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document
The effect of aging on circulating levels of proinflammatory cytokines during septic shock . Norasept II Study Investigators . BACKGROUND As the proportion of the population that is older continues to rise , infection in older people has become an important healthcare problem . Although aging is associated with multiple abnormalities in immune function , the effect of aging on the production of proinflammatory cytokines has not been well studied under conditions of clinical stress . OBJECTIVES The aim of this study was to examine the effect of aging on circulating levels of the proinflammatory cytokines in a large cohort of septic shock patients . We hypothesized that aging would be associated with a diminished proinflammatory cytokine response to sepsis . DESIGN Patients with septic shock who were enrolled in the placebo limb of the North American Sepsis Trial ( NORASEPT II ) study were analyzed . SETTING The intensive care units of 105 hospitals in the United States and Canada . PARTICIPANTS Nine hundred and thirty patients presenting to hospital within 12 hours of the onset of septic shock . MEASUREMENTS Interleukin-6 ( IL-6 ) , tumor necrosis factor-alpha ( TNF-alpha ) , soluble tumor necrosis factor-receptor-55 ( sTNF-R55 ) , and soluble tumor necrosis factor-receptor-75 ( sTNF-R75 ) concentrations were measured at enrollment . The study population was broken down into five age groups as follows : less than 50 years ( group one ) , 50 to 64 years ( group two ) , 65 to 74 years ( group three ) , 75 to 84 years ( group four ) , and 85 or older ( group five ) . Clinical , demographic , and cytokine data were extracted to describe each age group . RESULTS Data were available for 930 patients . The patients ' mean age ( +/- SD ) was 59 +/- 17 years ( range , 18 to 102 ) . There were 280 patients in group one , 242 in group two , 210 in group three , 150 in group four , and 48 in group five . The primary diagnoses ; clinical characteristics ; and IL-6 , sTNF-R55 , and sTNF-R75 levels were similar among the five age groups . The TNF-alpha levels were significantly higher , however , in the oldest group of patients ( group five ) . The 28-day survival was 49 % in patients over the age of 75 and 58 % in those under 75 years ( P = .03 ) . There was no gender difference in survival or cytokine levels . CONCLUSIONS Contrary to our expectations , we found that aging was not associated with a decline in the circulating levels of proinflammatory cytokines .
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Intervention_Pharmacological
Norasept II
5461
Intervention_Control
placebo
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Intervention_Other
North American Sepsis Trial ( NORASEPT II )
5463
Outcome_Physical
circulating levels of proinflammatory cytokines
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Outcome_Physical
proinflammatory
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Outcome_Physical
circulating levels of the proinflammatory cytokines
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Outcome_Physical
Interleukin-6 ( IL-6
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Outcome_Physical
tumor necrosis factor-alpha ( TNF-alpha )
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Outcome_Physical
soluble tumor necrosis factor-receptor-55 ( sTNF-R55 )
5469
Outcome_Physical
soluble tumor necrosis factor-receptor-75 ( sTNF-R75 )
5470
Outcome_Other
Clinical , demographic , and cytokine data
5471
Outcome_Physical
primary diagnoses
5472
Outcome_Physical
clinical characteristics
5473
Outcome_Physical
IL-6
5474
Outcome_Physical
sTNF-R55
5475
Outcome_Physical
sTNF-R75 levels
5476
Outcome_Physical
TNF-alpha levels
5477
Outcome_Mortality
28-day survival
5478
Outcome_Other
gender difference
5479
Outcome_Mortality
survival
5480
Outcome_Physical
cytokine levels
5481
Participant_Condition
septic shock
5482
Participant_Age
older
5483
Participant_Condition
septic shock
5484
Participant_Condition
septic shock
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Participant_Sample-size
Nine hundred and thirty
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Participant_Condition
septic shock
5487
Participant_Age
less than 50 years
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Participant_Age
50 to 64 years
5489
Participant_Age
65 to 74 years
5490
Participant_Age
75 to 84 years
5491
Participant_Age
85 or older
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Participant_Sample-size
930
5493
Participant_Age
59 +/- 17 years
5494
Participant_Sample-size
280
5495
Participant_Sample-size
242
5496
Participant_Sample-size
210
5497
Participant_Sample-size
150
5498
Participant_Sample-size
48