Coagulation and activation of inflammatory pathways in the development of functional decline and mortality in the elderly.
OBJECTIVE
This study was performed to determine the effects of markers of inflammation (interleukin 6) and coagulation (D-dimer) on mortality and functional status in older persons.


METHODS
Subjects were selected for the Duke Established Populations for Epidemiologic Studies of the Elderly. In 1992, 2569 subjects (age >71 years) were interviewed, of whom 1,723 had interleukin-6 and D-dimer measurements. Values of interleukin 6 and D-dimer were categorized into quartiles. Outcomes were mortality (through 5 years) and functional status (through 4 years). Relative risks were estimated with proportional hazards models that adjusted for potential confounders.


RESULTS
The relative risk of mortality was 1.28 (95% confidence interval [CI]: 0.98 to 1.69; P = 0.06) for those with only interleukin-6 levels in the highest quartile, 1.53 (95% CI: 1.18 to 1.97; P = 0.001) for subjects with only D-dimer levels in the highest quartile, and 2.00 (95% CI: 1.53 to 2.62; P = 0.0001) for those with levels of both in the highest quartile, as compared with those who were not in either of the highest quartiles. Those with high interleukin-6 and high D-dimer levels had the greatest declines in all measures of function.


CONCLUSIONS
Activation of the coagulation and inflammatory pathways is associated with mortality and decline in function, and may be part of the explanation for the development of a frailty phenotype in the elderly.
Cohen
Harvey Jay
HJ
Center for the Study of Aging and Human Development, Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina, USA. cohen015@mc.duke.edu
Harris
Tamara
T
Pieper
Carl F
CF
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D044383:Black People; D001777:Blood Coagulation / Q000276:immunology; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000401:mortality*; D015850:Interleukin-6 / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality; D009657:North Carolina / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality; D044465:White People; D001741:Black or African American
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D015850:Interleukin-6; C036309:fibrin fragment D