Sustained IL-6 and sTNF-αR1 levels after hip fracture predict 5-year mortality: A prospective cohort study from the Baltimore Hip Studies.

Autor: Câmara SMA; Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil.; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Hochberg MC; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Medical Care Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA., Miller R; Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA., Ryan AS; Geriatric Research Education and Clinical Center, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland, USA.; Division of Gerontology, Geriatrics, and Palliative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA., Orwig D; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Gruber-Baldini AL; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Guralnik J; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Magder LS; Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, Maryland, USA., Feng Z; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Falvey JR; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, USA., Beamer BA; Geriatric Research Education and Clinical Center, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland, USA.; Division of Gerontology, Geriatrics, and Palliative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA., Magaziner J; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Sep; Vol. 72 (9), pp. 2644-2655. Date of Electronic Publication: 2024 Jun 12.
DOI: 10.1111/jgs.19018
Abstrakt: Background: Persistent inflammation is associated with adverse health outcomes, but its impact on mortality has not been investigated previously among hip fracture patients. This article aims to investigate the influence of changes in levels of cytokines in the 2 months after a hip fracture repair on 5-year mortality.
Methods: This is a prospective cohort study from the Baltimore Hip Studies (BHS) with 191 community-dwelling older men and women (≥65 years) who had recently undergone surgical repair of an acute hip fracture, with recruitment from May 2006 to June 2011. Plasma interleukin-6 (IL-6), soluble tumor necrosis factor alpha receptor1 (sTNFα-R1), and interleukin-1 receptor agonist (IL-1RA) were obtained within 22 days of admission and at 2 months. All-cause mortality over 5 years was determined. Logistic regression analysis tested the associations between the cytokines' trajectories and mortality over 5 years, adjusted for covariates (age, sex, education, body mass index, lower extremity physical activities of daily living, and Charlson comorbidity index).
Results: High levels of IL-6 and sTNFα-R1 at baseline with small or no decline at 2 months were associated with higher odds of 5-year mortality compared with those with lower levels at baseline and greater decline at 2 months after adjustment for age, and other potential confounders (OR = 4.71, p = 0.01 for IL-6; OR = 15.03, p = 0.002 for sTNFα-R1). Similar results that failed to reach significance were found for IL-1RA (OR = 2.40, p = 0.18). Those with higher levels of cytokines at baseline with greater decline did not have significantly greater mortality than the reference group, those with lower levels at baseline and greater decline.
Conclusion: Persistent elevation of plasma IL-6 and sTNFα-R1 levels within the first 2 months after hospital admission in patients with hip fracture is associated with higher 5-year mortality. These patients may benefit from enhanced care and earlier intensive interventions to reduce the risk of death.
(© 2024 The American Geriatrics Society.)
Databáze: MEDLINE
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