Prognostic Value of Routinely Measured Inflammatory Biomarkers in Older Cancer Patients: Pooled Analysis of Three Cohorts

BACKGROUND: The prognostic assessment of older cancer patients is complicated by their heterogeneity. We aimed to assess the prognostic value of routine inflammatory biomarkers. METHODS: A pooled analysis of prospective multicenter cohorts of cancer patients aged >/=70 was performed. We measured CRP and albumin, and calculated Glasgow Prognostic Score (GPS) and CRP/albumin ratio. The GPS has three levels (0 = CRP /= 35 g/L, i.e., normal values; 1 = one abnormal value; 2 = two abnormal values). One-year mortality was assessed using Cox models. Discriminative power was assessed using Harrell's C index (C) and net reclassification improvement (NRI). RESULTS: Overall, 1800 patients were analyzed (mean age: 79 +/- 6; males: 62%; metastases: 38%). The GPS and CRP/albumin ratio were independently associated with mortality in patients not at risk of frailty (hazard ratio [95% confidence interval] = 4.48 [2.03-9.89] for GPS1, 11.64 [4.54-29.81] for GPS2, and 7.15 [3.22-15.90] for CRP/albumin ratio > 0.215) and in patients at risk of frailty (2.45 [1.79-3.34] for GPS1, 3.97 [2.93-5.37] for GPS2, and 2.81 [2.17-3.65] for CRP/albumin ratio > 0.215). The discriminative power of the baseline clinical model (C = 0.82 [0.80-0.83]) was increased by adding GPS (C = 0.84 [0.82-0.85]; NRI events (NRI+) = 10% [2-16]) and CRP/albumin ratio (C = 0.83 [0.82-0.85]; NRI+ = 14% [2-17]). CONCLUSIONS: Routine inflammatory biomarkers add prognostic value to clinical factors in older cancer patients

Assessing frailty in elderly community dwelling : interest and tools

L’objectif de la thèse était d’effectuer la validation psychométrique de la grille de fragilité SEGA modifiée (Short Emergency Geriatric Assessment) chez des sujets âgés vivant à domicile. Nous avons mené une étude longitudinale prospective dans deux régions françaises, incluant des sujets de 65 ans ou plus, vivant à domicile. Nous avons étudié l’acceptabilité et la faisabilité de l’instrument, sa validité de structure, sa fiabilité, sa validité discriminante, ainsi que sa capacité prédictive. Au total, 167 patients ont été inclus. Ils étaient âgés de 77 ± 7 ans, avec une majorité de femmes (70,7%). La faisabilité et acceptabilité du volet A de la grille SEGAm étaient excellentes : il n’y avait aucun refus de participation ni arrêt de passation, aucune donnée manquante ni aucun effet plancher ou plafond. Le temps moyen de passation était de 5,0 ± 3,5 min. Il s’agissait d’un outil unidimensionnel présentant une bonne cohérence interne (coefficient alpha de Cronbach à 0,68) et une bonne reproductibilité (coefficient de corrélation intraclasse à 0,88 pour le test-retest entre J0 et J7). La grille SEGAm avait également une très bonne capacité discriminante concernant l’état thymique, nutritionnel, l’équilibre, le niveau d’indépendance, et les comorbidités. La grille SEGAm avait une bonne capacité prédictive vis-à-vis de la perte d’indépendance ; le niveau de fragilité à l’inclusion était significativement associé à la perte d’indépendance à 12 mois (OR = 4,52 ; IC 95 % [1,40-14,68] ; p=0,01). La grille SEGAm nous apparaît comme un outil de choix dans la stratégie de dépistage de la fragilité en communauté, pour permettre la mise en place précoce d’interventions ciblées.We aimed to validate the modified version of the Short Emergency Geriatric Assessment (SEGAm) frailty instrument among elderly community-dwelling subjects. A longitudinal, prospective study was conducted in two French regions and subjects aged 65 years or more and living at home were included. For psychometric validation, feasibility, acceptability, internal structure validity, reliability, discriminant validity and predictive validity of the SEGAm instrument were studied. Overall, 167 patients were included. Average age was 77±7 years, the majority were women (70.7%). Feasibility and acceptability of the sheet A of the SEGAm instrument were excellent: no refusal to participate, no drop-out during administration, no missing items, no ceiling or floor effects were noted. Administration time was short (5.0±3.5 min). By factor analysis, the instrument proved to be unidimensional. It showed good internal consistency (Cronbach’s alpha coefficient: 0.68) and good test-retest (intra-class correlation: 0.88). Discriminant validity showed a significant difference for mood and depression risk, nutritional status, fall risk, dependency, and comorbidities. Frailty status at baseline was significantly associated with loss of autonomy at 12 months of follow-up (OR=4.52, 95% CI=1.40-14.68; p=0.01). The SEGAm appears to be an easy-to-use instrument that is particularly suitable for use in the community to identify frail elderly people who could benefit from early targeted interventions

