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The effects of age on inflammatory and coagulation-fibrinolysis response in patients hospitalized for pneumonia

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).

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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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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Kale, S
Yende, Sspy3@pitt.eduSPY30000-0002-6596-8034
Kong, L
Perkins, A
Kellum, JAkellum@pitt.eduKELLUM0000-0003-1995-2653
Vallejo, AN
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
ContributionContributors NameEmailPitt UsernameORCID
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


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