Differences in immune response may explain lower survival among older men with pneumonia

Reade, Michael C., Yende, Sachin, D'Angelo, Gina, Kong, Lan, Kellum, John A., Barnato, Amber E., Milbrandt, Eric B., Dooley, Christopher, Mayr, Florian B., Weissfeld, Lisa and Angus, Derek C. (2009) Differences in immune response may explain lower survival among older men with pneumonia. Critical Care Medicine, 37 5: 1655-1662. doi:10.1097/CCM.0b013e31819da853

Author Reade, Michael C.
Yende, Sachin
D'Angelo, Gina
Kong, Lan
Kellum, John A.
Barnato, Amber E.
Milbrandt, Eric B.
Dooley, Christopher
Mayr, Florian B.
Weissfeld, Lisa
Angus, Derek C.
Title Differences in immune response may explain lower survival among older men with pneumonia
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
Publication date 2009-05-01
Year available 2009
Sub-type Article (original research)
DOI 10.1097/CCM.0b013e31819da853
Open Access Status Not yet assessed
Volume 37
Issue 5
Start page 1655
End page 1662
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Objective: Lower life expectancy in men is generally attributed to higher likelihood of risky behavior and because men develop chronic conditions earlier. If sex-related differences in survival are independent of preinfection chronic health and health behavior, it would suggest that survival differences may occur because of sex differences in quality of care and biological response to infection, and these differences may contribute to sex differences in life expectancy. We assessed if sex-related survival difference following community-acquired pneumonia (CAP) is due to differences in clinical characteristics, quality of care, or immune response.

Design, Setting, and Subjects: Prospective observational cohort of 2183 subjects with CAP.

Measurements and Main Results: Mean age was 64.9 years. Men were more likely to smoke and had more comorbidity compared with women. At emergency department presentation, men had different biomarker patterns, as evidenced by higher inflammation (tumor necrosis factor, interleukin [IL]-6, and IL-10) and fibrinolysis (d-dimer), and lower coagulation biomarkers (antithrombin-III and factor IX) (p < 0.05). Small differences in favor of men were seen in care quality, including antibiotic timing and compliance with American Thoracic Society guidelines. Men had lower survival at 30, 90, and 365 days. The higher 1-year mortality was not attenuated when adjusted for differences in demographics, smoking, resuscitation, insurance, and vaccination status, comorbidity, hospital characteristics, and illness severity (unadjusted hazard ratio [HR] = 1.35, p = 0.003; and adjusted HR = 1.29, p = 0.004). HR was no longer statistically significant when additionally adjusted for differences in emergency department concentrations of tumor necrosis factor, IL-6, IL-10, d-dimer, antithrombin-III, and factor IX (adjusted HR = 1.27, p = 0.17). Patterns of biomarkers observed in men were associated with worse survival for 1 year.

Conclusions: Lower survival among men following CAP was not explained by differences in chronic diseases, health behaviors, and quality of care. Patterns of inflammatory, coagulation, and fibrinolysis biomarkers among men may explain reduced short-term and long-term survival.
Keyword Disparities
Inflammation mediators
Quality of health care
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID UL1 TR000005
R01 GM061992
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 36 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 35 times in Scopus Article | Citations
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