MPI

Mannose-6-phosphate isomerase (EC 5.3.1.8) (Phosphohexomutase) (Phosphomannose isomerase) (PMI) [PMI1]

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Age-related decline of lymphatic drainage from the eye: A noninvasive in vivo photoacoustic tomography study.

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We aim to determine whether lymphatic drainage from the eye changes with age. Using quantitative photoacoustic tomography, groups of young and older mice were studied in the live state. 10 CD-1 mice of 2-3 months (5M/5F) were studied in addition to 13 older mice of 12-13 months (6M/7F). In each of 23 mice, near-infrared tracer (a near-infrared dye, QC-1 conjugated with Bovine Serum Albumin) was injected into the right eye, and imaging of ipsilateral cervical lymph nodes was performed with laser pulses at 11 different wavelengths prior to and 20 min, 2, 4 and 6 h after injection. Mean pixel intensities (MPIs) of nodes were calculated at each imaging session. The areas under the curves (AUC) were calculated for both groups of mice and compared using the t-test. The slopes of MPI of each region of interest were compared using the linear mixed model before and after adjusting for sex, body weight and intraocular pressure of the right eye. The mean intraocular pressure of right eyes before injection was similar in older and younger groups (12.77 ± 2.01 mmHg and 12.90 ± 2.38 mmHg, respectively; p = 0.888). In each mouse, the photoacoustic signal was detected in the right cervical lymph nodes at the 2-h time point following tracer injection into the right eye. At the 4 and 6 h imaging times, a steady increase of tracer signal was observed. Areas under the curve in the right cervical nodes were decreased significantly in older mice compared to younger mice (p = 0.007). The slopes of MPI in the nodes were significantly decreased in old mice compared to young mice both before and after adjusting for sex, body weight and intraocular pressure of the right eye (p = 0.003). In conclusion, lymphatic drainage from the eye is significantly reduced in older eyes. This finding suggests that impaired lymphatic clearance of aqueous humor, proteins and antigens from the eye may contribute to age-related disease of the eye such as glaucoma and inflammatory eye disease.

Keywords

Age-related
Aging
Aqueous humor
Drainage
Eye
Glaucoma
Imaging
In vivo
Lymph node
Lymphatic
Mice
Photoacoustic tomography
Uveoscleral

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Interest of the multidimensional prognostic index (MPI) as an assessment tool in hospitalized patients in geriatrics.

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Reducing Potentially Inappropriate Medications in Older Adults: A Way Forward.

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La réduction des médicaments potentiellement inappropriés (MPI) chez les personnes âgées est un enjeu important selon de nombreux cliniciens et chercheurs à travers le monde, car ces médicaments accroissent significativement la morbidité et la mortalité dans la population plus âgée. La prévalence des MPI est un problème répandu malgré l'existence de plusieurs critères explicites et implicites de réduction des MPI chez les personnes âgées, les plus courants étant les critères de Beers, les critères STOPP/START et plusieurs critères nationaux spécifiques. Cette revue non systématique visait à examiner les critères de référence pour la réduction des MPI et à clarifier le rôle de certaines mesures, dont la déprescription, pour optimiser la prescription des médicaments chez les personnes âgées. Des recherches par mots-clés et termes MeSH ont été menées dans des bases de données électroniques. Les nombreux critères disponibles ont chacun leurs avantages et inconvénients. La déprescription, qui vise à réduire l'utilisation des MPI, a considérablement gagné en importance dans les initiatives associées à l'amélioration des pratiques de prescription. La déprescription est une approche méthodique qui implique l'arrêt graduel, éclairé et individualisé des médicaments inappropriés, avec un suivi rigoureux des patients pour assurer la détection d'événements indésirables ou de symptômes de rebond. Une approche combinée centrée sur le patient et le soignant favorise la collaboration entre les prescripteurs et les pharmaciens afin de réduire le nombre de MPI chez les personnes âgées. Reducing potentially inappropriate medications (PIMs) in older adults is an area of sustained interest for many clinicians and researchers across the globe, as PIMs contribute to a significant burden of morbidity and mortality in the aging population. The prevalence of PIMs is a pervasive problem despite the presence of several explicit and implicit criteria for reducing PIMs in older adults, the most common being the Beers criteria, the Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria, and several country-specific criteria. This narrative review aims to discuss the frequently used published criteria for reducing PIMs, and elucidates the role of certain measures, especially de-prescribing, to optimise medication prescription in older adults. Electronic databases were searched using keywords and MeSH terms. The numerous available criteria have their specific advantages and drawbacks. De-prescribing, an initiative to reduce the use of PIMs, has gained significant importance in improving appropriate prescribing practices. De-prescribing is a methodical approach to gradually stopping inappropriate medications judiciously for each patient and simultaneously monitoring the patient carefully for the onset of adverse events or rebound symptoms. A combined caregiver–patient-centred approach encourages the collaboration between prescribers and pharmacists to reduce PIMs in older adults.

