title: The Prognostic Value of High-sensitivity C-reactive Protein and Prealbumin for Short-term Mortality in Acutely Hospitalized Multimorbid Elderly Patients: A Prospective Cohort Study.
abstract: OBJECTIVE
  To establish the predictive value on mortality after 2 months from hospital admission of two laboratory markers of nutritional and inflammatory status, high-sensitivity C-reactive protein (hs-CRP) and prealbumin, in a cohort of frail multimorbid elderly without terminal illness.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Internal medicine ward of a large teaching hospital in Italy.
  
  
  METHODS
  544 Caucasian patients with acute disease consecutively admitted from January to June 2013. 102 were excluded for being younger than 65 years old, having life expectancy <30 days or not having frailty syndrome. Further 42 patients were excluded for missing data or withdrawn at follow-up. Final analysis was performed on 400 subjects (179 M, 221 F, mean age 79±10).
  
  
  METHODS
  Serum prealbumin and hs-CRP were measured at admission. Death within 2 months from hospital admission was assessed through a telephonic interview with the caregiver for each patient discharged alive. Inhospital mortality was also recorded. Survival was calculated from date of admission to our unit.
  
  
  RESULTS
  Mean prealbumin at admission was 17.3±7.7 mg/dl, while hs-CRP median was 24.2 mg/L (IQR 8.7 to 51.8). 108 patients (27%) died within two months from admission. In an age- and sex-adjusted analysis, log(hs-CRP) levels at admission, but not prealbumin, were independently associated with an increased risk for mortality (HR 1.40, 95% CI 1.18 to 1.66, p<0.001). After multiple adjustments for covariates, including comorbidity burden measured through Charlson score, log(hs-CRP) remained significantly associated with mortality (HR 1.38, 95% CI 1.08 to 1.76, p=0.01). A Receiver Operating Characteristic (ROC) curve was performed to test the predictive value of hs-CRP at admission on two-month mortality (AUC 0.68, 95% CI 0.63 to 0.72, p<0.001). Cut-off value was set at 38.4 mg/L. After dichotomization of hs-CRP values according to this cut-off, hs-CRP≥38.4 mg/L at admission proved to be a significant risk factor for mortality (HR 2.10, 95% CI 1.23 to 3.58, p=0.006).
  
  
  CONCLUSIONS
  Serum hs-CRP, but not prealbumin, values at admission are predictors of short-term mortality at hospital admission in elderly multimorbid patients. Inflammation seems to affect prognosis more than malnutrition in this setting and may therefore guide clinicians' attitude towards therapeutic choices.
authors.affiliation: Antonio Nouvenne M.D., Ph. D. University of Parma, Department of Clinical and Experimental Medicine, Via A. Gramsci 14, 43126 Parma, Italy, Phone: +39 0521 703626, Mobile: +39 3492258317, Fax: +39 0521 702383, e-mail: antonio.nouvenne@alice.it.
authors.forename: A
authors.initials: A
authors.lastname: Nouvenne
authors.forename: A
authors.initials: A
authors.lastname: Ticinesi
authors.forename: F
authors.initials: F
authors.lastname: Lauretani
authors.forename: M
authors.initials: M
authors.lastname: Maggio
authors.forename: G
authors.initials: G
authors.lastname: Lippi
authors.forename: B
authors.initials: B
authors.lastname: Prati
authors.forename: L
authors.initials: L
authors.lastname: Borghi
authors.forename: T
authors.initials: T
authors.lastname: Meschi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000401:mortality; D007558:Italy; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000401:mortality; D009026:Mortality; D011228:Prealbumin / Q000032:analysis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D044465:White People
chemical_list: D015415:Biomarkers; D011228:Prealbumin; D002097:C-Reactive Protein