Frailty has a stronger association with inflammation than age in older veterans.

P Van Epps,D H Canaday,T R Hornick,H Aung,P A Higgins,S Gravenstein,R E Banks,D Oswald,B M Wilson,C Burant

doi:10.1186/s12979-016-0082-z

Abstract

BackgroundUpregulation of pro-inflammatory cytokines has not only been associated with increased morbidity and mortality in older adults but also has been linked to frailty. In the current study we aimed to compare the relative relationship of age and frailty on inflammation and thrombosis in older veterans.ResultsWe analyzed 117 subjects (age range 62–95 years; median 81) divided into 3 cohorts: non-frail, pre-frail and frail based on the Fried phenotype of frailty. Serum inflammatory markers were determined using commercially available ELISA kits. Frail and pre-frail (PF) subjects had higher levels than non-frail (NF) subjects of IL-6 (NF vs. PF: p = 0.002; NF vs. F: p < 0.001), TNFR1 (NF vs. F: p = 0.012), TNFRII (NF vs. F: 0.002; NF vs. PF: p = 0.005) and inflammatory index: = 0.333*log(IL-6) + 0.666*log(sTNFR1) (NF vs. F: p = 0.009; NF vs. PF: p < 0.001). Frailty status explained a greater percent of variability in markers of inflammation than age: IL-6 (12 % vs. 0.3 %), TNFR1 (5 % vs. 4 %), TNFR2 (11 % vs. 6 %), inflammatory index (16 % vs. 8 %). Aging was significantly associated with higher fibrinogen (p = 0.04) and D-dimer levels (p = 0.01) but only among NF subjects.ConclusionIn conclusion, these data suggest that among older veterans, frailty status has a stronger association with inflammation and the inflammatory index than age does. Larger studies, in more diverse populations are needed to confirm these findings.

Highlights

Upregulation of pro-inflammatory cytokines has been associated with increased morbidity and mortality in older adults and has been linked to frailty
Immune dysregulation in older adults results in imbalance between pro and antiinflammatory cytokines and a low-grade chronic inflammatory state [1, 2]. Upregulation of cytokines such as interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) that contribute to systemic inflammation have been independently associated with increased morbidity and mortality in older adults [3, 4]
Mean IL-6 levels among frail subjects were nearly three times those found in NF subjects (1.88 pg/mL vs. 5.09 pg/mL; p < 0.001) and nearly twice as high among PF subjects compared with NF subjects (1.88 vs. 3.56; p = 0.002) than non-frail subjects

Summary

Introduction

Upregulation of pro-inflammatory cytokines has been associated with increased morbidity and mortality in older adults and has been linked to frailty. Immune dysregulation in older adults results in imbalance between pro and antiinflammatory cytokines and a low-grade chronic inflammatory state [1, 2]. Upregulation of cytokines such as interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) that contribute to systemic inflammation have been independently associated with increased morbidity and mortality in older adults [3, 4].

Objectives

Methods

Results

Discussion

Conclusion