MeSH Terms

Aged
Aged, 80 and over
Deprescriptions
Humans
Inappropriate Prescribing
Medication Reconciliation
Potentially Inappropriate Medication List

Keywords

aging
critères de prescription inappropriés
de-prescribing
déprescription
inappropriate prescribing criteria
older adults
personnes âgées
vieillissement

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The prognostic significance of geriatric syndromes and resources.

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[Polypharmacy and associated factors in elderly diabetic].

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An examination of the concordance between self-reported collisions, driver records, and insurance claims in older drivers.

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Background Previous studies of older drivers have found that there are discrepancies between their retrospective self-reports of collisions and the official jurisdictional record. Objectives The purpose of this study was to examine how older drivers self-report collisions in comparison to what was recorded in their official driver abstract as well as insurance claims, in a prospective study. Methods Participants (n = 125, age ≥ 70 years) in this study were part of the University of Manitoba site of the Candrive longitudinal study of older drivers. During the operation of the Manitoba site (2009 to 2013), participants were periodically asked to report on any collisions (at-fault or not) in which they were involved, while they were enrolled in the study. In addition, driver records (abstracts and insurance claims) from the provincial licensing agency and public insurer (Manitoba Pubic Insurance; MPI) were provided annually. Results In total there were 101 separate instances of collisions (regardless of at-fault status), whether self-reported, or recorded by MPI. There were 20 at-fault collisions that were recorded on the driver abstract. Eighteen of these collisions were self-reported by participants. In total, our participants were involved in 70 insurance claims (42 at-fault) - 61 of these were self-reported to study staff. In addition, there were 31 collisions that were self-reported to study staff, that were not reported to MPI. Conclusions In this prospective study, older drivers were diligent in reporting collisions in which they were involved. While some collisions were not reported that ultimately became a claim or part of their driver abstract, the biggest discrepancy was in the collisions that were reported to study staff but that were not reported to authorities.

MeSH Terms

Accidents, Traffic
Aged
Aged, 80 and over
Automobile Driving
Databases, Factual
Female
Humans
Insurance Claim Reporting
Longitudinal Studies
Male
Manitoba
Prospective Studies
Self Report

Keywords

Aging
Automobile driving
Motor vehicle collisions
Road safety

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Age Modifies the Association of Dietary Protein Intake with All-Cause Mortality in Patients with Chronic Kidney Disease.

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New associations of the Multidimensional Prognostic Index.

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Effects of oral amino acid supplementation on Multidimensional Prognostic Index in hospitalized older patients: a multicenter randomized, double-blind, placebo-controlled pilot study.

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It is not known whether amino acid supplementations may influence health status in hospitalized older acutely ill patients. The aim of this study was to determine whether nutritional supplementation with amino acids (Aminoglutam ) is associated with multidimensional improvement assessed with the Multidimensional Prognostic Index (MPI). In this randomized, double-blind, placebo-controlled pilot clinical trial, 126 patients aged ≥65 years were enrolled from 6 Italian geriatric wards. A multidimensional assessment to calculate the MPI was performed at baseline and after 4 weeks of treatment with nutritional supplementation (96 kcal, 12 g amino acids, 0.18 g fat, 11.6 g carbohydrate, and vitamins B1, B6, and C) or placebo administered twice a day. Logistic regression modeling was applied to determine the effect of treatment on the improvement of MPI (vs no-change/worsening), adjusting for gender, age, and MPI at baseline. Treatment's interactions with age, gender, and MPI at baseline were tested adding the appropriate interaction parameter in the regression models. Of the 126 patients included, 117 patients (93%) completed the study. A significant improvement in the MPI score was detected in the overall population (mean difference post-pretreatment: -0.03, [i]p[/i]=0.001), with no differences between active and placebo arms. Men in the amino acid supplementation group had a significantly higher rate of improvement in MPI (81%) compared to the placebo group (46%) (Fisher's exact test [i]p[/i]=0.03). Adjusting for age, diagnosis, and MPI at baseline, amino acid treatment was shown to be associated with an improvement in MPI in men (OR=4.82, 95% confidence interval [CI]: 0.87-26.7) and not in women (OR=0.70, 95% CI: 0.27-1.81). The interaction effect between active treatment and gender was significant ([i]p[/i]=0.04). A 4-week amino acid supplementation improved the MPI significantly in hospitalized older male patients but not in female patients. Further studies are needed to confirm the gender effect of amino acid supplementation on MPI in older patients.

