Inflammation, pressure ulcers and poor functional status predict negative rehabilitation outcomes in postacute geriatric patients

Aquilani, Roberto; Zuccarelli, Ginetto Carlo; Maestri, Roberto; Rutili, Carla; Colombo, Mauro; Condino, Anna Maria; Barbieri, Annalisa; Cecchetti, Alessandra; Vanzati, Simona; Bonazza, Edi; Lafiandra, Franco; Buonocore, Daniela; Verri, Manuela; Dossena, Maurizia; Boschi, Federica

doi:10.1007/s40520-020-01526-y

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…The impact of acute hospitalization on geriatric rehabilitation is a highly understudied field, while geriatric rehabilitation patients are at high risk of poor muscle status [ 48 ], which is related to worse recovery [ 49 , 50 ]. In geriatric patients after acute hospitalization, albumin and CRP have been associated with negative rehabilitation outcome and mortality [ 51 , 52 ]. Albumin and CRP are nonspecific markers of inflammation, but may also have a direct effect on muscle health: the size of myotubes in vitro may decrease after exposure to CRP with a decreased rate of protein synthesis through a decrease in regulators of mechanistic target of rapamycin complex 1 and an increase in phosphorylated AMP-activated protein kinase [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Albumin and C-reactive protein relate to functional and body composition parameters in patients admitted to geriatric rehabilitation after acute hospitalization: findings from the RESORT cohort

et al. 2022

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Purpose Albumin and C-reactive protein (CRP) are non-specific markers of inflammation, which could affect muscle tissue during acute hospitalization. We investigated the association between albumin and CRP during acute hospitalization with functional and body composition parameters in patients admitted to geriatric rehabilitation. Methods The REStORing Health of Acutely Unwell AdulTs (RESORT) cohort includes geriatric rehabilitation patients assessed for change in activities of daily living (ADL, using the Katz index) during acute hospitalization, and subsequently for Katz ADL, gait speed (GS), handgrip strength (HGS) and skeletal muscle mass index (SMI) at geriatric rehabilitation admission. Albumin and CRP average (median), variation (interquartile range), and maximum or minimum were collected from serum samples, and were examined for their association with functional and body composition parameters using multivariable linear regression analysis adjusted for age, sex and length of acute hospital stay. Results 1769 Inpatients were included for analyses (mean age 82.6 years ± 8.1, 56% female). Median length of acute hospitalization was 7 [IQR 4, 13] days and median number of albumin and CRP measurements was 5 [IQR 3, 12] times. ADL declined in 89% of patients (median − 3 points, IQR − 4, − 2). Lower average albumin, higher albumin variation and lower minimum albumin were associated with larger declines in ADL and with lower ADL, GS, HGS and SMI at geriatric rehabilitation admission. Higher average and maximum CRP were associated with lower GS. Conclusion Inflammation, especially lower albumin concentrations, during acute hospitalization is associated with lower physical function at geriatric rehabilitation admission.

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Section: Discussionmentioning

confidence: 99%

Albumin and C-reactive protein relate to functional and body composition parameters in patients admitted to geriatric rehabilitation after acute hospitalization: findings from the RESORT cohort

et al. 2022

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“…Infection is an important trigger for delirium, especially in the older people who already have compromised bodies and immune systems (Wilson et al., 2020). In addition, because pressure injuries themselves may cause pain, discomfort and anxiety in patients, they may contribute to the development of delirium (Aquilani et al., 2021).…”

Section: Discussionmentioning

confidence: 99%

Can admission Braden skin score predict delirium in older adults in the intensive care unit? Results from a multicenter study

Cheng,

Huang,

Yuan

et al. 2023

Journal of Clinical Nursing

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Aims and ObjectivesTo investigate whether a low Braden Skin Score (BSS), reflecting an increased risk of pressure injury, could predict the risk of delirium in older patients in the intensive care unit (ICU).BackgroundDelirium, a common acute encephalopathy syndrome in older ICU patients, is associated with prolonged hospital stay, long‐term cognitive impairment and increased mortality. However, few studies have explored the relationship between BSS and delirium.DesignMulticenter cohort study.MethodsThe study included 24,123 older adults from the Medical Information Mart for Intensive Care IV (MIMIC‐IV) database and 1090 older adults from the eICU Collaborative Research Database (eICU‐CRD), all of whom had a record of BSS on admission to the ICU. We used structured query language to extract relevant data from the electronic health records. Delirium, the primary outcome, was primarily diagnosed by the Confusion Assessment Method for the ICU or the Intensive Care Delirium Screening Checklist. Logistic regression models were used to validate the association between BSS and outcome. A STROBE checklist was the reporting guide for this study.ResultsThe median age within the MIMIC‐IV and eICU‐CRD databases was approximately 77 and 75 years, respectively, with 11,195 (46.4%) and 524 (48.1%) being female. The median BSS at enrollment in both databases was 15 (interquartile range: 13, 17). Multivariate logistic regression showed a negative association between BSS on ICU admission and the prevalence of delirium. Similar patterns were found in the eICU‐CRD database.ConclusionsThis study found a significant negative relationship between ICU admission BSS and the prevalence of delirium in older patients.Relevance to Clinical PracticeThe BSS, which is simple and accessible, may reflect the health and frailty of older patients. It is recommended that BSS assessment be included as an essential component of delirium management strategies for older patients in the ICU.No Patient or Public ContributionThis is a retrospective cohort study, and no patients or the public were involved in the design and conduct of the study.

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“… 33 Thirdly, mild inflammation is a negative predictor of both neurocognitive recovery of stroke patients 10 and physical autonomy in post-acute rehab elderly patients. 12 , 14 , 25 Fourthly, increased CRP levels hide increased interleukine-6 (IL-6) production and activity. IL-6 has pleiotropic actions including the stimulation of muscle protein catabolism, 34 impaired aerobic energy formation 35 and increased activation of catabolic hormones such as cortisol and glucagon.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…11,12 Moreover, high CRP levels predict the development of infection 13 and negative rehab outcomes in sub-acute elderly patients. 14 A recent study has reported that postoperative morbidity is independently associated with inflammation but not with hyperglycemia or markers of insulin resistance. 15 Inflammation is especially problematic in elderly patients as it can be magnified by age-related deteriorations of immune cells (immunosenescence).…”

Section: Introductionmentioning

confidence: 99%

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Essential amino acid supplementation is associated with reduced serum C-reactive protein levels and improved circulating lymphocytes in post-acute inflamed elderly patients

Aquilani

Zuccarelli²,

Maestri

et al. 2021

Int J Immunopathol Pharmacol

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Background Persistent systemic inflammation leads to multidistrectual body dysfunctions. Attenuation of inflammation may improve patients’ functional and life prognoses. We hypothesized that essential amino acids (EAAs) given to elderly patients in rehabilitation after acute diseases may be associated with a reduced inflammatory state. Therefore, this retrospective study investigated whether the supplementation of EAAs – modulators of immune competence – was associated with a reduced inflammation rate in elderly patients. Methods The medical records of 282 patients admitted to the rehabilitation (rehab) institute after acute index events (surgery or medical diseases) (age: 81.18 ± 8.58 years; females: 67.9%) were analyzed. Results 46 patients (16.3% of the entire population) had received EAA supplements (S), whereas the remaining 236 patients had not (N-S). Systemic inflammation (I) (serum C-reactive protein (CRP) > 0.5 mg/dL) was present in 67.4% of the I-S group and 57.2% of the I-N-S group. During rehab, the I-S group (but not the I-N-S group) showed a reduction in CRP levels ( p = 0.03) and an increase in circulating lymphocytes ( p = 0.035), immune cells of the adaptive immune system. C-reactive protein levels remained virtually unchanged in non-inflamed patients who received supplements but increased in non-inflamed patients who did not receive supplements ( p = 0.05). Stratified for developed infections, CRP levels reduced in S patients ( p = 0.008) but did not in N-S patients. Conclusion EAA supplementation was associated with reduced inflammation in both inflamed and infected patients. In addition, EAA supplementation was associated with increased circulating lymphocytes in inflamed patients.

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Inflammation, pressure ulcers and poor functional status predict negative rehabilitation outcomes in postacute geriatric patients

Cited by 7 publications

References 18 publications

Albumin and C-reactive protein relate to functional and body composition parameters in patients admitted to geriatric rehabilitation after acute hospitalization: findings from the RESORT cohort

Albumin and C-reactive protein relate to functional and body composition parameters in patients admitted to geriatric rehabilitation after acute hospitalization: findings from the RESORT cohort

Can admission Braden skin score predict delirium in older adults in the intensive care unit? Results from a multicenter study

Essential amino acid supplementation is associated with reduced serum C-reactive protein levels and improved circulating lymphocytes in post-acute inflamed elderly patients

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