title: Impaired Immune Response in Elderly Burn Patients: New Insights Into the Immune-senescence Phenotype.
abstract: Comparing the inflammatory and immunological trajectories in burned adults versus burned elderly patients to gain novel insights and better understanding why elderly have poor outcomes.
  
  
  
  Despite receiving the same treatment and clinical consideration as all other burn patients, elderly patients continue to have substantially poorer outcomes compared with adults. In light of an aging population, gaining a better understanding of their susceptibility to complications and creating new treatment strategies is imperative.
  
  
  
  We included 130 burn patients (94 adults: <65 years old and 36 elderly: ≥65 years old) and 10 healthy controls in this study. Immune activity and expression was assessed using bioplex at various time points. Clinical outcomes such as infection, sepsis, and mortality were prospectively collected.
  
  
  
  Elderly burn patients had significantly lower burn size but significantly higher Baux scores. Morbidity and mortality was significantly increased in the elderly cohort. Immune biomarkers indicated that elderly are immune compromised and unable to respond with the expected inflammatory response during the early phase after injury. This trajectory changes to a hyperinflammatory pattern during the later phase after burn. These findings are even more pronounced when comparing sepsis versus nonsepsis patients as well as survivors versus nonsurvivors in the elderly.
  
  
  
  Elderly burned patients mount a delayed immune and dampened inflammatory response early after burn injury that changes to an augmented response at later time points. Late-onset sepsis and nonsurvivors had an immune exhaustion phenotype, which may represent one of the main mediators responsible for the striking mortality in elderly.
authors.affiliation: *Sunnybrook Research Institute, University of Toronto, Toronto, Canada†Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Canada‡Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Mile
authors.initials: M
authors.lastname: Stanojcic
authors.forename: Peter
authors.initials: P
authors.lastname: Chen
authors.forename: Fangming
authors.initials: F
authors.lastname: Xiu
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015415:Biomarkers / Q000097:blood; D001830:Body Surface Area; D002056:Burns / Q000276:immunology* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016022:Case-Control Studies; D018925:Chemokines / Q000276:immunology; D003422:Critical Care; D016207:Cytokines / Q000276:immunology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015601:Injury Severity Score; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011446:Prospective Studies; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology; D014945:Wound Healing
chemical_list: D015415:Biomarkers; D018925:Chemokines; D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha