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J Gerontol A Biol Sci Med Sci. 2018 Jan 16;73(2):211-217. doi: 10.1093/gerona/glx106.

Combined Plasma Elevation of CRP, Intestinal-Type Fatty Acid-Binding Protein (I-FABP), and sCD14 Identify Older Patients at High Risk for Health Care-Associated Infections.

Author information

1
Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Henri-Mondor, Département de médecine interne et gériatrie, Creteil, France.
2
Université Paris Est (UPEC), DHU A-TVB, IMRB, CEpiA (Clinical Epidemiology and Ageing) Unit EA, Creteil, France.
3
Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service de Santé Publique, Creteil, France.
4
Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Unité de Recherche Clinique (URC Mondor), Creteil, France.
5
Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service d'immunologie biologique, Creteil, France.
6
INSERM U955, team 16, IMRB Créteil, France.
7
Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, France.
8
Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service de biochimie, Creteil, France.
9
Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service d'immunologie clinique, Creteil, France.

Abstract

Background:

We hypothesized that low-grade inflammation was driven by microbial translocation and associated with an increased risk of health care-associated infections (HAIs).

Methods:

We included 121 patients aged 75 years or over in this prospective cohort study. High-sensitivity C-reactive protein (hs-CRP), I-FABP, and sCD14-as markers for low-grade inflammation, intestinal epithelial barrier integrity, and monocyte activation, respectively-were measured at admission.

Results:

HAIs occurred during hospitalization in 62 (51%) patients. Elevated hs-CRP (≥6.02 mg/L, ie, the median) was associated with a significantly higher HAI risk when I-FABP was in the highest quartile (odds ratio [OR], 4; 95% confidence interval [95% CI], 1.39-11.49; p = .010). In patients with hs-CRP elevation and highest-quartile I-FABP, sCD14 elevation (≥0.65 µg/mL, ie, the median) was associated with an 11-fold higher HAI risk (OR, 10.8; 95% CI, 2.28-51.1; p = .003). Multivariate analyses adjusted for invasive procedures and comorbidities did not change the associations linking the three markers to the HAI risk.

Conclusion:

Increased levels of hs-CRP, I-FABP, and sCD14 may reflect loss of intestinal epithelial barrier integrity with microbial translocation leading to monocyte activation and low-grade inflammation. In our cohort, these markers identified patients at high risk for HAIs.

KEYWORDS:

Inflammaging; Microbial translocation; Nosocomial infections; Prediction

PMID:
28582475
DOI:
10.1093/gerona/glx106

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