Can a biomarker for oxidative stress and antioxidant reserves identify frailty in geriatric trauma patients?. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Bourg, Pamela; Salottolo, Kristin; Klein, Joseph; Bar-Or, David
• Is Part Of: Injury. Volume 52:Issue 10(2021)
• Page Start: 2908
• Page End: 2913
• Publication Date: 2021-10
• Subjects: Geriatrics -- Frailty -- plasma -- point-of-care testing; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.01.046
• Languages: English
• ISSNs: 0020-1383

Abstract

HIGHLIGHTS: 1 A rapid, quantitative assessment of frailty may aid clinicians to better understand health status and manage underlying, often undetected conditions affecting a patient's hospital course. 2 Our findings demonstrate that greater age, elevated lactate at admission, lower ISS, alcohol use, and lower log cORP values (less antioxidant reserves) were independently predictive of increasing frailty scores. 3 This preliminary study suggests that capacity ORP, a novel biomarker for antioxidant reserves, may have application in emergent trauma situations. Abstract: Objective: Frailty is a state of systematic physiologic decline and reduced ability to recover from illness. There are no rapid quantitative biological measures to assess frailty. The study objective was to determine whether oxidation-reduction potential (ORP) is correlated with frailty score. Methods: This prospective, observational cohort study was performed using plasma samples of geriatric trauma patients (≥65 years) admitted to a level I trauma center. Frailty was measured with the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (7-point scale; 1 = robust health and 7 = severely frail). Plasma ORP was determined using the RedoxSYS™ system to measure static ORP (aggregate measure of oxidative stress) and capacity ORP (antioxidant reserves; log transformed). Spearman rank correlation (presented as rs ) and ordinal logistic regression (presented as adjusted odds ratios, AOR) were used to examine the unadjusted and adjusted relationship between frailty score and ORP values. Results: There were 93 geriatric trauma patients in our study. The majority (86%) had frailty scores 1-5, 11% were moderately frail and 3% were severely frail. There was a u-shaped relationship between ORP and frailty scale that became monotonic for scores 1-5. Each increase in frailty score demonstrated significant decreases in antioxidant reserves (log cORP rs = -0.26, p = 0.02) and nonsignificant increases in oxidative stress (sORP rs = 0.17, p = 0.15). After adjustment, variables significantly associated with frailty included log cORP (e.g., fewer antioxidant reserves, AOR: 0.70), age (AOR: 1.82), injury severity score (AOR: 0.50), admission lactate ≥2.5 mMol (AOR: 4.31), and alcohol use (AOR: 0.34). Conclusions: The amount of antioxidant reserves (cORP) appears to be a quantitative marker to differentiate the degree of frailty ranging from robust health to mild frailty in geriatric trauma patients. We propose that direct quantification of frailty by way of a biomarker for oxidative reserves could have application in emergent trauma situations.