Health Sciences Division, Universidad del Norte and Hospital Universidad del Norte, Barranquilla, Colombia.
Internal Medicine Department, Consorci Sanitari Alt Penedès-Garraf, Barcelona, Spain.
Eur J Clin Invest. 2021 Jun;51(6):e13480. doi: 10.1111/eci.13480. Epub 2021 Jan 4.
Studies have suggested that an inappropriate inflammatory response is a major cause of treatment failure and mortality in patients with community-acquired pneumonia (CAP). We aimed to determine the effect of age and comorbidities on serum inflammatory markers in CAP.
We performed a prospective cohort study of adults hospitalized with CAP. For the purposes of this study, we compared patients according to comorbidities and age. Inflammatory markers were measured at hospital admission, focusing on acute phase proteins, cytokines and monocyte human leucocyte antigen DR (mHLA-DR) expression.
In patients with chronic pulmonary disease (COPD), serum cytokines had significantly decreased levels of tumour necrosis factor (TNF)-α, interleukin (IL)-6 and mHLA-DR expression, as well as the C-reactive protein (CRP), compared with patients who had no comorbidities. Similarly, patients with chronic heart disease had a significantly reduced CRP levels and mHLA-DR expression, whereas patients with chronic kidney disease had significantly higher serum levels of procalcitonin and TNF-α. Lower procalcitonin, IL-6 and IL-10 levels, as well as mHLA-DR expression, were documented in older patients, but with no significant differences compared to younger patients. Multimorbidity in older patients was associated with significant lower levels of CRP and mHLA-DR expression.
The circulating inflammatory markers to CAP have profiles that differ with age and underlying comorbidities. Multimorbidity in the elderly is also associated with lower serum levels of some inflammatory markers. Our findings suggest that inflammatory markers in CAP should be interpreted after considering age and comorbid conditions.
研究表明，炎症反应失调是导致社区获得性肺炎（CAP）患者治疗失败和死亡的主要原因。我们旨在确定年龄和合并症对 CAP 患者血清炎症标志物的影响。
我们对因 CAP 住院的成年人进行了前瞻性队列研究。在本研究中，我们根据合并症和年龄对患者进行了比较。在入院时测量了炎症标志物，重点是急性期蛋白、细胞因子和单核细胞人类白细胞抗原 DR（mHLA-DR）表达。
与无合并症的患者相比，患有慢性肺部疾病（COPD）的患者血清细胞因子 TNF-α、IL-6 和 mHLA-DR 表达以及 C 反应蛋白（CRP）水平显著降低。同样，患有慢性心脏病的患者 CRP 水平和 mHLA-DR 表达显著降低，而患有慢性肾脏病的患者降钙素原和 TNF-α 血清水平显著升高。与年轻患者相比，老年患者的降钙素原、IL-6 和 IL-10 水平以及 mHLA-DR 表达水平较低，但无统计学差异。老年患者的多种合并症与 CRP 和 mHLA-DR 表达水平显著降低相关。
CAP 的循环炎症标志物具有与年龄和潜在合并症不同的特征。老年人的多种合并症也与某些炎症标志物的血清水平降低有关。我们的研究结果表明，在考虑年龄和合并症的情况下，应该对 CAP 中的炎症标志物进行解释。
