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

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-06-12 DOI:10.1111/jgs.19018

Saionara M. A. Câmara PhD, Marc C. Hochberg MD, MPH, Ram Miller MD, CM, MS, Alice S. Ryan PhD, Denise Orwig PhD, Ann L. Gruber-Baldini PhD, Jack Guralnik MD, PhD, Laurence S. Magder PhD, Zhaoyong Feng MS, Jason R. Falvey DPT, PhD, Brock A. Beamer MD, Jay Magaziner PhD

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Abstract

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.

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髋部骨折后持续的 IL-6 和 sTNF-αR1 水平可预测 5 年死亡率：巴尔的摩髋关节研究的前瞻性队列研究。

背景：持续的炎症与不良的健康后果有关，但在髋部骨折患者中，炎症对死亡率的影响尚未得到研究。本文旨在研究髋部骨折修复后 2 个月内细胞因子水平的变化对 5 年死亡率的影响：这是巴尔的摩髋关节研究（Baltimore Hip Studies，BHS）的一项前瞻性队列研究，共招募了 191 名社区居住的老年男性和女性（≥65 岁），他们最近都接受了急性髋部骨折的手术修复，招募时间为 2006 年 5 月至 2011 年 6 月。在入院 22 天内和 2 个月时采集血浆白细胞介素-6 (IL-6)、可溶性肿瘤坏死因子α受体 1 (sTNFα-R1)和白细胞介素-1 受体激动剂 (IL-1RA)。测定了 5 年内的全因死亡率。逻辑回归分析检验了细胞因子的变化轨迹与 5 年内死亡率之间的关系，并对共变量（年龄、性别、教育程度、体重指数、下肢日常生活体力活动和 Charlson 合并症指数）进行了调整：基线时IL-6和sTNFα-R1水平较高，2个月后下降幅度较小或没有下降，与基线时IL-6和sTNFα-R1水平较低，2个月后下降幅度较大的患者相比，经调整年龄和其他潜在混杂因素后，后者的5年死亡率较高（IL-6的OR = 4.71，p = 0.01；sTNFα-R1的OR = 15.03，p = 0.002）。IL-1RA（OR = 2.40，p = 0.18）也有类似的结果，但未达到显著性。基线时细胞因子水平较高且下降幅度较大的人群，其死亡率并不比基线时细胞因子水平较低且下降幅度较大的参照组明显更高：结论：髋部骨折患者入院后 2 个月内血浆 IL-6 和 sTNFα-R1 水平的持续升高与较高的 5 年死亡率有关。这些患者可能受益于加强护理和早期强化干预，以降低死亡风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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