Enhanced Pro-inflammatory Response and Higher Mortality Rates in Geriatric Trauma Patients

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2019 Dec 26

PMID 31875239

Citations 10

Authors

Katharina Mors

Nils Wagner

Ramona Sturm

Philipp Stormann

Jan Tilmann Vollrath

Ingo Marzi

Borna Relja

Affiliations

Soon will be listed here.

Abstract

Background: Age has been associated with increased morbidity and mortality after traumatic injury. Disregarding trauma-related factors, this may be caused by the diminished ability to cope with stressors due to limited reserve, the so-called frailty. Inflammation is assumed to promote frailty, and thus, pro-inflammatory markers may constitute as being predictive factors in geriatric trauma patients (TP). Here, we analyzed the influence of age on systemic inflammatory markers and outcome parameters in TP.

Patients And Methods: 204 TP with injury severity score (ISS) ≥ 16 were included and grouped to younger vs. geriatric, defining an age of 65 as cut-off. ISS, vital signs, physiological parameters, stay at the intensive-care unit (ICU) or in-hospital, and outcome parameters were analyzed. Systemic fibrinogen, interleukin (IL)-6, and IL-10 levels were determined upon admission. A p value < 0.05 was considered statistically significant.

Results: 43 geriatric and 161 younger TP were included. ISS (24.19 ± 9.59 vs. 26.93 ± 9.68) was comparable between both groups. Abbreviated Injury Scale (AIS) ≥ 3 of head trauma was more prevalent in geriatric TP (74.42 vs. 64.59%). In both groups, there were significantly more male than female patients; however, this disparity was significantly more distinct in younger TP. Geriatric group showed significantly lower shock indices, higher fibrinogen, and lower IL-10 levels (all p < 0.05). A significant spearman´s rank correlation with age was found for fibrinogen (positive correlation, r = 0.364, p < 0.05), and for IL-10 (negative correlation, r = - 0.168, p < 0.05). In-hospital mortality was significantly increased in geriatric TP.

Conclusions: An enhanced inflammatory response is associated with higher mortality rates in geriatric trauma patients.

Citing Articles

[Perioperative changes of serum interleukin 6 levels in elderly male patients with intertrochanteric fracture].

Chen X, Zhu H, Wu W, Tian C, Shi L, Fan W Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024; 38(10):1249-1253.

PMID: 39433500 PMC: 11522526. DOI: 10.7507/1002-1892.202405057.

Development and validation of a machine learning-based model to assess probability of systemic inflammatory response syndrome in patients with severe multiple traumas.

Prokazyuk A, Tlemissov A, Zhanaspayev M, Aubakirova S, Mussabekov A BMC Med Inform Decis Mak. 2024; 24(1):235.

PMID: 39192291 PMC: 11351256. DOI: 10.1186/s12911-024-02640-x.

Extremity fractures, attempted suicide, blood transfusion and thromboembolic events are independent risk factors for a prolonged hospital stay in severely injured elderly.

Stormann P, Horauf J, Sturm R, Zankena L, Zumsteg J, Lefering R Aging Clin Exp Res. 2024; 36(1):161.

PMID: 39110267 PMC: 11306748. DOI: 10.1007/s40520-024-02817-4.

Reality of treatment for severely injured patients: are there age-specific differences?.

Maek T, Fochtmann U, Jungbluth P, Pass B, Lefering R, Schoeneberg C BMC Emerg Med. 2024; 24(1):14.

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Utilizing predictive machine-learning modelling unveils feature-based risk assessment system for hyperinflammatory patterns and infectious outcomes in polytrauma.

Fachet M, Mushunuri R, Bergmann C, Marzi I, Hoeschen C, Relja B Front Immunol. 2024; 14:1281674.

PMID: 38193076 PMC: 10773821. DOI: 10.3389/fimmu.2023.1281674.