MeSH Terms

Acute Disease
Administration, Oral
Aged
Aged, 80 and over
Amino Acids
Dietary Supplements
Double-Blind Method
Elder Nutritional Physiological Phenomena
Female
Health Status Disparities
Humans
Male
Nutrition Assessment
Pilot Projects
Prognosis
Treatment Outcome

Keywords

Multidimensional Prognostic Index
aging
amino acids
hospitalization
oral supplementation

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Degree of Peripheral Thyroxin Deiodination, Frailty, and Long-Term Survival in Hospitalized Older Patients.

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Although the association between low free triiodothyronine (FT3) and poor outcome has been extensively reported in literature, the degree of peripheral thyroxin deiodination and its relationship with frailty and survival in hospitalized older patients has not yet been fully established. The aim of the current study was to evaluate the possible correlation between FT3/free thyroxine (FT4) ratio reduction, an indirect marker of thyroxin deiodination impairment, and frailty status and survival in hospitalized older patients. We consecutively enrolled older patients, hospitalized in the geriatrics ward of the University of Pisa. At admission, Multidimensional Geriatric Assessment (MGA) and Multi Prognostic Index (MPI), an indirect measure of frailty, were obtained from all the patients. Causes of hospitalization and prevalence of delirium were recorded. Blood samples for FT3, FT4, and thyrotropin value evaluation were drawn after an overnight fast. A total of 643 patients (83.8 ± 7.4 years, 53% women) were studied. FT3 was inversely and strongly correlated, whereas FT4 was moderately positively correlated with MGA parameters, MPI score (P < 0.001 and P < 0.05, respectively), and survival (P < 0.001 and P = 0.09, respectively). FT3/FT4 ratio reduction was highly associated with worse MGA (P < 0.001) and MPI scores (P < 0.0001), even in patients without low FT3. The inclusion of FT3 in the final model of multivariate Cox regression confirmed the independent role of FT3/FT4 ratio in predicting survival (P = 0.005). Overall, our study documented a strong association between FT3/FT4 ratio reduction, a surrogate marker of peripheral thyroxin deiodination, and frailty. Moreover, FT3/FT4 ratio value emerged as independent marker of survival, even in patients with normal FT3 values.

MeSH Terms

Aged
Aged, 80 and over
Female
Frailty
Geriatric Assessment
Halogenation
Hospitalization
Humans
Italy
Life Expectancy
Male
Thyroid Function Tests
Thyrotropin
Thyroxine
Triiodothyronine

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Age-Related Difference in Functional Brain Connectivity of Mastication.

PubMed

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The age-related decline in motor function is associated with changes in intrinsic brain signatures. Here, we investigated the functional connectivity (FC) associated with masticatory performance, a clinical index evaluating general masticatory function. Twenty-six older adults (OA) and 26 younger (YA) healthy adults were recruited and assessed using the masticatory performance index (MPI) and resting-state functional magnetic resonance imaging (rs-fMRI). We analyzed the rs-fMRI FC network related to mastication, which was constructed based on 12 bilateral mastication-related brain regions according to the literature. For the OA and the YA group, we identified the mastication-related hubs, i.e., the nodes for which the degree centrality (DC) was positively correlated with the MPI. For each pair of nodes, we identified the inter-nodal link for which the FC was positively correlated with the MPI. The network analysis revealed that, in the YA group, the FC between the sensorimotor cortex, the thalamus (THA) and the cerebellum was positively correlated with the MPI. Consistently, the cerebellum nodes were defined as the mastication-related hubs. In contrast, in the OA group, we found a sparser connection within the sensorimotor regions and cerebellum and a denser connection across distributed regions, including the FC between the superior parietal lobe (SPL), the anterior insula (aINS) and the dorsal anterior cingulate cortex (dACC). Compared to the YA group, the network of the OA group also comprised more mastication-related hubs, which were spatially distributed outside the sensorimotor regions, including the right SPL, the right aINS, and the bilateral dACC. In general, the findings supported the hypothesis that in OA, higher masticatory performance is associated with a widespread pattern of mastication-related hubs. Such a widespread engagement of multiple brain regions associated with the MPI may reflect an increased demand in sensorimotor integration, attentional control and monitoring for OA to maintain good mastication.

