Slower Decline in C-Reactive Protein after an Inflammatory Insult Is Associated with Longer Survival in Older Hospitalised Patients

Maryam Barma, James A. Goodbrand, Peter T. Donnan, Mark M. McGilchrist, Helen Frost, Marion E. T. McMurdo, Miles D. Witham (Lead / Corresponding author)

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Abstract

Background: Enhancing biological resilience may offer a novel way to prevent and ameliorate disease in older patients. We investigated whether changes in C-reactive protein (CRP), as a dynamic marker of the acute inflammatory response to diverse stressors, may provide a way to operationalize the concept of resilience in older adults. We tested this hypothesis by examining whether such changes could predict prognosis by identifying which individuals are at greater risk of 6-month mortality.

Methods: Analysis of prospective, routinely collected datasets containing data on hospitalization, clinical chemistry and rehabilitation outcomes for rehabilitation inpatients between 1999 and 2011. Maximum CRP response during acute illness and CRP recovery indices (time and slope of CRP decay to half maximum, and to <50mg/L if peak values were greater than 50mg/L) were derived from biochemistry data. 6-month survival plots were conducted on quartiles of CRP recovery indices. Cox proportional hazards models were used to test univariate and multivariate predictors of 6-month mortality. Covariates included age, sex, number of medications, serum calcium, haemoglobin level, renal function, and the presence of previous myocardial infarction, stroke, chronic heart failure, COPD and diabetes.

Results: 3723 patients, mean age 84 years, were included. 1535 (41%) were male and 733 (20%) died during six-month follow-up. The lower an individual’s peak CRP reading, and the longer the time taken for their CRP to fall, the better their 6-month survival. The time for CRP to reach half of its maximum value was the best dynamic CRP index of survival (HR 0.93 per week, 95% CI 0.89 to 0.98; p=0.004); this remained significant even after adjustment for maximum CRP level and covariates listed above.

Conclusion: CRP recovery indices are associated with survival in older people; further work is required to explain differences in physiology between patients with a fast and slow CRP recovery.
Original languageEnglish
Article numbere0159412
Number of pages10
JournalPLoS ONE
Volume11
Issue number7
DOIs
Publication statusPublished - 28 Jul 2016

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C-reactive protein
C-Reactive Protein
Survival
Recovery
rehabilitation (people)
Patient rehabilitation
Clinical Chemistry
Biochemistry
Mortality
myocardial infarction
Physiology
renal function
heart failure
Medical problems
stroke
Proportional Hazards Models
biochemistry
Chronic Obstructive Pulmonary Disease
prognosis
drug therapy

Keywords

  • Resilience
  • older
  • C-reactive protein
  • mortality

Cite this

@article{b3d149aac1bd454281e3e0607fab2cda,
title = "Slower Decline in C-Reactive Protein after an Inflammatory Insult Is Associated with Longer Survival in Older Hospitalised Patients",
abstract = "Background: Enhancing biological resilience may offer a novel way to prevent and ameliorate disease in older patients. We investigated whether changes in C-reactive protein (CRP), as a dynamic marker of the acute inflammatory response to diverse stressors, may provide a way to operationalize the concept of resilience in older adults. We tested this hypothesis by examining whether such changes could predict prognosis by identifying which individuals are at greater risk of 6-month mortality.Methods: Analysis of prospective, routinely collected datasets containing data on hospitalization, clinical chemistry and rehabilitation outcomes for rehabilitation inpatients between 1999 and 2011. Maximum CRP response during acute illness and CRP recovery indices (time and slope of CRP decay to half maximum, and to <50mg/L if peak values were greater than 50mg/L) were derived from biochemistry data. 6-month survival plots were conducted on quartiles of CRP recovery indices. Cox proportional hazards models were used to test univariate and multivariate predictors of 6-month mortality. Covariates included age, sex, number of medications, serum calcium, haemoglobin level, renal function, and the presence of previous myocardial infarction, stroke, chronic heart failure, COPD and diabetes.Results: 3723 patients, mean age 84 years, were included. 1535 (41{\%}) were male and 733 (20{\%}) died during six-month follow-up. The lower an individual’s peak CRP reading, and the longer the time taken for their CRP to fall, the better their 6-month survival. The time for CRP to reach half of its maximum value was the best dynamic CRP index of survival (HR 0.93 per week, 95{\%} CI 0.89 to 0.98; p=0.004); this remained significant even after adjustment for maximum CRP level and covariates listed above.Conclusion: CRP recovery indices are associated with survival in older people; further work is required to explain differences in physiology between patients with a fast and slow CRP recovery.",
keywords = "Resilience, older, C-reactive protein, mortality",
author = "Maryam Barma and Goodbrand, {James A.} and Donnan, {Peter T.} and McGilchrist, {Mark M.} and Helen Frost and McMurdo, {Marion E. T.} and Witham, {Miles D.}",
note = "This work was supported by Chief Scientist Office, Scottish Government, Grant number: SCPH/10 (http://www.cso.scot.nhs.uk/funding-2/) to MDW, METM, HF, and MMM; Dundee Clinical Academic Track (http://dcat.cmdn.dundee.ac.uk) to MB; and British Geriatrics Society (http://www.bgs.org.uk) to MB.",
year = "2016",
month = "7",
day = "28",
doi = "10.1371/journal.pone.0159412",
language = "English",
volume = "11",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "7",

}

TY - JOUR

T1 - Slower Decline in C-Reactive Protein after an Inflammatory Insult Is Associated with Longer Survival in Older Hospitalised Patients

AU - Barma, Maryam

AU - Goodbrand, James A.

