The Acute Inflammatory Response after Trauma is heightened by Frailty: A Prospective Evaluation of Inflammatory and Endocrine System Alterations in Frailty

Introduction Frailty is a geriatric syndrome characterized by decreased physiological reserves, increased inflammation, and decreased anabolic-endocrine response. The biomarkers associated with frailty are poorly understood in trauma. The aim of this study was to analyze the association between frailty and immune: IL-1β, IL-6, IL-2Rα, TNF-α and endocrine biomarkers: Insulin-like growth factor-1(IGF-1), and growth hormone(GH) in trauma patients. Methods We conducted a one-year(2017-2018) prospective analysis of geriatric(≥ 65y) trauma patients admitted to our level-1 trauma center. Frailty was measured using the trauma specific frailty index (TSFI) and blood samples were collected within 24-hours of admission. Patients were stratified into two groups: frail(TSFI>0.25) and non-frail(TSFI≤0.25). We then measured the levels of immune and endocrine biomarkers by a colorimetric output that was read by a spectrophotometer(Quantikine® ELISA). The outcome measures were the levels of the immune and endocrine markers in the two groups. Multivariable linear regression was performed. Results A total of 100 geriatric trauma patients were consented and enrolled. The mean age was 77.1±9.8 years and 34% were female. 39(39%) patients were frail. Frail patients were more likely to present after falls(p=0.01). There was no difference in age(p=0.78), gender(p=0.77), systolic blood pressure(p=0.16), and heart rate(p=0.24) between the two groups. Frail patients had higher levels of TNF-α(p=0.01), IL-1β(p=0.01), and IL-6(p=0.01) but lower levels of GH(p=0.03) and IGF-1 (p

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