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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

Advanced age is associated with worsened outcomes and a unique genomic response in severely injured patients with hemorrhagic shock

Authors: Erin L Vanzant, Rachael E Hilton, Cecilia M Lopez, Jianyi Zhang, Ricardo F Ungaro, Lori F Gentile, Benjamin E Szpila, Ronald V Maier, Joseph Cuschieri, Azra Bihorac, Christiaan Leeuwenburgh, Frederick A Moore, Henry V Baker, Lyle L Moldawer, Scott C Brakenridge, Philip A Efron, The Inflammation and Host Response to Injury Investigators

Published in: Critical Care | Issue 1/2015

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Abstract

Introduction

We wished to characterize the relationship of advanced age to clinical outcomes and to transcriptomic responses after severe blunt traumatic injury with hemorrhagic shock.

Methods

We performed epidemiological, cytokine, and transcriptomic analyses on a prospective, multi-center cohort of 1,928 severely injured patients.

Results

We found that there was no difference in injury severity between the aged (age ≥55, n = 533) and young (age <55, n = 1395) cohorts. However, aged patients had more comorbidities. Advanced age was associated with more severe organ failure, infectious complications, ventilator days, and intensive care unit length of stay, as well as, an increased likelihood of being discharged to skilled nursing or long-term care facilities. Additionally, advanced age was an independent predictor of a complicated recovery and 28-day mortality. Acutely after trauma, blood neutrophil genome-wide expression analysis revealed an attenuated transcriptomic response as compared to the young; this attenuated response was supported by the patients’ plasma cytokine and chemokine concentrations. Later, these patients demonstrated gene expression changes consistent with simultaneous, persistent pro-inflammatory and immunosuppressive states.

Conclusions

We concluded that advanced age is one of the strongest non-injury related risk factors for poor outcomes after severe trauma with hemorrhagic shock and is associated with an altered and unique peripheral leukocyte genomic response. As the general population’s age increases, it will be important to individualize prediction models and therapeutic targets to this high risk cohort.
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Metadata
Title
Advanced age is associated with worsened outcomes and a unique genomic response in severely injured patients with hemorrhagic shock
Authors
Erin L Vanzant
Rachael E Hilton
Cecilia M Lopez
Jianyi Zhang
Ricardo F Ungaro
Lori F Gentile
Benjamin E Szpila
Ronald V Maier
Joseph Cuschieri
Azra Bihorac
Christiaan Leeuwenburgh
Frederick A Moore
Henry V Baker
Lyle L Moldawer
Scott C Brakenridge
Philip A Efron
The Inflammation and Host Response to Injury Investigators
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-0788-x

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