Age-related differences in biomarkers of acute inflammation during hospitalization for sepsis.

TitleAge-related differences in biomarkers of acute inflammation during hospitalization for sepsis.
Publication TypeJournal Article
Year of Publication2014
AuthorsGinde AA, Blatchford PJ, Trzeciak S, Hollander JE, Birkhahn R, Otero R, Osborn TM, Moretti E, H Nguyen B, Gunnerson KJ, Milzman D, Gaieski DF, Goyal M, Cairns CB, Rivers EP, Shapiro NI
JournalShock
Volume42
Issue2
Pagination99-107
Date Published2014 Aug
ISSN Number1540-0514
KeywordsAdolescent, Adult, Age Distribution, Age Factors, Aged, Aged, 80 and over, Biological Markers, Female, Hospitalization, Humans, Inflammation Mediators, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Sepsis, Severity of Illness Index, Systemic Inflammatory Response Syndrome, Young Adult
Abstract

The authors aimed to evaluate age-related differences in inflammation biomarkers during the first 72 h of hospitalization for sepsis. This was a secondary analysis of a prospective observational cohort of adult patients (n = 855) from 10 urban academic emergency departments with confirmed infection and two or more systemic inflammatory response syndrome criteria. Six inflammation-related biomarkers were analyzed-chemokine (CC-motif) ligand-23, C-reactive protein, interleukin-1 receptor antagonist, neutrophil gelatinase-associated lipocalin (NGAL), peptidoglycan recognition protein, and tumor necrosis factor receptor-1a (TNFR-1a)-measured at presentation and 3, 6, 12, 24, 48, or 72 h later. The median age was 56 (interquartile range, 43 - 72) years, and sepsis severity was 38% sepsis, 16% severe sepsis without shock, and 46% septic shock; the overall 30-day mortality was 12%. Older age was associated with higher sepsis severity: 41% of subjects aged 18 to 34 years had severe sepsis or septic shock compared with 71% for those aged 65 years or older (P < 0.001). In longitudinal models adjusting for demographics, comorbidities, and infection source, older age was associated with higher baseline values for chemokine (CC-motif) ligand-23, interleukin-1 receptor antagonist, NGAL, and TNFR-1a (all P < 0.05). However, older adults had higher mean values during the entire 72-h period only for NGAL and TNFR-1a and higher final 72-h values only for TNFR-1a. Adjustment or stratification by sepsis severity did not change the age-inflammation associations. Although older adults had higher levels of inflammation at presentation and an increased incidence of severe sepsis and septic shock, these age-related differences in inflammation largely resolved during the first 72 h of hospitalization.

DOI10.1097/SHK.0000000000000182
Alternate JournalShock
PubMed ID24978893
PubMed Central IDPMC4101036
Grant ListK23 AG040708 / AG / NIA NIH HHS / United States
K23AG040708 / AG / NIA NIH HHS / United States
R01HL091757 / HL / NHLBI NIH HHS / United States
Faculty Reference: 
Charles B. Cairns, MD, FACEP, FAHA