Clinical research studyPrediction of Mortality Risk in the Elderly
Section snippets
Study Population and Outcome Ascertainment
The design of this single-center community-based prospective cohort study has been reported in detail.33 Briefly, 1567 men living independently in Zoetermeer, a medium-sized town in The Netherlands, were invited to join the study. Inclusion criteria were age more than 70 years and sufficient mobility to attend the baseline visit. A total of 403 men responded and gave written informed consent. The study was approved by the Medical Ethics Committee of the Erasmus University Hospital Rotterdam.
Results
During a follow-up period of 48 months (for survivors), 75 (19%) men died; the cause of death was CV disease in 31 of the men (8%). The mean time of death was 30 months since the study start (range, 3-47 months). The mean age of the cohort at study start was 78 years (range, 73-94 years), and their baseline characteristics are shown in Table 1.
The three different modalities of the Framingham Score and the PROCAM risk function did not discriminate all-cause or CV mortality (areas under the ROC
Discussion
The principal finding of the present study is that in the old and very old, CRP, IL-6, and the presence of carotid plaques seem to be particularly associated with a graded risk of all-cause and CV mortality. These markers of inflammation and atherosclerotic burden offer incremental prognostic value and allow good mortality risk prediction. Our findings expand the results of previous studies of the associations between inflammatory markers and morbidity/mortality in the elderly by demonstrating
Conclusion
In old and very old men, the risk of dying in the years to come is more adequately predicted by elevated levels of IL-6 and the presence of carotid plaques, whereas low IL-6 levels and fewer plaques predict survival. Conventional risk scores seem to perform unsatisfactorily in this age group.
Acknowledgments
The authors thank Hanneke van Meurs for performing the ultrasound measurements and gratefully appreciate the contribution of Dicky Mooiweer-Bogaerdt and Inge Haumersen to data collection. Andro Medical Research, Rotterdam, facilitated the investigation by offering assistance and its study center in the city of Zoetermeer. Finally, the cooperation of the city board and the general practitioners of the city of Zoetermeer is acknowledged.
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