A Study on Inflammatory markers level in elderly with Comorbid illness, without Comorbid illness and with Frailty attending Government General Hospital, Chennai: A Clinical and Biochemical profile

Abstract

INTRODUCTION: Chronic inflammation has been implicated as predictor and contributor of aging and age associated diseases. Inflammation involves elevation of serum inflammatory markers such as C-Reactive protein, interleukin-6. Association of cardiovascular diseases and elevated level of inflammatory markers is well known. Many studies have demonstrated the association of elevated level of inflammatory markers in cardiovascular diseases. Absence of vascular disease has been established as a major determinant of longevity. Recent studies have shown elevated level of serum inflammatory markers such as Interleukin-6, C-reactive protein in diseases primarily associated with aging like Coronary heart disease, diabetes mellitus, systemic hypertension, stroke, Dementia, Frailty, Osteoarthritis, Osteoporosis, Cancer, Rheumatoid Arthritis. AIM OF THE STUDY: 1. To Compare the level of inflammatory markers Interleukin-6, High-sensitivity C-Reactive protein in elderly patients: i) Healthy elders (without comorbid elders), ii) Frail elders, iii) With comorbid illness. 2. To correlate the role of Infammatory markers in Aging. 3. To analyse whether elevated level of inflammatory markers could be used in predicting the risk of aging in elders, with a view of primary prevention. MATERIALS AND METHODS: Setting: Outpatient and Inpatient setting of the Department of Geriatric Medicine, Madras Medical College & Government General Hospital, Chennai. Study Design: Single Center, Cross Sectional, clinical and analytical study. Period of study: August 2008 to September 2010. Sample size: 90. Selection of patients: Inclusion criteria: 90 elderly patients age more than 75years from Geriatric outpatient and inpatient Department are included in the study. Exclusion criteria: 1. Acutely toxic patients, 2. Rheumatoid arthritis, chronic liver disease, Multiple myeloma, Proliferative diseases like psoriasis, mesangial proliferative glomerulonephritis. DISCUSSION: In this study inflammatory markers C-Reactive protein and Interleukin-6 of 90 elderly patients were analysed, under the three groups namely healthy elders, frail elders and elders with comorbid illness. Among them 63% are males and 37% are females. In healthy elders 19 are male and 11 are female. In frailty group 17 are male and 13 are female. In elders with comorbid illness 21 are male and 9 are female. T he age distribution was 89% in age group of 75 to 80 years. 10% in age group of 81 to 90 years. Remaining 1% in age group of >90 years. More number of patients were found in age group of 75 to 80 years. In the study group 28.9% were smokers and 71.1% were non smokers. C-Reactive protein levels are elevated in smokers as well as non smokers in all the three groups. Hence it is not a significant association. Where as Interleukin-6 levels are more elevated in smokers in healthy elders and elders with comorbid illness, than non smokers of the same groups. In the comorbid group, diabetes was detected in 14, systemic hypertension in 20, Coronary heart disease in 8, stroke in 6 and dementia in 5 patients. CRP level are elevated in all the patients. Interleukin-6 level are elevated more in diabetic and coronary heart disease patients. In the frailty group 6 were Pre frail and 24 were frail. CRP are elevated in both Pre frail and frail group. Interleukin-6 was elevated, more in frail group than in Pre frail group. 83% of patients in Pre frail group, and 96% of patients in frail group had elevated level of interleukin-6. CRP levels are elevated in all the 3 groups. The mean CRP level was 63.7 in healthy elders, 89 in Frail elders, 99.3 in elders with comorbid illness. CRP is 10 fold increased in healthy elders, 15 fold increased in frail elders, 16.5 folds increased in elders with comorbid illness. Thus the patients with comorbid illness have higher CRP level. In healthy elders 21(70%) have elevated level of interleukin-6. In frail elders 28(93%) have elevated level of interleukin-6. In comorbid illness 27 (90%) have elevated level of interleukin-6. The mean interleukin-6 level was 6.6 in healthy elders, 11.4 in frail group, 5.5 in comorbid illness. Interleukin-6 is 3 fold increased in healthy elders, 6 fold in frail elders and 2.75 fold increased in elders with comorbid illness. Thus in frail elders interleukin-6 is more elevated. In summary CRP level are elevated in all the three groups. In patients with comorbid illness CRP levels are higher compared with other two groups. Interleukin-6 level are elevated more in diabetes and coronary heart disease patients. Interleukin-6 is more elevated in frail elders. CONCLUSION: 1. CRP levels are elevated in all patients age more than 75 years. 2. Elders with comorbid illness have higher CRP level, compared to healthy groups. 3. Interleukin-6 levels are elevated in smokers, both in healthy group and in comorbid group. 4. Interleukin-6 level are elevated more in diabetic and coronary heart disease patients. 5. Interleukin-6 was elevated more in frail group than in Pre frailgroup