Kinetics of inflammatory biomarkers to predict one-year mortality in older patients hospitalized for pneumonia: a multivariable analysis. (September 2022)

• Record Type: Journal Article
• Authors: Malézieux-Picard, Astrid; Nascè, Alberto; Azurmendi, Leire; Pagano, Sabrina; Vuilleumier, Nicolas; Sanchez, Jean-Charles; Reny, Jean-Luc; Zekry, Dina; Roux, Xavier; Stirnemann, Jérôme; Garin, Nicolas; Prendki, Virginie
• Is Part Of: International journal of infectious diseases. Volume 122(2022)
• Page Start: 63
• Page End: 69
• Publication Date: 2022-09
• Subjects: Pneumonia -- Elderly -- Biomarkers -- CRP -- IL-8 -- Long-term mortality; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.05.002
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Higher interleukin-8 and C-reactive protein (CRP) levels at discharge were associated with one-year mortality. A decrease of CRP less than 67% during hospitalization was associated with death. Malnutrition was the only clinical risk factor for mortality in this cohort. Abstract: Objectives: Long-term mortality is increased in older patients with pneumonia. We aimed to test whether residual inflammation is predictive of one-year mortality after pneumonia. Methods: Inflammation biomarkers (C-reactive protein [CRP], interleukin [IL]-6 and IL-8, tumor necrosis factor–α, serum amyloid A, neopterin, myeloperoxidase, anti-apolipoprotein A-1, and anti-phosphorylcholine IgM) were measured at admission and discharge in older patients hospitalized for pneumonia in a prospective study. Univariate and multivariate analyses were conducted using absolute level at discharge and relative and absolute differences between admission and discharge for all biomarkers, along with usual prognostic factors. Results: In the 133 included patients (median age, 83 years [interquartile range: 78–89]), one-year mortality was 26%. In univariate analysis, the relative difference of CRP levels had the highest area under the receiver operating characteristic curve (0.70; 95% confidence interval [CI] 0.60–0.80). A decrease of CRP levels of more than 67% between admission and discharge had 68% sensitivity and 68% specificity to predict survival. In multivariate analysis, lower body mass index (hazard ratio=0.87 [CI 95% 0.79–0.96], P -value=0.01), higher IL-8 (hazard ratio=1.02 [CI 95% 1.00–1.04], P -value=0.02), and higher CRP (1.01 [95% CI 1.00–1.02], P =0.01) at discharge were independently associated with mortality. Conclusion: Higher IL-8 and CRP levels at discharge were independently associated with one-year mortality. The relative CRP difference during hospitalization was the best individual biomarker for predicting one-year mortality.