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首页> 外文期刊>Injury >Plasma concentrations of pro- and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients.
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Plasma concentrations of pro- and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients.

机译：老年髋部骨折患者血浆中促炎和抗炎细胞因子的浓度及结果预测。

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BACKGROUND: Hip fractures, particularly intertrochanteric fractures, frequently occur in the elderly, and they are associated with a high incidence of complications and mortality. The development of markers is essential to allow for adjustments to treatment strategies in patients, as it remains unclear why some patients endure organ failure and others do not under seemingly similar clinical conditions. OBJECTIVE: Our objective was to determine the kinetics of tumour necrosis factor (TNF)-a, interleukin (IL)-6 and IL-10 during the hospitalisation of patients and to examine the relationship of these parameters to outcome (mortality and complications) 6 months and 12 months postoperatively. METHODS AND SUBJECTS: A total of 127 elderly patients, who underwent hip fracture surgery, were prospectively followed up for 12 months, and 60 healthy elderly volunteers were enrolled in the control group to examine the effects of trauma and surgery on the inflammatory response. The epidemiological characteristics, chronic medical conditions and type of operation and anaesthetic were recorded. Cognition was evaluated using the Mini-Mental State Examination, and TNF-a, IL-6 and IL-10 levels were assessed during admission and preoperatively (post-anaesthesia) as well as 1 h, 1 day, 3 days and 5 days postoperatively. During the follow-up period, serious complications and mortality within 1 year were evaluated. RESULTS: Overall, 96 patients survived, and 31 died within the 6-month postoperative period; 43 patients died, and 84 survived when examining the 12-month postoperative period. There were significant within-subject effects of time on TNF-a, IL-6 and IL-10 (P<0.001, P<0.001 and P<0.001). The above three cytokines were all significantly increased in the hip fracture patients compared with the control group. There were also differences in the kinetic patterns of all three parameters when the patients who died were compared with those who survived during the 6-month and 12-month postoperative periods. Multiple logistic regression analysis showed that TNF-a at 1 day (odds ratio (OR)=1.020, P=0.045) and 3 days (OR=1.034, P=0.037) postoperatively and IL-6 at 1 day (OR=1.048, P=0.000) postoperatively were independent predictors of mortality at 6 months; IL-6 (OR=1.019, P=0.025) and IL-10 (OR=1.018, P=0.042) at 1 day postoperatively were independent predictors of mortality at 1 year. The analysis of the receiver operating characteristics curve (ROC) showed that only IL-6 or IL-10 had the highest values for the area under the curve for mortality at 6 months and 12 months. Of the 84 patients who survived, 23 patients had 32 complications. The most common complication was pneumonia infection (11/84, 13%). TNF-a, IL-6 and IL-10 kinetics were found to differ in patients with complications compared to those without complications and in patients with infections compared with patients without complications. Multiple logistic regression analysis showed that IL-6 (OR=1.081, P=0.000) at 1 day postoperatively was an independent outcome predictor. CONCLUSION: In elderly hip fracture patients, cytokine concentrations (TNF-a, IL-6 and IL-10) represented independent outcome predictors for adverse postoperative outcomes (mortality and complications). The inflammatory response played an important role in postoperative organ dysfunction in elderly hip fracture patients, and further study is needed to define whether decreasing the inflammatory response through cytokine antibodies or damage control strategies would decrease mortality and complication following hip fracture.
机译：背景：髋部骨折，特别是股骨转子间骨折，经常发生在老年人中，并且与并发症和死亡率的高发生率相关。标记物的开发对于调整患者的治疗策略至关重要，因为目前尚不清楚为什么有些患者会忍受器官衰竭，而另一些患者在看似相似的临床条件下却不会。目的：我们的目标是确定患者住院期间肿瘤坏死因子（TNF）-a，白介素（IL）-6和IL-10的动力学，并检查这些参数与结果（死亡率和并发症）的关系6术后12个月和12个月。方法和对象：前瞻性对总共127例接受髋部骨折手术的老年患者进行了12个月的随访，将60名健康的老年志愿者纳入对照组，以检查创伤和手术对炎症反应的影响。记录流行病学特征，慢性医疗状况，手术类型和麻醉剂。使用小精神状态检查评估认知度，并在入院期间和术前（麻醉后）以及术后1小时，1天，3天和5天评估TNF-a，IL-6和IL-10水平。 。在随访期间，评估了一年内的严重并发症和死亡率。结果：总体而言，术后6个月内存活了96例患者，其中31例死亡。检查术后12个月的期间，有43例患者死亡，84例存活。时间对TNF-α，IL-6和IL-10具有显着的受试者内影响（P <0.001，P <0.001和P <0.001）。与对照组相比，髋部骨折患者的上述三种细胞因子均显着增加。当比较死亡患者与术后6个月和12个月内存活的患者时，所有三个参数的动力学模式也存在差异。多元logistic回归分析显示，术后1天（比值比（OR）= 1.020，P = 0.045）和3天（OR = 1.034，P = 0.037）时的TNF-a和1天时（OR = 1.048， P = 0.000）是术后6个月死亡率的独立预测因子;术后1天的IL-6（OR = 1.019，P = 0.025）和IL-10（OR = 1.018，P = 0.042）是1岁时死亡率的独立预测因子。接收器工作特性曲线（ROC）的分析显示，在6个月和12个月时，只有IL-6或IL-10的曲线下面积具有最高值。在存活的84例患者中，有23例有32例并发症。最常见的并发症是肺炎感染（11 / 84，13％）。发现有并发症的患者与没有并发症的患者以及有感染的患者与没有并发症的患者相比，TNF-α，IL-6和IL-10动力学有所不同。多元logistic回归分析显示，术后1天IL-6（OR = 1.081，P = 0.000）是独立的预后指标。结论：在老年髋部骨折患者中，细胞因子浓度（TNF-α，IL-6和IL-10）是术后不良后果（死亡率和并发症）的独立预测指标。炎症反应在老年髋部骨折患者的术后器官功能障碍中起着重要作用，还需要进一步的研究来确定通过细胞因子抗体降低炎症反应或通过损伤控制策略是否会降低髋部骨折后的死亡率和并发症。

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