Kale, S and Yende, S and Kong, L and Perkins, A and Kellum, JA and Newman, AB and Vallejo, AN and Angus, DC
(2010)
The effects of age on inflammatory and coagulation-fibrinolysis response in patients hospitalized for pneumonia.
PLoS ONE, 5 (11).
Abstract
Objective: To determine whether inflammatory and hemostasis response in patients hospitalized for pneumonia varies by age and whether these differences explain higher mortality in the elderly. Methods: In an observational cohort of subjects with community-acquired pneumonia (CAP) recruited from emergency departments (ED) in 28 hospitals, we divided subjects into 5 age groups (<50, 51-64, 65-74, 75-84, and ≥85). We measured circulating levels of inflammatory (TNF, IL-6, and IL-10), hemostasis (D-dimer, Factor IX, thrombin-antithrombin complex, antithrombin and plasminogen-activator inhibitor-1), and cell-surface markers (TLR-2, TLR-4, and HLA-DR) during the first week of hospitalization and at discharge and compared 90-day mortality. We used logistic regression to compare odds ratios (OR) for 90-day mortality between age groups, adjusting for differences in pre-infection factors alone and then additionally adjusting for immune markers. Results: Of 2,183 subjects, 495, 444, 403, 583, and 258 subjects were <50, 51-64, 65-74, 75-84, and ≥85 years of age, respectively. Large age-related differences were observed in 90-day mortality (0.82% vs. 3.2% vs. 6.4% vs. 12.8% vs. 13.6%, p<0.01). No age-related differences in inflammatory and cell surface markers occurred during the first week. Older subjects had higher pro-coagulant markers on ED presentation and over first week (p≤0.03), but these differences were modest (1.0-1.7-fold differences). Odds of death for older adults changed minimally in models incorporating differences in hemostasis and inflammatory markers (for subjects ≥85 compared to those <50, OR = 4.36, when adjusted for pre-infection factors and OR = 3.49 when additionally adjusted for hemostasis markers). At discharge, despite clinical recovery as evidenced by normal vital signs in >85% subjects, older subjects had modestly increased hemostasis markers and IL-6 levels (p,0.01). Conclusions: Modest age-related increases in coagulation response occur during hospitalization for CAP; however these differences do not explain the large differences in mortality. Despite clinical recovery, immune resolution may be delayed in older adults at discharge. © 2010 Kale et al.
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Details
| Item Type: |
Article
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| Status: |
Published |
| Creators/Authors: |
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| Contributors: |
| Contribution | Contributors Name | Email | Pitt Username | ORCID  |
|---|
| Editor | Deng, Jane | UNSPECIFIED | UNSPECIFIED | UNSPECIFIED |
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| Date: |
19 November 2010 |
| Date Type: |
Publication |
| Journal or Publication Title: |
PLoS ONE |
| Volume: |
5 |
| Number: |
11 |
| DOI or Unique Handle: |
10.1371/journal.pone.0013852 |
| Schools and Programs: |
School of Public Health > Biostatistics
School of Public Health > Epidemiology
School of Medicine > Critical Care Medicine |
| Refereed: |
Yes |
| MeSH Headings: |
Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antithrombin III--analysis; Biological Markers--blood; Blood Coagulation Factors--analysis; Factor IX--analysis; Female; Fibrinolysis; Hospitalization--statistics & numerical data; Humans; Inflammation Mediators--blood; Interleukin-10--blood; Interleukin-6--blood; Logistic Models; Male; Middle Aged; Odds Ratio; Peptide Hydrolases--analysis; Pneumonia--blood; Pneumonia--mortality; Pneumonia--therapy; Survival Rate; Tumor Necrosis Factor-alpha--blood; Young Adult |
| Other ID: |
NLM PMC2973976 |
| PubMed Central ID: |
PMC2973976 |
| PubMed ID: |
21085465 |
| Date Deposited: |
22 Aug 2012 21:56 |
| Last Modified: |
01 Sep 2020 13:55 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/13566 |
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