Prognostic Value of Routinely Measured Inflammatory Biomarkers in Older Cancer Patients: Pooled Analysis of Three Cohorts

Background: The prognostic assessment of older cancer patients is complicated by their heterogeneity. We aimed to assess the prognostic value of routine inflammatory biomarkers. Methods: A pooled analysis of prospective multicenter cohorts of cancer patients aged ≥70 was performed. We measured CRP and albumin, and calculated Glasgow Prognostic Score (GPS) and CRP/albumin ratio. The GPS has three levels (0 = CRP ≤ 10 mg/L, albumin ≥ 35 g/L, i.e., normal values; 1 = one abnormal value; 2 = two abnormal values). One-year mortality was assessed using Cox models. Discriminative power was assessed using Harrell’s C index (C) and net reclassification improvement (NRI). Results: Overall, 1800 patients were analyzed (mean age: 79 ± 6; males: 62%; metastases: 38%). The GPS and CRP/albumin ratio were independently associated with mortality in patients not at risk of frailty (hazard ratio [95% confidence interval] = 4.48 [2.03–9.89] for GPS1, 11.64 [4.54–29.81] for GPS2, and 7.15 [3.22–15.90] for CRP/albumin ratio > 0.215) and in patients at risk of frailty (2.45 [1.79–3.34] for GPS1, 3.97 [2.93–5.37] for GPS2, and 2.81 [2.17–3.65] for CRP/albumin ratio > 0.215). The discriminative power of the baseline clinical model (C = 0.82 [0.80–0.83]) was increased by adding GPS (C = 0.84 [0.82–0.85]; NRI events (NRI+) = 10% [2–16]) and CRP/albumin ratio (C = 0.83 [0.82–0.85]; NRI+ = 14% [2–17]). Conclusions: Routine inflammatory biomarkers add prognostic value to clinical factors in older cancer patients

Dépistage de la fragilité du sujet âgé à domicile : validation de l'outil SEGA modifiè

REIMS-BU Santé (514542104) / SudocSudocFranceF

Most randomized controlled trials for psoriasis used placebo comparators despite the availability of effective treatments

International audienceBackground: The availability of effective treatments for psoriasis raises ethical questions about the use of a placebo group in therapeutic trials. We evaluated the use of the placebo over time in such trials.Methods: From trials in a living Cochrane review and network meta-analysis for psoriasis, we included trials comparing a biologic to a placebo or other systemic treatment. First, we tested the changes in placebo rate from 2001 to 2019 by linear regression, then constructed networks for 2004-2019 and evaluated the contribution of the placebo to the network meta-analysis estimates per trial and per comparison.Results: We included 81 trials (36,774 patients). The placebo rate did not decrease significantly over time. The proportion contribution of trials with a placebo decreased from 100% in 2004 to 86% in 2008 and 75% in 2019. However, the proportion contribution of trials without a placebo remained low (from 0% in 2004 to 25% in 2019).Conclusion: The design of future psoriasis trials should be reviewed to improve the number of patients to be included in a placebo group

Most randomized controlled trials for psoriasis used placebo comparators despite the availability of effective treatments

International audienceThe availability of effective treatments for psoriasis raises ethical questions about the use of a placebo group in therapeutic trials. We evaluated the use of the placebo over time in such trials

CBCT-Based Image Guidance for Percutaneous Access: Electromagnetic Navigation Versus 3D Image Fusion with Fluoroscopy Versus Combination of Both Technologies—A Phantom Study

International audienc

Adverse drug reactions in elderly patients with cognitive disorders: A systematic review

International audienc

Several frailty parameters highly prevalent in middle age (50–65) are independent predictors of adverse events

International audienceAbstract Although frailty can arise in middle age, very few studies have investigated frailty before 65 years. Our objectives were to assess the prevalence of frailty parameters in middle-aged individuals and probe the association with future adverse events. We performed cross-sectional and longitudinal analyses of community-dwelling individuals aged 50 to 65 (n = 411, median age: 59.0) having undergone a multidomain geriatric assessment (2010–2015) in an outpatient clinic in the greater Paris area of France (SUCCEED cohort). The primary outcome was a composite measure of adverse events (non-accidental falls, fractures, unplanned hospitalizations, death), recorded in 2016/2017. Multivariable logistic regression models were built to identify independent predictors. Six frailty parameters were highly prevalent (> 20%): low activity (40.1%), exhaustion (31.3%), living alone (28.5%), balance impairment (26.8%), weakness (26.7%), and executive dysfunction (23.2%). Female sex (odds ratio: 2.67 [95% confidence interval: 1.17–6.11]), living alone (2.39 [1.32–4.33]), balance impairment (2.09 [1.16–3.78]), executive dysfunction (2.61, [1.18–5.77]), and exhaustion (2.98 [1.65–5.39]) were independent predictors of adverse events. Many frailty parameters are already altered in middle-aged individuals and are predictive of adverse health events. Our findings highlight a possible need for frailty screening and preventive programs targeting middle-aged individuals