Older Adults Demonstrate Biomarker Evidence of the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) After Sepsis

Author:

Mankowski Robert T1,Anton Stephen D2,Ghita Gabriela L3,Brumback Babette34,Darden Dijoia B4,Bihorac Azra2,Leeuwenburgh Christiaan1,Moldawer Lyle L4,Efron Philip A4,Brakenridge Scott C4,Moore Frederick A4

Affiliation:

1. Department of Aging and Geriatric Research, University of Florida, Gainesville, USA

2. Department of Neprhology, University of Florida, Gainesville, USA

3. Department of Biostatistics, University of Florida, Gainesville, USA

4. Department of Surgery, University of Florida, Gainesville, USA

Abstract

Abstract Background Hospital deaths after sepsis have decreased substantially and most young adult survivors rapidly recover (RAP). However, many older survivors develop chronic critical illness (CCI) with poor long-term outcomes. The etiology of CCI is multifactorial and the relative importance remains unclear. Sepsis is caused by a dysregulated immune response and biomarkers reflecting a persistent inflammation, immunosuppression, and catabolism syndrome (PICS) have been observed in CCI after sepsis. Therefore, the purpose of this study was to compare serial PICS biomarkers in (i) older (vs young) adults and (ii) older CCI (vs older RAP) patients to gain insight into underlying pathobiology of CCI in older adults. Method Prospective longitudinal study with young (≤45 years) and older (≥65 years) septic adults, who were characterized by (i) baseline predisposition, (ii) hospital outcomes, (iii) serial Sequential Organ Failure Assessment (SOFA) organ dysfunction scores over 14 days, (iv) Zubrod Performance status at 3-, 6-, and 12-month follow-up, and (v) mortality over 12 months, was conducted. Serial blood samples over 14 days were analyzed for selected biomarkers reflecting PICS. Results Compared to the young, more older adults developed CCI (20% vs 42%) and had markedly worse serial SOFA scores, performance status, and mortality over 12 months. Additionally, older (vs young) and older CCI (vs older RAP) patients had more persistent aberrations in biomarkers reflecting inflammation, immunosuppression, stress metabolism, lack of anabolism, and antiangiogenesis over 14 days after sepsis. Conclusion Older (vs young) and older CCI (vs older RAP) patient subgroups demonstrate early biomarker evidence of the underlying pathobiology of PICS.

Funder

National Institute of General Medical Sciences

Publisher

Oxford University Press (OUP)

Subject

Geriatrics and Gerontology,Aging

Reference42 articles.

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