Buket ALTUN ÖZDEMİR, Güzelali ÖZDEMİR, Niyazi Erdem YAŞAR, Olgun BİNGÖL, Hakan ATAŞ, Bülent ÇOMÇALI

ARE THE FACTORS AFFECTING MORTALITY IN ELDERLY POLYTRAUMA PATIENTS DIFFERENT FROM THOSE AFFECTING YOUNGER PATIENTS?

Objective The purpose of this study was to evaluate the diffe rences in mortality between young and elderly polyt rauma patients. Materials and Methods In the present study, all consecutive polytrauma pa tients treated at our hospital between January 2014 and December 2018 were reviewed retrospectively. Patients younger than 65 years old were classified as Group I (n = 60), and patients aged 65 years and older were classified as Group II (n = 60). Age, gen der, mechanism of injury, time of injury, injury severity score (ISS), preclinical hemodynamics, hospitaliza tion, operative treatment, intubation rate, intensive care unit (ICU) treatment, and 1-year mortality were analyzed. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI) were calculated. Results The mean age was 36.6 ± 13.0 (18–64) years in Group I and 73.5 ± 7.4 (56–91) years in Group II. There was no difference in mortality rates between groups. Elderly polytrauma patients tend to be fema le, and lower ISS and higher blood pressure, as well as low-energy injury types, typically in the summer. A statistically significant positive correlation was found between mortality and ISS scores in both Group I and Group II. There was no statistically significant differen ce was found between elderly and younger polytrau ma patients in terms of NLR, MLR, and SIRI scores. Conclusion There are several differences between elderly polyt rauma patients and their younger counterparts. It was found that mortality in the elderly patient group was affected by many system injuries. However, the cur rent study presents no differences in mortality rates between young and elderly polytrauma patients.

YAŞLI POLİTRAVMA HASTALARINDA MORTALİTEYİ ETKİLEYEN FAKTÖRLER GENÇ HASTALARDAN FARKLI MIDIR?

Amaç Bu çalışmanın amacı, genç ve yaşlı politravma hasta ları arasındaki mortalite farklılıklarını değerlendirmektir. Gereç ve Yöntem Bu çalışmada Ocak 2014-Aralık 2018 tarihleri ara sında hastanemizde tedavi edilen politravma hasta larının tümü retrospektif olarak incelendi. 65 yaşın dan küçük hastalar Grup I (n = 60), 65 yaş ve üstü hastalar Grup II (n = 60) olarak sınıflandırıldı. Yaş, cinsiyet, yaralanma mekanizması, yaralanma süresi, yaralanma ciddiyeti skoru (YCS), klinik öncesi hemo dinami, hastaneye yatış, operatif tedavi, entübasyon oranı, yoğun bakım ünitesinde (YBÜ) tedavi ve 1 yıllık mortalite analiz edildi. Nötrofil-lenfosit oranı, mono sit-lenfosit oranı ve sistemik inflamasyon yanıt indeksi hesaplandı. Bulgular Grup I'de yaş ortalaması 36,6 ± 13,0 (18-64), Grup II'de 73,5 ± 7,4 (56-91) idi. Gruplar arasında mortalite oranları arasında fark yoktu. Yaşlı politravma hasta ları genellikle yaz aylarında kadın, daha düşük YCS, daha yüksek kan basıncı ve düşük enerjili yaralanma tipinde olma eğilimindedir. Grup I ve Grup II'de mor talite ve YCS skorları arasında istatistiksel olarak an lamlı bir pozitif korelasyon bulundu. Nötrofil-lenfosit oranı, monosit-lenfosit oranı ve sistemik inflamasyon yanıt indeksi skorları açısından yaşlı ve genç politrav ma hastaları arasında istatistiksel olarak anlamlı bir fark bulunmadı. Sonuç Yaşlı politravma hastaları ile genç hastalar arasında çeşitli farklılıklar vardır. Yaşlı hasta grubundaki morta litenin birçok sistem yaralanmasından etkilendiği bu lunmuştur. Bununla birlikte, bu çalışma genç ve yaşlı politravma hastaları arasında mortalite oranlarında hiçbir farklılık göstermemektedir.

PDF

___

1. Braun BJ, Holstein J, Fritz T, Veith NT, Herath S, Mörsdorf P, et al. Polytrauma in the elderly: a review. EFORT open Rev. 2016;1(5):146–51.

2. de Vries R, Reininga IHF, Pieske O, Lefering R, El Moumni M, Wendt K. Injury mechanisms, patterns and outcomes of older polytrauma patients—An analysis of the Dutch Trauma Registry. PLoS One. 2018;13(1):e0190587.

3. Aldrian S, Nau T, Koenig F, Vecsei V. Geriatric polytrauma. Wien Klin Wochenschr. 2005 Feb;117(4):145–9.

4. van der Sluis CK, Klasen HJ, Eisma WH, ten Duis HJ. Major trauma in young and old: what is the difference? J Trauma. 1996 Jan;40(1):78–82.

