title: Association of cytomegalovirus and other pathogens with frailty and diabetes mellitus, but not with cardiovascular disease and mortality in psycho-geriatric patients; a prospective cohort study.
abstract: BACKGROUND
  Studies about associations of infections with herpes viruses and other pathogens, such as Chlamydia pneumoniae (CP) and Helicobacter pylori (HP) with cardiovascular disease (CVD), diabetes mellitus (DM), frailty and/or mortality are conflicting. Since high levels of antibodies against these pathogens occur in the elderly, the role of these pathogens in morbidity and mortality of vulnerable elderly was explored.
  
  
  RESULTS
  Blood samples of 295 community dwelling psycho-geriatric patients were tested for IgG antibodies to herpes simplex virus type 1 and 2, varicella zoster virus, Epstein Barr virus (EBV), cytomegalovirus (CMV), human herpes virus type 6 (HHV6), CP and HP. Frailty was defined with an easy-to-use previously described frailty risk score. Relative risks (RR) with 95% confidence intervals were calculated to evaluate associations between CVD, DM, frailty and pathogens. Pathogens as a predictor for subsequent mortality were tested using Kaplan Meier analyses and Cox proportional hazard models. The mean age was 78 (SD: 6.7) years, 20% died, 44% were defined as frail, 20% had DM and 49% had CVD. Presence of CMV antibody titers was associated with frailty, as shown by using both qualitative and quantitative tests, RR ratio 1.4 (95% CI: 1.003-2.16) and RR ratio 1.5 (95% CI: 1.06-2.30), respectively. High IgG antibody titers of HHV6 and EBV were associated with DM, RR ratio 3.3 (95% CI: 1.57-6.49). None of the single or combined pathogens were significantly associated with mortality and/or CVD.
  
  
  CONCLUSIONS
  Prior CMV infection is associated with frailty, which could be in line with the concept that CMV might have an important role in immunosenescence, while high IgG titers of HHV6 and EBV are associated with DM. No association between a high pathogen burden and morbidity and/or mortality could be demonstrated.
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Centre, P, Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands. m.haeseker@mumc.nl.
authors.forename: Michiel B
authors.initials: MB
authors.lastname: Haeseker
authors.forename: Evelien
authors.initials: E
authors.lastname: Pijpers
authors.forename: Nicole Htm
authors.initials: NH
authors.lastname: Dukers-Muijrers
authors.forename: Patty
authors.initials: P
authors.lastname: Nelemans
authors.forename: Christian Jpa
authors.initials: CJ
authors.lastname: Hoebe
authors.forename: Cathrien A
authors.initials: CA
authors.lastname: Bruggeman
authors.forename: Annelies
authors.initials: A
authors.lastname: Verbon
authors.forename: Valère J
authors.initials: VJ
authors.lastname: Goossens