Keywords

aging
functional connectivity
graph theory
magnetic resonance imaging
mastication

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Warfarin Treatment and All-Cause Mortality in Community-Dwelling Older Adults with Atrial Fibrillation: A Retrospective Observational Study.

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To investigate the relationship between warfarin treatment and different strata of all-cause mortality risk assessed using the Multidimensional Prognostic Index (MPI) based on information collected using the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) in community-dwelling older adults with atrial fibrillation (AF). Retrospective observational study. Older community-dwelling adults who underwent a SVaMA evaluation establishing accessibility to homecare services and nursing home admission from 2005 to 2013 in the Padova Health District, Italy. Community-dwelling individuals with AF aged 65 and older (N = 1,827). Participants were classified as being at mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), or severe (MPI-SVaMA-3) risk of mortality using the MPI-SVaMA, a validated prognostic tool based on age, sex, comorbidity, cognitive status, mobility and functional disability, pressure sore risk, and social support. The association between warfarin treatment and mortality was tested using multivariate- and propensity score-adjusted Cox regression models, controlling for age, sex, all SVaMA domains, concomitant diseases, and drug treatments. Higher MPI-SVaMA scores were associated with lower rates of warfarin treatment and higher 3-year mortality. After adjustment for propensity score quintiles, warfarin treatment was significantly associated with lower 2-year mortality in individuals with MPI-SVaMA-1 (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.50-0.82), MPI-SVaMA-2 (HR = 0.68, 95% CI = 0.55-0.85), and MPI-SVaMA-3 (HR = 0.55, 95% CI = 0.44-0.67). Heterogeneity analyses confirmed that the effect of warfarin treatment was not different between MPI-SVaMA groups (P for heterogeneity = .48). Community-dwelling older adults with AF benefitted from anticoagulation in terms of lower all-cause mortality over a mean follow-up of 2 years, regardless of poor health and functional condition. Although this benefit can be ascribed to the treatment, it may also reflect better overall care.

MeSH Terms

Aged
Aged, 80 and over
Anticoagulants
Atrial Fibrillation
Cause of Death
Female
Geriatric Assessment
Humans
Independent Living
Italy
Male
Prognosis
Propensity Score
Retrospective Studies
Risk Assessment
Risk Factors
Warfarin

Keywords

aging
all-cause mortality
atrial fibrillation
frailty
multidimensional prognostic index
warfarin

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Change in the Multidimensional Prognostic Index Score During Hospitalization in Older Patients.

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We investigated and describe change in the Multidimensional Prognostic Index (MPI) score between admission and discharge in 960 older patients admitted to 20 geriatric units for an acute disease or a relapse of a chronic disease. The MPI was calculated at admission and at discharge. Subjects were divided into three groups of MPI score, low risk (MPI-1 value ≤0.33), moderate risk (MPI-2 value 0.34-0.66), and severe risk of mortality (MPI-3 value ≥0.67), on the basis of previously established cutoffs. Variation of MPI values over length of hospital stay (LOS) was analyzed with a multivariable longitudinal linear model for repeated measurements. At admission, 23.5% subjects had an MPI-1 score, 33.3% had an MPI-2 score, and 43.0% had an MPI-3 score. Overall, for almost 60% of the patients, MPI score at hospital discharge was different compared with the score at admission, although the difference was not statistically significant (-0.003; p = 0.708). Patients with high and intermediate MPI scores at admission had a decrease of MPI score at discharge (delta-MPI -0.026, p < 0.001, and delta-MPI -0.066, p = 0.569, respectively), whereas patients in the MPI-low group, experienced a significant increase in MPI score (delta-MPI 0.041, p < 0.001). The evolution of MPI score as a function of LOS had a curvilinear shape because it significantly decreased for patients with short hospitalization (1-6 days) and tended to increase for those with longer LOS. The MPI, a well-established prognostic tool, is sensitive to change of patient's health status and might be used to objectively track and monitor the clinical evolution of acutely ill geriatric patients admitted to the hospital.

