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Johnson LE, Dennis RA, Roberson PK, Heif M, Bopp MM, Cook J, Sullivan D. The Interrelationship Among Inflammatory Markers, Serum Albumin, and Death in Elderly Transitional Care Patients. Poster session presented at: American Geriatrics Society Annual Meeting; 2007 May 4; Seattle, WA.
Purpose: To assess the interrelationship among various serum inflammatory markers, serum albumin, and mortality in frail older adults admitted for transitional care. Methods: 36 male patients [33 white, 3 black; ave age = 80.5 (range 69-92)] admitted to a VA Extended Care Unit for rehabilitation and recuperation (transitional care) following hospitalization were enrolled. Serum albumin and various inflammatory markers (e.g.,TNFa, soluble TNF receptors [sTNFr] I and II, IL6, sgp130) were measured at admission and discharge [ave length of stay (LOS) = 23d (range = 8-70d)] and patient mortality was followed for 7 months. Results: Admission albumin (30+5 g/L) was inversely correlated with admission IL6 (p < 0.001, R2 = 0.28), TNFa, and sTNFr I and II (p < 0.05 all analyses); the same relationships did not hold for these parameters measured at discharge. However, the change in albumin between admission and discharge was correlated with the change in each of these 4 inflammatory markers. By multivariable regression, the strongest predictors of albumin change were change in IL6 and LOS (p < 0.02, R2 = 0.42). During follow up, there have been 5 deaths; of all admission and discharge variables, the strongest predictor of mortality by Cox Regression was the change in TNFa. When TNFa increased, the subsequent risk of death over 7 months was 29%; for the remaining subjects, death risk was 5% (p = 0.045, Chi Square = 4.0). Conclusions: These early results suggest that inflammation may be the underlying determinant of both hypoalbuminemia and mortality in older transitional care patients. This hypothesis is currently being evaluated in a much larger study of this patient cohort.
