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

Adit A. Ginde, Patrick J. Blatchford, Stephen Trzeciak, Judd E. Hollander, Robert Birkhahn, Ronny Otero, Tiffany M. Osborn, Eugene Moretti, H. Bryant Nguyen, Kyle J. Gunnerson, David Milzman, David F. Gaieski, Munish Goyal, Charles B. Cairns, Emanuel P. Rivers, Nathan I. Shapiro

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

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.

Original languageEnglish
Pages (from-to)99-107
Number of pages9
JournalShock
Volume42
Issue number2
DOIs
StatePublished - Aug 2014

Keywords

  • Sepsis
  • biomarkers
  • critical care
  • emergency medicine
  • geriatrics
  • infection
  • severity

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