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Age and Ageing 2003; 32: 37-42
© 2003, British Geriatrics Society

Research paper

Alpha 1-acid glycoprotein is an independent predictor of in-hospital death in the elderly

Olivier F. Henry1, Jacques Blacher2, Jacqueline Verdavaine1, Monique Duviquet3 and Michel E. Safar

1 Service de Médecine Gériatrique, HÔpital Emile Roux, AP-HP, Limeil-Brévannes, France
2 Service de Médecine Interne, HÔpital Broussais, AP-HP, Paris, France
3 Service de Médecine Gériatrique, HÔpital Charles Richet, AP-HP, Villiers-Le-Bel, France

Abstract

Objectives:  to determine the contribution of the two acute phase proteins alpha 1-acid glycoprotein, and C-reactive protein to the prediction of overall mortality in hospitalised elderly patients.

Design: prospective cohort study.

Setting: a department of geriatric medicine of Charles Richet Hospital, in the Paris-Ile de France area.

Subjects: 433 consecutive patients (mean age 84±7 years) admitted for rehabilitation in a department of geriatric medicine.

Methods: clinical and laboratory examinations were performed at baseline. Follow-up ended at hospital discharge or death. Prognostic factors of survival were identified using Cox proportional hazards regression model.

Results: compared with the survivor group, the mean serum levels of both C-reactive protein and alpha 1-acid glycoprotein at baseline were higher in the deceased group (44±51 mg/l versus 22±34 mg/l and 1691±69 mg/l versus 1340±456 mg/l respectively; P<0.001 for each). Baseline levels of albumin and prealbumin were significantly lower in patients who died than in patients who survived. In multivariate analysis, alpha 1-acid glycoprotein (but not C-reactive protein), previous stroke, previous heart failure, and age emerged as the only parameters significantly and independently related to overall mortality.

Conclusion: this study shows that the increase in plasma levels at admission of two acute-phase proteins, alpha 1-acid glycoprotein and C-reactive protein, were associated with in-hospital mortality in a population of hospitalised elderly patients. Furthermore, associations of overall mortality with inflammation differed among the markers and only alpha 1-acid glycoprotein entered the multivariate prediction model. Our findings support the hypothesis that alpha 1-acid glycoprotein may be superior to C-reactive protein in mortality risk assessment strategies for elderly patients.

Keywords: elderly, inflammation, C-reactive protein, alpha 1-acid glycoprotein, mortality


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