The international St-aging system as a prognostic marker in general senior population: Findings from the EPIDOS cohort study

  • Marie Pouzoullic
    Department of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, Angers, France
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  • Anne-Marie Schott
    Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, F-69003 Lyon, France

    INSERM U1033, F-69000 Lyon, France

    Université Lyon 1, F-69000 Lyon, France
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  • Dolores Sánchez-Rodríguez
    Geriatrics Department, Parc de Salut Mar (Centre Fòrum-Hospital del Mar), Barcelona, Spain

    Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain

    School of Medicine, Universitat Autònoma de Barcelona, Spain
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  • Regis Bataille
    Institut de Cancérologie de l'Ouest, Angers, France

    INSERM UMR 892, Institut de Recherche Thérapeutique de l'Université de Nantes, France
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  • Cedric Annweiler
    Corresponding author at: Department of Geriatrics, Angers University Hospital, 49933 Angers cedex 9, France.
    Department of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, Angers, France

    Robarts Research Institute, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Ontario, Canada
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  • On behalf of the SOCOS group
Published:August 03, 2019DOI:


      • The ISS combines concentrations of albumin and beta-2 microglobulin.
      • The ISS may be a prognostic staging system unspecific of MM.
      • Older adults with abnormal ISS had 44%-shorter survival time over 17 years.
      • The ISS may serve as a potent prognostic marker in the general senior population.


      The International Staging System (ISS) -calculated from serum albumin and beta-2 microglobulin (β2m)- is an established prognostic marker in multiple myeloma (MM), which has also been suggested to account for survival among general senior population. Our objective was to examine long-term survival of older women free of MM according to baseline ISS. The study included 230 community-dwelling healthy older women without known MM from the EPIDOS cohort (mean ± SD, 80.4 ± 3.4 years). Serum albumin and β2m were measured at baseline, and used to calculate the ISS a posteriori. Abnormal ISS was defined as ISS = 2 or ISS = 3, although ISS = 1 was considered normal. The vital status was sought after a mean follow-up of 17.6 ± 0.2 years (range, 16.8–18.3). Age, body mass index, mean arterial pressure, diabetes mellitus, hypertension, coronary heart disease, stroke, use corticosteroids, number of drugs daily taken, smoking, physical activity, fall history, bone mineral density, and creatinine clearance were used as potential confounders. All participants died during the 17-year follow-up. Compared to women with normal ISS, those with abnormal ISS (n = 24) had shorter survival time (4.9 ± 4.3 versus 8.7 ± 5.2 years, P = .001) and died earlier (85.6 ± 4.8 versus 89.1 ± 5.6 years old, P = .003). Survival time after blood test correlated with both serum albumin (r = 0.16, P = .015) and β2m (r = −0.27, P < .001). Cox regression revealed that abnormal ISS was associated with mortality (adjusted HR = 3.03, P < .001). Kaplan-Meier distributions showed that participants with abnormal ISS died earlier than those with normal ISS (log-rank P < .001). In conclusion, community-dwelling older women with abnormal ISS had shorter survival time than the others, suggesting that ISS could be considered as a universal prognostic “aging system” rather than a specific MM “staging system”.


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