References

Bardenheuer M, Obertacke U, Waydhas C, Nast-Kolb D . [Epidemiology of the severely injured patient. A prospective assessment of preclinical and clinical management. AG Polytrauma of DGU]. Unfallchirurg. 2000; 103(5):355-63. DOI: 10.1007/s001130050550. View

Sakran J, Greer S, Werlin E, McCunn M . Care of the injured worldwide: trauma still the neglected disease of modern society. Scand J Trauma Resusc Emerg Med. 2012; 20:64. PMC: 3518175. DOI: 10.1186/1757-7241-20-64. View

Pfeifer R, Tarkin I, Rocos B, Pape H . Patterns of mortality and causes of death in polytrauma patients--has anything changed?. Injury. 2009; 40(9):907-11. DOI: 10.1016/j.injury.2009.05.006. View

Matthes G, Seifert J, Bogatzki S, Steinhage K, Ekkernkamp A, Stengel D . [Age and survival likelihood of polytrauma patients. "Local tailoring" of the DGU prognosis model]. Unfallchirurg. 2005; 108(4):288-92. DOI: 10.1007/s00113-005-0929-9. View

Bhattacharya B, Maung A, Schuster K, Davis K . The older they are the harder they fall: Injury patterns and outcomes by age after ground level falls. Injury. 2016; 47(9):1955-9. DOI: 10.1016/j.injury.2016.06.019. View

Mors K, Braun O, Wagner N, Auner B, Voth M, Stormann P . Influence of gender on systemic IL-6 levels, complication rates and outcome after major trauma. Immunobiology. 2016; 221(8):904-10. DOI: 10.1016/j.imbio.2016.03.005. View

Relja B, Menke J, Wagner N, Auner B, Voth M, Nau C . Effects of positive blood alcohol concentration on outcome and systemic interleukin-6 in major trauma patients. Injury. 2016; 47(3):640-5. DOI: 10.1016/j.injury.2016.01.016. View

Kuhne C, Ruchholtz S, Kaiser G, Nast-Kolb D . Mortality in severely injured elderly trauma patients--when does age become a risk factor?. World J Surg. 2005; 29(11):1476-82. DOI: 10.1007/s00268-005-7796-y. View

Earl-Royal E, Kaufman E, Hsu J, Wiebe D, Reilly P, Holena D . Age and preexisting conditions as risk factors for severe adverse events and failure to rescue after injury. J Surg Res. 2016; 205(2):368-377. PMC: 5119648. DOI: 10.1016/j.jss.2016.06.082. View

10.

Keith R, Granger C, Hamilton B, Sherwin F . The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil. 1987; 1:6-18. View

11.

Morley J, Vellas B, Abellan van Kan G, Anker S, Bauer J, Bernabei R . Frailty consensus: a call to action. J Am Med Dir Assoc. 2013; 14(6):392-7. PMC: 4084863. DOI: 10.1016/j.jamda.2013.03.022. View

12.

Liu C, Lyass A, Larson M, Massaro J, Wang N, DAgostino Sr R . Biomarkers of oxidative stress are associated with frailty: the Framingham Offspring Study. Age (Dordr). 2015; 38(1):1. PMC: 5005887. DOI: 10.1007/s11357-015-9864-z. View

13.

Leng S, Xue Q, Tian J, Walston J, Fried L . Inflammation and frailty in older women. J Am Geriatr Soc. 2007; 55(6):864-71. DOI: 10.1111/j.1532-5415.2007.01186.x. View

14.

Hubbard R, OMahony M, Savva G, Calver B, Woodhouse K . Inflammation and frailty measures in older people. J Cell Mol Med. 2009; 13(9B):3103-9. PMC: 4516469. DOI: 10.1111/j.1582-4934.2009.00733.x. View

15.

Lenz A, Franklin G, Cheadle W . Systemic inflammation after trauma. Injury. 2007; 38(12):1336-45. DOI: 10.1016/j.injury.2007.10.003. View

16.

Hietbrink F, Koenderman L, Rijkers G, Leenen L . Trauma: the role of the innate immune system. World J Emerg Surg. 2006; 1:15. PMC: 1481567. DOI: 10.1186/1749-7922-1-15. View

17.

Baker S, ONeill B, HADDON Jr W, Long W . The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14(3):187-96. View

18.

Calandra T, Cohen J . The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005; 33(7):1538-48. DOI: 10.1097/01.ccm.0000168253.91200.83. View

19.

Heinrich S, Rapp K, Rissmann U, Becker C, Konig H . Cost of falls in old age: a systematic review. Osteoporos Int. 2009; 21(6):891-902. DOI: 10.1007/s00198-009-1100-1. View

20.

Meisler R, Thomsen A, Theilade P, Abildstrom H, Borge P, Treschow M . Age-related differences in mechanism, cause, and location of trauma deaths. Minerva Anestesiol. 2011; 77(6):592-7. View