Effects of acute-phase response on nutritional status and clinical outcome of hospitalized patients.
OBJECTIVE
We measured the effects of acute-phase response on nutritional status and clinical outcome in hospitalized older patients.


METHODS
Four hundred forty-five patients who took part in a randomized, double-blind, placebo-controlled trial of nutritional supplementation had their nutritional status assessed from anthropometric, hematologic, and biochemical data at baseline, 6 wk, and 6 mo. Outcome measures including disability, length of stay, and 1-y mortality were recorded. C-reactive protein (CRP) concentration, a marker of acute-phase response, was also measured. Multivariate analysis was used to measure the association between acute-phase response and nutritional assessment variables after adjusting for age, disability, chronic illness, medications, and smoking.


RESULTS
Energy intake in the hospital was significantly lower among patients with higher CRP concentrations. Serum albumin, transferrin, plasma ascorbic acid, and hemoglobin concentrations were significantly lower and serum ferritin higher in patients with acute-phase response (CRP > 10 mg/L) than in patients without acute-phase response (CRP < or = 10 mg/L; P < 0.001). Nutritional status deteriorated among patients with acute-phase response in contrast to the improvement seen in patients without acute-phase response. After adjusting for age, disability, and comorbidity in a multivariate analysis, acute-phase response had a significant and independent effect on nutritional status and clinical outcome. The benefit of nutritional support was mainly confined to patients with acute-phase response.


CONCLUSIONS
Acute-phase response is associated with poor nutritional status and poor clinical outcome in older patients. Whether nutritional support removes or mitigates the hazard of poor outcome associated with acute-phase response needs to be determined.
Gariballa
Salah
S
Sheffield Institute for Studies on Ageing, The University of Sheffield, Sheffield, United Kingdom. s.gariballa@uaeu.ac.ae
Forster
Sarah
S
D000210:Acute-Phase Reaction / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001205:Ascorbic Acid / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004311:Double-Blind Method; D002149:Energy Intake; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D009752:Nutritional Status / Q000502:physiology*; D018529:Nutritional Support; D010919:Placebos; D011379:Prognosis; D012709:Serum Albumin / Q000032:analysis; D014168:Transferrin / Q000032:analysis
D006454:Hemoglobins; D010919:Placebos; D012709:Serum Albumin; D014168:Transferrin; D002097:C-Reactive Protein; D001205:Ascorbic Acid