MeSH Terms

Activities of Daily Living
Acute Disease
Age Factors
Aged
Aged, 80 and over
Aging
Chi-Square Distribution
Chronic Disease
Cognition
Comorbidity
Female
Geriatric Assessment
Hospitalization
Humans
Italy
Length of Stay
Linear Models
Male
Multivariate Analysis
Nutrition Assessment
Nutritional Status
Patient Admission
Patient Discharge
Polypharmacy
Predictive Value of Tests
Prognosis
Psychiatric Status Rating Scales
Recurrence
Risk Assessment
Risk Factors
Time Factors

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Diffusion-weighted multiparametric MRI for monitoring longitudinal changes of parameters in rabbit VX2 liver tumors.

PubMed

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To investigate the value of different quantitative models of diffusion-weighted multiparametric imaging (DW-MPI) including traditional as well as several advanced models for monitoring the longitudinal parameter changes in rabbit liver VX2 carcinoma and for correlating the perfusion-related imaging parameters to vascularity of tumor tissue. Rabbit liver VX2 carcinoma was imaged by DW-MPI at the 2nd, 3rd, and 4th weeks after tumor implantation at 1.5T using two sets of b values ranging from 0 to 2000 s/mm(2) . Serial parameter changes of each model at three timepoints were compared. Univariate and multivariate regression analyses were carried out to analyze the ability of perfusion-related parameters, including apparent diffusion coefficient (ADC), perfusion fraction (f), and pseudodiffusion coefficient (D*), to predict mean microvessel density (MVD) as determined by quantitative histopathology. For the period from Week 2 to Week 4, the measurements of ADC, f, and KDKI illustrated a statistical difference (P = 0.000, P = 0.000, and P = 0.002, respectively), whereas the comparison of D, D*, DDKI , DSEM , and αSEM demonstrated no statistical significance. ADC and f showed highest correlation with MVD at Week 4 (r(2) = 0.307, P = 0.017, and r(2) = 0.402, P < 0.01, respectively). Multivariate analyses confirmed highest correlation of f and ADC with MVD at Week 4 (P = 0.001 and P = 0.002). ADC, f, and KDKI were identified as the most promising parameters for monitoring changes in rabbit liver VX2 carcinoma and f and ADC showed highest correlation with MVD. J. Magn. Reson. Imaging 2016;44:707-714.

MeSH Terms

Aging
Animals
Cell Line, Tumor
Diffusion Magnetic Resonance Imaging
Female
Humans
Image Enhancement
Image Interpretation, Computer-Assisted
Liver Neoplasms
Longitudinal Studies
Male
Multimodal Imaging
Rabbits
Reproducibility of Results
Sensitivity and Specificity
Subtraction Technique

Keywords

apparent diffusion coefficient
diffusion-weighted MRI
liver carcinoma

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Immune senescence and cancer in elderly patients: results from an exploratory study.

PubMed

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The challenge of immune senescence has never been addressed in elderly cancer patients. This study compares the thymic output and peripheral blood telomere length in ≥70year old cancer patients. Fifty-two elderly cancer patients and 39 age-matched controls without personal history of cancer were enrolled. All patients underwent a Comprehensive Geriatric Assessment (CGA), from which a multidimensional prognostic index (MPI) score was calculated. Peripheral blood samples were studied for naïve and recent thymic emigrant (RTE) CD4( ) and CD8( ) cells by flow cytometry. T-cell receptor rearrangement excision circle (TREC) levels, telomere length and telomerase activity in peripheral blood cells were quantified by real-time PCR. The percentages of CD8( ) naïve and CD8( ) RTE cells and TREC levels were significantly lower in cancer patients than in controls (p=0.003, p=0.004, p=0.031, respectively). Telomere lengths in peripheral blood cells were significantly shorter in cancer patients than in controls (p=0.046) and did not correlate with age in patients, whereas it did in controls (r=-0.354, p=0.031). Short telomere (≤median)/low TREC (≤median) profile was associated with higher risk of cancer (OR=3.68 [95% CI 1.22-11.11]; p=0.021). Neither unfitness on CGA nor MPI score were significantly related to thymic output or telomere length in either group. Immune senescence is significantly worse in elderly cancer patients than in age-matched controls. The low thymic output and the shorter telomeres in peripheral blood cells of cancer patients may reflect a pre-existing condition which facilitates the onset of malignancies in elderly people.

