vs -0.51 （IQR：0.87），p<0.001]。PC2 代表大细胞性贫血，因此代表维生素 B12 或叶酸缺乏，而 PC3 代表血液学病理。当控制年龄、性别、药物数量和合并症时，只有 PC1 与虚弱状态相关 （OR： 2.018,95% CI： 1.316;3.094，p=0.001）。PC2 和 PC3 与虚弱无关。结论 我们的结果表明，虚弱患者的贫血是由炎症驱动的，而不是与疾病相关或仅仅是微量营养素缺乏的结果。