Elena Paillaud1,2, Sylvie Bastuji-Garin2,3,4, Anne Plonquet5, Emile Foucat6,7, Bénédicte Fournier8, Emmanuelle Boutin2,4, Aurélie Le Thuaut2,4, Yves Levy6,7,9, Sophie Hue5,6,7. 1. Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Henri-Mondor, Département de médecine interne et gériatrie, Creteil, France. 2. Université Paris Est (UPEC), DHU A-TVB, IMRB, CEpiA (Clinical Epidemiology and Ageing) Unit EA, Creteil, France. 3. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service de Santé Publique, Creteil, France. 4. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Unité de Recherche Clinique (URC Mondor), Creteil, France. 5. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service d'immunologie biologique, Creteil, France. 6. INSERM U955, team 16, IMRB Créteil, France. 7. Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, France. 8. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service de biochimie, Creteil, France. 9. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service d'immunologie clinique, Creteil, France.
Abstract
Background: We hypothesized that low-grade inflammation was driven by microbial translocation and associated with an increased risk of health care-associated infections (HAIs). Methods: We included 121 patients aged 75 years or over in this prospective cohort study. High-sensitivity C-reactive protein (hs-CRP), I-FABP, and sCD14-as markers for low-grade inflammation, intestinal epithelial barrier integrity, and monocyte activation, respectively-were measured at admission. Results: HAIs occurred during hospitalization in 62 (51%) patients. Elevated hs-CRP (≥6.02 mg/L, ie, the median) was associated with a significantly higher HAI risk when I-FABP was in the highest quartile (odds ratio [OR], 4; 95% confidence interval [95% CI], 1.39-11.49; p = .010). In patients with hs-CRP elevation and highest-quartile I-FABP, sCD14 elevation (≥0.65 µg/mL, ie, the median) was associated with an 11-fold higher HAI risk (OR, 10.8; 95% CI, 2.28-51.1; p = .003). Multivariate analyses adjusted for invasive procedures and comorbidities did not change the associations linking the three markers to the HAI risk. Conclusion: Increased levels of hs-CRP, I-FABP, and sCD14 may reflect loss of intestinal epithelial barrier integrity with microbial translocation leading to monocyte activation and low-grade inflammation. In our cohort, these markers identified patients at high risk for HAIs.
Background: We hypothesized that low-grade inflammation was driven by microbial translocation and associated with an increased risk of health care-associated infections (HAIs). Methods: We included 121 patients aged 75 years or over in this prospective cohort study. High-sensitivity C-reactive protein (hs-CRP), I-FABP, and sCD14-as markers for low-grade inflammation, intestinal epithelial barrier integrity, and monocyte activation, respectively-were measured at admission. Results: HAIs occurred during hospitalization in 62 (51%) patients. Elevated hs-CRP (≥6.02 mg/L, ie, the median) was associated with a significantly higher HAI risk when I-FABP was in the highest quartile (odds ratio [OR], 4; 95% confidence interval [95% CI], 1.39-11.49; p = .010). In patients with hs-CRP elevation and highest-quartile I-FABP, sCD14 elevation (≥0.65 µg/mL, ie, the median) was associated with an 11-fold higher HAI risk (OR, 10.8; 95% CI, 2.28-51.1; p = .003). Multivariate analyses adjusted for invasive procedures and comorbidities did not change the associations linking the three markers to the HAI risk. Conclusion: Increased levels of hs-CRP, I-FABP, and sCD14 may reflect loss of intestinal epithelial barrier integrity with microbial translocation leading to monocyte activation and low-grade inflammation. In our cohort, these markers identified patients at high risk for HAIs.
Authors: Javier Fontecha; Lauren Brink; Steven Wu; Yves Pouliot; Francesco Visioli; Rafael Jiménez-Flores Journal: Nutrients Date: 2020-05-30 Impact factor: 5.717