Community-acquired pneumonia in older patients: does age influence systemic cytokine levels in community-acquired pneumonia?
OBJECTIVE
Community-acquired pneumonia (CAP) is a major cause of death in the elderly. The age-related increase in comorbid illnesses plays a part but the effect of aging on the immune response may be equally important. We aimed to evaluate patients with CAP for evidence of a muted response to infection in elderly patients admitted to hospital compared with a younger patient group.


METHODS
Patients with CAP admitted through the Emergency Department were recruited for this prospective observational study. Clinical data were collected at presentation. Severity of pneumonia was assessed using the British Thoracic Society confusion, urea nitrogen, respiratory rate, blood pressure (CURB) score, the Pneumonia Severity Index (PSI) and the systemic inflammatory response syndrome (SIRS) definition. IL-6 and IL-10 levels were measured within 24 h of admission.


RESULTS
Eighty patients were included in the study, of whom 38 (48%) were female. The median age was 74 years (range 18-95). Patients greater than 65 years of age had a lower incidence of chest pain and a higher incidence of altered mental status on presentation. CURB score and PSI were higher in the older patients. SIRS showed similar frequencies in both groups. IL-6 and IL-10 levels were similar in young (< 65 years), older (> 65 years) and very elderly (> 80 years) patients. This finding was not altered by severity of pneumonia.


CONCLUSIONS
Age does not diminish the severity of illness scores in patients with CAP. There was no blunting of the systemic cytokine response with advanced age in this study.
Kelly
Emer
E
Division of Respiratory Research, Department of Medicine, RCSI Education and Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. emerkelly@rcsi.ie
MacRedmond
Ruth E
RE
Cullen
Garret
G
Greene
Catherine M
CM
McElvaney
Noel G
NG
O'Neill
Shane J
SJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood*; D001794:Blood Pressure / Q000502:physiology; D001806:Blood Urea Nitrogen; D017714:Community-Acquired Infections / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D015656:Respiratory Mechanics / Q000502:physiology; D012720:Severity of Illness Index; D055815:Young Adult
D015850:Interleukin-6; D016753:Interleukin-10