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Acute Phase Response in Critically Ill Elderly Burn Patients
Sarah Rehou1,2, Shahriar Shahrokhi1,3, Joanne Thai2
1Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Critical Care Medicine
|October 30, 2018
Summary
Elderly burn patients exhibit a distinct acute phase response, characterized by cardiac depression and lower inflammation. This difference contributes to their significantly higher mortality rates compared to younger adults.
Area of Science:
- Burn injury research
- Geriatric medicine
- Trauma critical care
Background:
- Survival rates for elderly burn patients are poor.
- The initial 96 hours post-burn (acute phase) critically impacts outcomes.
- Understanding age-related differences in the acute phase response is vital.
Purpose of the Study:
- Compare the acute phase response in elderly versus adult burn patients.
- Identify factors contributing to adverse outcomes in elderly burn patients.
- Investigate age-specific hemodynamic and inflammatory differences.
Main Methods:
- Cohort study comparing adult (<65 years) and elderly (≥65 years) burn patients (≥20% Total Body Surface Area).
- Analysis of clinical and laboratory data during the acute phase (first 96 hours).
- Comparison of hemodynamic parameters, organ biomarkers, fluid resuscitation, and cytokine profiles.
Main Results:
- Elderly patients showed lower heart rate, cardiac index, mean arterial pressure, PaO2/FIO2, and pH, with higher lactate.
- Distinct differences in organ biomarkers (creatinine, BUN) were observed between age groups.
- Elderly patients had significantly lower levels of key inflammatory cytokines (IL-6, MCP-1, MCP-3, G-CSF).
- Overall mortality was substantially higher in the elderly group (52% vs. 5%).
Conclusions:
- The acute phase response to burn injury differs significantly between elderly and adult patients.
- Elderly burn patients experience cardiac depression and a hypoinflammatory state.
- These age-related differences are critical factors in the poor survival outcomes observed in older burn patients.
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