gms | German Medical Science

Objectives: Age has been shown to be an independent risk factor for poor outcome after severe traumatic injury associated with increased morbidity and mortality. Beyond trauma specific factors such as injury severity and/or pattern, detrimental outcome may be caused by the diminished ability to cope with external and internal stressors due to limited reserve and function in geriatric trauma patients (TP), so-called frailty. Inflammation is assumed to promote frailty, thus, proinflammatory markers may be potential predictive factors in elderly TP.

Here, we analyzed the influence of age on systemic inflammatory markers as well as on outcome parameters in TP admitted to our emergency department (ED).

Methods: 204 TP with injury severity scores (ISS) ≥ 16 admitted to our university trauma center were included, and grouped to younger vs. geriatric patients, defining an age of 65 years as cut-off. Data were prospectively collected and approval by the university ethics committee was taken. Injury severity, vital signs, physiological parameters, length of stay at the intensive care unit (ICU) or in-hospital, outcome parameters including sepsis, pneumonia and in-hospital mortality were analyzed. Systemic fibrinogen, interleukin (IL)-6 and IL-10 levels were determined upon patient's admission, in part by separate ELISA techniques. A p-value <0.05 was considered statistically significant.

Results and conclusion: 43 geriatric TP 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 significantly more prevalent in geriatric groups compared with younger 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 group.

Geriatric trauma patients showed significantly lower shock indices, higher fibrinogen levels as well as lower IL-10 levels upon admittance to the ED in contrast to the younger TP (all p <0.05). There was a non-significant trend to increase IL-6 levels in geriatric group. A significant spearman's rank correlation with age was found for fibrinogen (positive correlation, r =0.364, p <0.00001), and for IL-10 (negative correlation, r =-0.168, p <0.05). In-hospital mortality was significantly increased in geriatric TP.

Increased fibrinogen and decreased IL-10 levels at slightly increased IL-6 levels reveal a shift to an increased proinflammatory and reduced anti-inflammatory response in elderly patients. This might be a contributing factor to higher mortality rates in geriatric TP.