AU - Donnan, Peter T.

AU - McGilchrist, Mark M.

AU - Frost, Helen

AU - McMurdo, Marion E. T.

AU - Witham, Miles D.

N1 - This work was supported by Chief Scientist Office, Scottish Government, Grant number: SCPH/10 (http://www.cso.scot.nhs.uk/funding-2/) to MDW, METM, HF, and MMM; Dundee Clinical Academic Track (http://dcat.cmdn.dundee.ac.uk) to MB; and British Geriatrics Society (http://www.bgs.org.uk) to MB.

PY - 2016/7/28

Y1 - 2016/7/28

N2 - Background: Enhancing biological resilience may offer a novel way to prevent and ameliorate disease in older patients. We investigated whether changes in C-reactive protein (CRP), as a dynamic marker of the acute inflammatory response to diverse stressors, may provide a way to operationalize the concept of resilience in older adults. We tested this hypothesis by examining whether such changes could predict prognosis by identifying which individuals are at greater risk of 6-month mortality.Methods: Analysis of prospective, routinely collected datasets containing data on hospitalization, clinical chemistry and rehabilitation outcomes for rehabilitation inpatients between 1999 and 2011. Maximum CRP response during acute illness and CRP recovery indices (time and slope of CRP decay to half maximum, and to <50mg/L if peak values were greater than 50mg/L) were derived from biochemistry data. 6-month survival plots were conducted on quartiles of CRP recovery indices. Cox proportional hazards models were used to test univariate and multivariate predictors of 6-month mortality. Covariates included age, sex, number of medications, serum calcium, haemoglobin level, renal function, and the presence of previous myocardial infarction, stroke, chronic heart failure, COPD and diabetes.Results: 3723 patients, mean age 84 years, were included. 1535 (41%) were male and 733 (20%) died during six-month follow-up. The lower an individual’s peak CRP reading, and the longer the time taken for their CRP to fall, the better their 6-month survival. The time for CRP to reach half of its maximum value was the best dynamic CRP index of survival (HR 0.93 per week, 95% CI 0.89 to 0.98; p=0.004); this remained significant even after adjustment for maximum CRP level and covariates listed above.Conclusion: CRP recovery indices are associated with survival in older people; further work is required to explain differences in physiology between patients with a fast and slow CRP recovery.

AB - Background: Enhancing biological resilience may offer a novel way to prevent and ameliorate disease in older patients. We investigated whether changes in C-reactive protein (CRP), as a dynamic marker of the acute inflammatory response to diverse stressors, may provide a way to operationalize the concept of resilience in older adults. We tested this hypothesis by examining whether such changes could predict prognosis by identifying which individuals are at greater risk of 6-month mortality.Methods: Analysis of prospective, routinely collected datasets containing data on hospitalization, clinical chemistry and rehabilitation outcomes for rehabilitation inpatients between 1999 and 2011. Maximum CRP response during acute illness and CRP recovery indices (time and slope of CRP decay to half maximum, and to <50mg/L if peak values were greater than 50mg/L) were derived from biochemistry data. 6-month survival plots were conducted on quartiles of CRP recovery indices. Cox proportional hazards models were used to test univariate and multivariate predictors of 6-month mortality. Covariates included age, sex, number of medications, serum calcium, haemoglobin level, renal function, and the presence of previous myocardial infarction, stroke, chronic heart failure, COPD and diabetes.Results: 3723 patients, mean age 84 years, were included. 1535 (41%) were male and 733 (20%) died during six-month follow-up. The lower an individual’s peak CRP reading, and the longer the time taken for their CRP to fall, the better their 6-month survival. The time for CRP to reach half of its maximum value was the best dynamic CRP index of survival (HR 0.93 per week, 95% CI 0.89 to 0.98; p=0.004); this remained significant even after adjustment for maximum CRP level and covariates listed above.Conclusion: CRP recovery indices are associated with survival in older people; further work is required to explain differences in physiology between patients with a fast and slow CRP recovery.

KW - Resilience

KW - older

KW - C-reactive protein

KW - mortality

U2 - 10.1371/journal.pone.0159412

DO - 10.1371/journal.pone.0159412

M3 - Article

C2 - 27467771

VL - 11

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 7

M1 - e0159412

ER -