Sarah Rehou1,2, Shahriar Shahrokhi1,3, Joanne Thai2, Mile Stanojcic2,4, Marc G Jeschke. 1. Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 2. Sunnybrook Research Institute, Toronto, ON, Canada. 3. Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 4. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Abstract
OBJECTIVES: Survival of elderly burn patients remains unacceptably poor. The acute phase, defined as the first 96 hours after burn, includes the resuscitation period and influences subsequent outcomes and survival. The aim of this study was to determine if the acute phase response post burn injury is significantly different in elderly patients compared with adult patients and to identify elements contributing to adverse outcomes. DESIGN: Cohort study. SETTING: Tertiary burn center. PATIENTS: Adult (< 65 yr old) and elderly (≥ 65 yr old) patients with an acute burn injury. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included all patients with an acute burn injury greater than or equal to 20% total body surface area to our burn center from 2011 to 2016. Clinical and laboratory measures during the acute phase were compared between adult and elderly patients. Outcomes included clinical hemodynamic measurements, organ biomarkers, volume of fluid resuscitation, cardiac agents, and the inflammatory cytokine response in plasma. Data were analyzed using the Student t test, Mann-Whitney U test, and Fisher exact test. A total of 149 patients were included, with 126 adults and 23 elderly. Injury severity was not significantly different among adult and elderly patients. Elderly had significantly lower heart rates (p < 0.05), cardiac index (p < 0.05), mean arterial pressure (p < 0.05), PaO2/FIO2 (p < 0.05), and pH (p < 0.05), along with higher lactate (p < 0.05). Organ biomarkers, particularly creatinine and blood urea nitrogen, showed distinct differences between adults and elderly (p < 0.05). Elderly had significantly lower levels of interleukin-6, monocyte chemotactic protein-1, monocyte chemotactic protein-3, and granulocyte-colony stimulating factor during the acute phase (p < 0.05). Overall mortality was significantly higher in elderly patients (5% vs 52%; p < 0.0001). CONCLUSIONS: Response to the burn injury during the acute phase response after burn is substantially different between elderly and adult burn patients and is characterized by cardiac depression and hypoinflammation.
OBJECTIVES: Survival of elderly burn patients remains unacceptably poor. The acute phase, defined as the first 96 hours after burn, includes the resuscitation period and influences subsequent outcomes and survival. The aim of this study was to determine if the acute phase response post burn injury is significantly different in elderly patients compared with adult patients and to identify elements contributing to adverse outcomes. DESIGN: Cohort study. SETTING: Tertiary burn center. PATIENTS: Adult (< 65 yr old) and elderly (≥ 65 yr old) patients with an acute burn injury. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included all patients with an acute burn injury greater than or equal to 20% total body surface area to our burn center from 2011 to 2016. Clinical and laboratory measures during the acute phase were compared between adult and elderly patients. Outcomes included clinical hemodynamic measurements, organ biomarkers, volume of fluid resuscitation, cardiac agents, and the inflammatory cytokine response in plasma. Data were analyzed using the Student t test, Mann-Whitney U test, and Fisher exact test. A total of 149 patients were included, with 126 adults and 23 elderly. Injury severity was not significantly different among adult and elderly patients. Elderly had significantly lower heart rates (p < 0.05), cardiac index (p < 0.05), mean arterial pressure (p < 0.05), PaO2/FIO2 (p < 0.05), and pH (p < 0.05), along with higher lactate (p < 0.05). Organ biomarkers, particularly creatinine and blood urea nitrogen, showed distinct differences between adults and elderly (p < 0.05). Elderly had significantly lower levels of interleukin-6, monocyte chemotactic protein-1, monocyte chemotactic protein-3, and granulocyte-colony stimulating factor during the acute phase (p < 0.05). Overall mortality was significantly higher in elderly patients (5% vs 52%; p < 0.0001). CONCLUSIONS: Response to the burn injury during the acute phase response after burn is substantially different between elderly and adult burn patients and is characterized by cardiac depression and hypoinflammation.
Authors: Marc G Jeschke; Margriet E van Baar; Mashkoor A Choudhry; Kevin K Chung; Nicole S Gibran; Sarvesh Logsetty Journal: Nat Rev Dis Primers Date: 2020-02-13 Impact factor: 52.329
Authors: Stephanie C Dreckmann; Saeid Amini-Nik; Ronald G Tompkins; Miliana Vojvodic; Marc G Jeschke Journal: PLoS One Date: 2019-12-13 Impact factor: 3.240
Authors: Abdikarim Abdullahi; Carly M Knuth; Christopher Auger; Thibacg Sivayoganathan; Alexandra Parousis; Marc G Jeschke Journal: JCI Insight Date: 2021-08-23