Abstract
Background: The presence of oxidative stress, telomere shortening, and apoptosis in polypathological patients (PP) with sarcopenia and frailty remains unknown. Methods: Multicentric prospective observational study in order to assess oxidative stress markers (catalase, glutathione reductase (GR), total antioxidant capacity to reactive oxygen species (TAC-ROS), and superoxide dismutase (SOD)), absolute telomere length (aTL), and apoptosis (DNA fragmentation) in peripheral blood samples of a hospital-based population of PP. Associations of these biomarkers to sarcopenia, frailty, functional status, and 12-month mortality were analyzed. Results: Of the 444 recruited patients, 97 (21.8%), 278 (62.6%), and 80 (18%) were sarcopenic, frail, or both, respectively. Oxidative stress markers (lower TAC-ROS and higher SOD) were significantly enhanced and aTL significantly shortened in patients with sarcopenia, frailty or both syndromes. No evidence of apoptosis was detected in blood leukocytes of any of the patients. Both oxidative stress markers (GR, p = 0.04) and telomere shortening (p = 0.001) were associated to death risk and to less survival days. Conclusions: Oxidative stress markers and telomere length were enhanced and shortened, respectively, in blood samples of polypathological patients with sarcopenia and/or frailty. Both were associated to decreased survival. They could be useful in the clinical practice to assess vulnerable populations with multimorbidity and of potential interest as therapeutic targets.
Highlights
As a result of populations’ aging throughout the world, the prevalence of chronic conditions has drastically increased; these coexist frequently in the same patient, conditioning deleterious relationships, faster clinical and functional deterioration, poorer quality of life, and higher mortality
A detailed clinical description of the included patients has already been published [7]; briefly, sarcopenia was more frequent in men, and associated to chronic lung diseases, cancer, lower BMI, and previous hospital admissions, whereas frailty was more frequent in women and associated to a higher number of polypathology categories, chronic pain, anxiety, and pressure ulcers; both phenotypes shared association with age, asthenia, and lower BI scores
Sarcopenia was prevalent in our cohort of polypathological patients and was associated to a significant higher superoxide dismutase (SOD) activity; other oxidative stress markers activity was elevated, and the TAC-reactive oxygen species (ROS) decreased, but differences in these last were not significant
Summary
As a result of populations’ aging throughout the world, the prevalence of chronic conditions has drastically increased; these coexist frequently in the same patient, conditioning deleterious relationships, faster clinical and functional deterioration, poorer quality of life, and higher mortality. Frailty has been associated to inflammation pathways (demonstrated in the case of C-reactive protein, interleukin-1β, the IL-1 receptor antagonist, IL-18, and tumor necrosis factor alpha), unspecific immunological alterations linked to immunosenescence (mainly thymus involution and the corresponding decrease of T and B lymphocyte precursors and the reduction in the proliferative capacity of the T and B lymphocytes), and oxidative stress [12,13,14]. From these data, the narrow relation between frailty and sarcopenia can be extracted. We hypothesized that all these biological markers have a deep impact and association to sarcopenia and frailty
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