Evaluation And Prediction Of Response To Recombinant Human Erythropoietin In Anemia Of Chronic Disease With Senile Patients

Objective (1)To observe the laboratory features of senile patients with anemia of chronic disease (ACD). (2) To observe the therapeutic effects who were applied Recombinant human erythropoietin (rhEPo) eight weeks in senile patients with anemia of chronic disease, and to filtrate the best predictive value of various parameters.Methods The questionnaires were done among 74 senile patients who were divided into nonanemia group, ACD group and IDA group. The level of serum EPO, hemoglobin(Hb), reticulocyte count(Ret), total iron binding capacity(TIBC), serum iron (SI), serum ferritin serum(SF) and serum transferrin receptor(sTfR) were measured. the laboratory features were observed. (2) rhEPO was applied eight weeks with 32 senile AcD patients and effectivity was defined as a Hb increase ≥20g/L. The level of serum EPO, Hb, Ret, TIBC, SI, SF and sTfR were measured. We observed the therapeutic effects and examined the predictive value of various parameters.Results (1) The AcD group had mild or moderate anemia. The Ret level of ACD group was higher than those nonanemia group. The serum ferritin level and The LgEPO level of ACD group were lower than those nonanemia group. Compared with iron deficiency anemia, the levels of EPO with ACD patients were lower, but they had similar anemia levels (P<0.05). (2)After eight weeks’treatments, the levels of reticulocyte counts、 serum ferritin and lgEPO raised, the levels of serum transferrin receptors depressed.By the treatments, the Hb and sTfR were increased, and both SI and LgSF were decreased (P<0.05) in 32 senile AcD patients.20 in the 32 senile AcD patients achieved effective treatments. Multiple regression analysis indicated that hemoglobin level change was negatively correlated with LgEPO and sTfR. By prior standard, all patients were divided two groups:effective groups and noneffective groups, then we began STfR and Lg EPO ROC curve analysis.the area under curves of Lg EPO is bigger (AUC:0.81,P<0.05,95% Confidence interval:0.627～0.993) and the cutoff was EPO≤58mIu/mL by the largest Youden exponent. and The serum EPO≥58mIu/mL may predict good response to rhEPO treatment.Conclusions (1)The level of TIBC of ACD group was lower than normal person, and the level of serum iron protein was increased significantly. The level of STfR of ACD group was in the normal range, so we considered the phenomenon of abnormal iron metabolism existed.Compared with iron deficiency anemia, the levels of EPO with ACD patients were lower, if they had similar anemia levels.(2)This study suggested that rhEPO treatment can get better effects in some older ACD patients, improved their clinical signs and the qualities of life. Some elderly ACD patients resisted the rhEPO treatment, even if the increasement with EPO’s content we were very difficult to achieve the predetermined goal of treatment. Application of rhEPO treatment, clinicians should pay attention to the adverse reactions. Elderly patients proned to fluctuations in blood pressure, heart failure, adverse reaction in the treatment of rhEPO, we need to strengthen the monitoring of blood pressure and cardiac function, in order to reduce the occurrence of cerebrovascular accident.The EPO’s level in patients has the best predictive value with Clinical application of rhEPO in ACD, the level of EPO≤58mIu/mLmeaned curative effect, whereas it meaned poor effect.