Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Centre for Quantitative Neuroimaging, Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
Exp Gerontol. 2021 Dec;156:111597. doi: 10.1016/j.exger.2021.111597. Epub 2021 Oct 20.
Inflammation contributes to adverse health outcomes in community-dwelling populations. Little is known about inflammation in hospitalized older adults and its association with adverse outcomes. This study aimed to evaluate the association of the inflammatory markers C-reactive protein (CRP) and albumin measured during acute and geriatric rehabilitation hospitalization with institutionalization and mortality in geriatric rehabilitation inpatients.
Within the REStORing health of acutely unwell adulTs (RESORT) cohort, CRP and albumin were measured as part of usual care during acute and geriatric rehabilitation hospitalization. Inflammatory markers are presented as median, peak (CRP: maximum; albumin: minimum), variation (interquartile range) and direction of change (increased CRP or decreased albumin: positive or negative difference between last measurement and median of preceding measurements). Logistic regression was used to determine the associations between inflammatory markers and institutionalization at three-month and all-cause mortality at three- and twelve-month post-discharge.
Geriatric rehabilitation inpatients (n = 1846) with a median age of 83.3 years (interquartile range 77.6-88.3) and 56.6% of female were included. Increased CRP during geriatric rehabilitation was associated with institutionalization. Higher median, peak and increased levels of CRP during geriatric rehabilitation but not during acute hospitalization were associated with higher mortality. Lower CRP variation during acute hospitalization but higher CRP variation during geriatric rehabilitation was associated with higher mortality. Lower median level of albumin during both hospitalizations were associated with higher mortality.
Inflammation characterized by lower albumin during acute hospitalization and, higher CRP and lower albumin during geriatric rehabilitation was associated with mortality in geriatric rehabilitation inpatients. Increased CRP during geriatric rehabilitation was associated with institutionalization. Unresolved inflammation in geriatric rehabilitation might indicate ongoing disease activity leading to adverse outcomes.
炎症会导致社区居住人群的健康状况恶化。人们对住院老年患者的炎症及其与不良结局的关系知之甚少。本研究旨在评估在老年康复住院期间急性和老年康复住院期间测量的炎症标志物 C 反应蛋白（CRP）和白蛋白与老年康复住院患者的住院和死亡的相关性。
在 REStORing health of acutely unwell adulTs (RESORT) 队列中，CRP 和白蛋白作为急性和老年康复住院期间常规护理的一部分进行测量。炎症标志物以中位数、峰值（CRP：最大值；白蛋白：最小值）、变化（四分位距）和变化方向（CRP 增加或白蛋白减少：前几次测量的中位数与最后一次测量之间的差异为正或负）表示。使用逻辑回归确定炎症标志物与 3 个月时的住院和 3 个月和 12 个月时的全因死亡率之间的关系。
纳入了 1846 名年龄中位数为 83.3 岁（四分位距 77.6-88.3）、56.6%为女性的老年康复住院患者。老年康复期间 CRP 增加与住院有关。老年康复期间 CRP 中位数、峰值和增加水平较高，但急性住院期间 CRP 中位数、峰值和增加水平较低与死亡率较高有关。急性住院期间 CRP 变化较低，但老年康复期间 CRP 变化较高与死亡率较高有关。两次住院期间白蛋白中位数较低与死亡率较高有关。
急性住院期间白蛋白水平较低，老年康复期间 CRP 水平较高且白蛋白水平较低的炎症与老年康复住院患者的死亡率有关。老年康复期间 CRP 增加与住院有关。老年康复期间未解决的炎症可能表明持续的疾病活动导致不良结局。
