title: Association between inflammatory markers and frailty in institutionalized older men.
abstract: OBJECTIVE
  To determine whether higher serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and high sensitivity C-reactive protein (CRP) were associated with frailty in the older institutionalized men.
  
  
  METHODS
  The study enrolled 386 residents from a veterans care home in northern Taiwan in 2007. All participants were men. Residents younger than 65 years or with acute illness were excluded.
  
  
  METHODS
  Frailty status was determined based on the frailty phenotype (indicators include weight loss, exhaustion, and low grip strength, slow walking speed). Participants with 3 or more of the indicators were defined as frail, with 1 or 2 as intermediate frail, with no as non-frail. Serum IL-6, TNF-α, and hsCRP levels were measured using enzyme-linked immunosorbent assay and modeled as tertile for severely skewed distributions.
  
  
  RESULTS
  The mean age of the participants was 81.5±4.9 years. The percentages of frail were 33.2%, intermediate frail 59.1% and nonfrail 7.8%. Higher IL-6 level was positively associated with the frail status. Adjusting for age, body mass index, smoking status, and comorbid conditions, serum IL-6 showed significant trend across frailty categories (P=0.03 [95% CI 1.40-5.24]). No significant associations of TNF-α, and CRP level with frailty were observed. An IL-6 level of 1.79pg/mL had the optimal predictive value for frailty, with an area under the receiver operating characteristic (ROC) curve of 0.66 (P=0.01 [95% CI 0.53-0.78]).
  
  
  CONCLUSIONS
  Higher serum levels of IL-6 were associated with frailty status in the older institutionalized men with multiple comorbidities.
authors.affiliation: Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd., Hsinchu City 30059, Taiwan, R.O.C.
authors.forename: Hsiu-Yun
authors.initials: HY
authors.lastname: Lai
authors.affiliation: Division of Family Medicine, Taipei Hospital, Ministry of Health and Welfare, No. 127, Su-Yuan Rd., Hsin-Chuang District, New Taipei City 24213, Taiwan, R.O.C.
authors.forename: Hsiao-ting
authors.initials: HT
authors.lastname: Chang
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health. National Taiwan University, No. 17, Xu-Zhou Rd., Zhongzheng District, Taipei 10055, Taiwan, R.O.C.
authors.forename: Yungling Leo
authors.initials: YL
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan, R.O.C.; Department of Family Medicine, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong St., Beitou District, Taipei 11221, Taiwan, R.O.C.. Electronic address: sjhwang@vghtpe.gov.tw.
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000276:immunology*; D015897:Comorbidity; D004797:Enzyme-Linked Immunosorbent Assay; D005221:Fatigue / Q000276:immunology; D016330:Frail Elderly; D018737:Hand Strength; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000276:immunology*; D008297:Male; D009735:Nursing Homes; D013624:Taiwan; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*; D014728:Veterans
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein
keywords: Frailty; Inflammatory markers; Institutionalization