5. Giannoudis P V, Harwood PJ, Court-Brown C, Pape HC. Severe and multiple trauma in older patients; incidence and mortality. Injury. 2009 Apr;40(4):362–7.

6. Tornetta P 3rd, Mostafavi H, Riina J, Turen C, Reimer B, Levine R, et al. Morbidity and mortality in elderly trauma patients. J Trauma. 1999 Apr;46(4):702–6.

7. Hashmi A, Ibrahim-Zada I, Rhee P, Aziz H, Fain MJ, Friese RS, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014 Mar;76(3):894–901.

8. Sammy I, Lecky F, Sutton A, Leaviss J, O’Cathain A. Factors affecting mortality in older trauma patients-A systematic review and meta-analysis. Injury. 2016 Jun;47(6):1170–83.

9. Zietlow SP, Capizzi PJ, Bannon MP, Farnell MB. Multisystem geriatric trauma. J Trauma. 1994 Dec;37(6):985–8.

10. Djordjevic D, Rondovic G, Surbatovic M, Stanojevic I, Udovicic I, Andjelic T, et al. Ratio , Platelet-to-Lymphocyte Ratio , and Mean Platelet Volume- to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients : Which Ratio to Choose to Predict Outcome and Nature of Bacteremia ? 2018;2018.

11. Demetriades D, Murray J, Sinz B, Myles D, Chan L, Sathyaragiswaran L, et al. Epidemiology of major trauma and trauma deaths in Los Angeles County. J Am Coll Surg. 1998 Oct;187(4):373–83.

12. Champion HR, Copes WS, Buyer D, Flanagan ME, Bain L, Sacco WJ. Major trauma in geriatric patients. Am J Public Health. 1989 Sep;79(9):1278–82.

13. Horst HM, Obeid FN, Sorensen VJ, Bivins BA. Factors influencing survival of elderly trauma patients. Crit Care Med. 1986 Aug;14(8):681–4.

14. Rupprecht H, Heppner HJ, Wohlfart K, Turkoglu A. The geriatric polytrauma: Risk profile and prognostic factors. Ulus Travma Acil Cerrahi Derg. 2017 Mar;23(2):156–62.

15. Bouamra O, Wrotchford A, Hollis S, Vail A, Woodford M, Lecky F. A new approach to outcome prediction in trauma: A comparison with the TRISS model. J Trauma. 2006 Sep;61(3):701–10.

16. Aitken LM, Burmeister E, Lang J, Chaboyer W, Richmond TS. Characteristics and outcomes of injured older adults after hospital admission. J Am Geriatr Soc. 2010 Mar;58(3):442–9.

17. Richmond TS, Kauder D, Strumpf N, Meredith T. Characteristics and outcomes of serious traumatic injury in older adults. J Am Geriatr Soc. 2002 Feb;50(2):215–22.

18. Lionakis N, Mendrinos D, Sanidas E, Favatas G, Georgopoulou M. Hypertension in the elderly. World J Cardiol. 2012 May;4(5):135–47.

19. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5–14.

20. Vaughan-Shaw PG, Rees JRE, King AT. Neutrophil lymphocyte ratio in outcome prediction after emergency abdominal surgery in the elderly. Int J Surg. 2012;10(3):157–62.

21. Tan TP, Arekapudi A, Metha J, Prasad A, Venkatraghavan L. Neutrophil-lymphocyte ratio as predictor of mortality and morbidity in cardiovascular surgery: a systematic review. ANZ J Surg. 2015 Jun;85(6):414–9.

22. Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014 Jun;106(6):dju124.

23. Paramanathan A, Saxena A, Morris DL. A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surg Oncol. 2014 Mar;23(1):31–9.

24. Malietzis G, Giacometti M, Kennedy RH, Athanasiou T, Aziz O, Jenkins JT. The emerging role of neutrophil to lymphocyte ratio in determining colorectal cancer treatment outcomes: a systematic review and meta-analysis. Ann Surg Oncol. 2014 Nov;21(12):3938–46.

25. Qi Q, Zhuang L, Shen Y, Geng Y, Yu S, Chen H, et al. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy. Cancer. 2016 Jul;122(14):2158–67.

26. Chen Z, Wang K, Lu H, Xue D, Fan M, Zhuang Q, et al. Systemic inflammation response index predicts prognosis in patients with clear cell renal cell carcinoma: a propensity score-matched analysis. Cancer Manag Res. 2019;11:909–19.

27. Xu L, Yu S, Zhuang L, Wang P, Shen Y, Lin J, et al. Systemic inflammation response index (SIRI) predicts prognosis in hepatocellular carcinoma patients. Oncotarget. 2017 May;8(21):34954–60.

28. Li S, Xu H, Wang W, Gao H, Li H, Zhang S, et al. The systemic inflammation response index predicts survival and recurrence in patients with resectable pancreatic ductal adenocarcinoma. Cancer Manag Res. 2019;11:3327.