Alpha 1-acid glycoprotein is an independent predictor of in-hospital death in the elderly.

Abstract

to determine the contribution of the two acute phase proteins alpha 1-acid glycoprotein, and C-reactive protein to the prediction of overall mortality in hospitalised elderly patients. prospective cohort study. a department of geriatric medicine of Charles Richet Hospital, in the Paris-Ile de France area. 433 consecutive patients (mean age 84+/-7 years) admitted for rehabilitation in a department of geriatric medicine. clinical and laboratory examinations were performed at baseline. Follow-up ended at hospital discharge or death. Prognostic factors of survival were identified using Cox proportional hazards regression model. compared with the survivor group, the mean serum levels of both C-reactive protein and alpha 1-acid glycoprotein at baseline were higher in the deceased group (44+/-51 mg/l versus 22+/-34 mg/l and 1691+/-69 mg/l versus 1340+/-456 mg/l respectively; P<0.001 for each). Baseline levels of albumin and prealbumin were significantly lower in patients who died than in patients who survived. In multivariate analysis, alpha 1-acid glycoprotein (but not C-reactive protein), previous stroke, previous heart failure, and age emerged as the only parameters significantly and independently related to overall mortality. this study shows that the increase in plasma levels at admission of two acute-phase proteins, alpha 1-acid glycoprotein and C-reactive protein, were associated with in-hospital mortality in a population of hospitalised elderly patients. Furthermore, associations of overall mortality with inflammation differed among the markers and only alpha 1-acid glycoprotein entered the multivariate prediction model. Our findings support the hypothesis that alpha 1-acid glycoprotein may be superior to C-reactive protein in mortality risk assessment strategies for elderly patients.