title: Pathophysiologic Response to Burns in the Elderly.
abstract: Over the last decades advancements have improved survival and outcomes of severely burned patients except one population, elderly. The Lethal Dose 50 (LD50) burn size in elderly has remained the same over the past three decades, and so has morbidity and mortality, despite the increased demand for elderly burn care. The objective of this study is to gain insights on why elderly burn patients have had such a poor outcome when compared to adult burn patients. The significance of this project is that to this date, burn care providers recognize the extreme poor outcome of elderly, but the reason remains unclear. In this prospective translational trial, we have determined clinical, metabolic, inflammatory, immune, and skin healing aspects. We found that elderly have a profound increased mortality, more premorbid conditions, and stay at the hospital for longer, p < 0.05. Interestingly, we could not find a higher incidence of infection or sepsis in elderly, p > 0.05, but a significant increased incidence of multi organ failure, p < 0.05. These clinical outcomes were associated with a delayed hypermetabolic response, increased hyperglycemic and hyperlipidemic responses, inversed inflammatory response, immune-compromisation and substantial delay in wound healing predominantly due to alteration in characteristics of progenitor cells, p < 0.05. In summary, elderly have substantially different responses to burns when compared to adults associated with increased morbidity and mortality. This study indicates that these responses are complex and not linear, requiring a multi-modal approach to improve the outcome of severely burned elderly.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Patsouris
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada.
authors.forename: Mile
authors.initials: M
authors.lastname: Stanojcic
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada.
authors.forename: Abdikarim
authors.initials: A
authors.lastname: Abdullahi
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rehou
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada.
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Pinto
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Chen
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Burnett
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada.
authors.forename: Saeid
authors.initials: S
authors.lastname: Amini-Nik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001786:Blood Glucose; D002056:Burns / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism*; D015331:Cohort Studies; D015897:Comorbidity; D016207:Cytokines / Q000378:metabolism; D020405:Dermis / Q000378:metabolism / Q000473:pathology; D004734:Energy Metabolism; D004817:Epidermis / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D058847:Inflammasomes / Q000378:metabolism; D018836:Inflammation Mediators / Q000378:metabolism; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012720:Severity of Illness Index; D014945:Wound Healing
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D016207:Cytokines; D058847:Inflammasomes; D018836:Inflammation Mediators
keywords: Burn; Elderly; Hypermetabolism; Inflammasome; Inflammation; Morbidity; Mortality; Pathophysiologic response; Skin healing; Stem cell