The influence of inflammation during acute hospitalization on muscle measures in older patients
Jeanine Van Ancum (1, 2), Camilla Tuttle (2), René Koopman (3), Mirjam Pijnappels (2), Carel Meskers (4), Sanjoy Paul (5), Wen Kwang Lim (2), Esmee Reijnierse (2), Gordon Lynch (3) and Andrea Maier (1, 2) on behalf of the CGA-GR study group
@AgeMelbourne, Department of Medicine and Aged Care, University of Melbourne, Melbourne, Victoria, Australia
@AgeAmsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
Centre for Muscle Research, Department of Physiology, The University of Melbourne, Victoria, Australia
Department of Rehabilitation Medicine, Amsterdam UMC, The Netherlands. 5. Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
Serum levels of C-reactive protein and albumin are non-specific markers of inflammation. Inflammation during acute hospitalization could negatively affect muscle measures. We investigated the association between C-reactive protein and albumin during acute hospitalization with change in activities of daily living score from two weeks before to immediately after acute hospitalization, and with activities of daily living score, gait speed, handgrip strength and skeletal muscle mass index immediately after acute hospitalization.
The Comprehensive Geriatric Assessment in Geriatric Rehabilitation study is an ongoing inception cohort conducted from October 2017 onwards at four geriatric rehabilitation wards of the Royal Melbourne Hospital, Victoria, Australia. Wave 1 included 693 geriatric rehabilitation patients assessed for change in Katz activities of daily living score from two weeks before to immediately after acute hospitalization, and for four muscle measures; activities of daily living score, gait speed, handgrip strength and skeletal muscle mass index, immediately after acute hospitalization. Multiple C-reactive protein and albumin levels were collected from serum samples during acute hospitalization and associated with all five muscle measures using multivariable linear regression analysis adjusted for age, sex and length of hospital stay. Additionally, four clusters of C-reactive protein and albumin were formed.
638 patients with a mean age was 82.3 years (SD 7.8) were included. Activities of daily living score declined in 88% of patients from two weeks before acute hospitalization to immediately after acute hospitalization (median -3 points, IQR -4, -2). Larger declines in activities of daily living scores were observed for patients with lower average, higher variation and lower peak albumin levels during acute hospitalization. Change in activities of daily living score was not associated with measures of C-reactive protein. Average C-reactive protein was associated with gait speed, whereas average, variation and peak albumin were associated with all four muscle measures immediately after acute hospitalization. The least favorable cluster combining C-reactive protein and albumin associated with a larger decline in activities of daily living score, and with activities of daily living score, gait speed and handgrip strength immediately after acute hospitalization.
Albumin was associated with larger declines in activities of daily living scores and with lower muscle measures, as opposed to C-reactive protein which was rarely associated with muscle measures. Combining CRP and albumin may provide further characterization of patients at risk of muscle deterioration during acute hospitalization.