MeSH Terms

Age Factors
Aged
Aged, 80 and over
Aging
Biomarkers
Breast Neoplasms
CD4-Positive T-Lymphocytes
CD8-Positive T-Lymphocytes
Case-Control Studies
Chi-Square Distribution
Colorectal Neoplasms
Female
Flow Cytometry
Gene Rearrangement, T-Lymphocyte
Geriatric Assessment
Humans
Logistic Models
Male
Odds Ratio
Polymerase Chain Reaction
Prospective Studies
Risk Factors
Telomerase
Telomere Shortening
Thymus Gland

Keywords

ADL
Activities of Daily Living
CGA
CIRS-CI
CIRS-SI
CMV
Cancer
Cumulative Illness Rating Scale-Comorbidity Index
Cumulative Illness Rating Scale-Severity Index
Cytomegalovirus
Elderly
GDS
Geriatric Depression Scale
IADL
Immune senescence
Instrumental Activities of Daily Living
MMSE
MNA
MPI
Mini Mental Status Examination
Mini Nutritional Assessment
PBMC
RTE
RU
SPMSQ
Short Portable Mental Status Questionnaire
T-cell receptor rearrangement excision circle
T/S
TREC
Telomerase activity
Telomere length
Thymic output
comprehensive geriatric assessment
multidimensional prognostic index
peripheral blood mononuclear cells
recent thymic emigrant
relative units
telomere/single-copy gene

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Identification of a metabolic signature for multidimensional impairment and mortality risk in hospitalized older patients.

PubMed

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A combination of several metabolic and hormonal adaptations has been proposed to control aging. Little is known regarding the effects of multiple deregulations of these metabolic and hormonal systems in modulating frailty and mortality in hospitalized elderly patients. We measured 17 biological serum parameters from different metabolic/hormonal pathways in 594 hospitalized elderly patients followed up to 1 year who were stratified into three groups according to their multidimensional impairment, evaluated by a Comprehensive Geriatric Assessment (CGA)-based Multidimensional Prognostic Index (MPI). The mortality incidence rates were 7% at 1 month and 21% at 1 year. Our data show that frailty and mortality rate were positively associated with chronic inflammation and with a down-regulation of multiple endocrine factors. Of the 17 biomarkers examined, blood levels of IGF-1, triiodothyronine, C-reactive protein, erythrocyte sedimentation rate, white blood cell and lymphocyte counts, iron, albumin, total cholesterol, and LDL-c were significantly associated with both MPI severity grade and mortality. In multivariate Cox proportional hazard model, the following biomarkers most strongly predicted the risk of mortality (adjusted hazard ratio (HR) per 1 quintile increment in predictor distribution): IGF-1 HR = 0.71 (95% CI: 0.63-0.80), CRP HR = 1.48 (95% CI: 1.32-1.65), hemoglobin HR = 0.82 (95% CI: 0.73-0.92), and glucose HR = 1.17 (95% CI: 1.04-1.30). Multidimensional impairment assessed by MPI is associated with a distinctive metabolic 'signature'. The concomitant elevation of markers of inflammation, associated with a simultaneous reduction in multiple metabolic and hormonal factors, predicts mortality in hospitalized elderly patients.

MeSH Terms

Aged
Aged, 80 and over
Aging
Biomarkers
Blood Sedimentation
C-Reactive Protein
Cholesterol, LDL
Female
Frail Elderly
Hormones
Hospitalization
Humans
Inflammation
Insulin-Like Growth Factor I
Iron
Leukocyte Count
Lymphocyte Count
Male
Mortality
Proportional Hazards Models
Serum Albumin
Triiodothyronine

MPI

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