Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.
Inj Prev. 2020 Oct;26(5):471-477. doi: 10.1136/injuryprev-2019-043325. Epub 2019 Sep 3.
Traumatic brain injury (TBI) in older adults leads to considerable morbidity and mortality. Outcomes among older adults with TBI are disparately worse than in younger adults. Differences in immunological response to injury may account for at least some of this disparity. Understanding how ageing differentially affects the immune response to TBI and how older age and these immunological changes affect the natural history of recovery following TBI are the goals of this study.
DESIGN/METHODS: A prospective multiple cohort design is being used to assess the effects of ageing and TBI on immune makers and to test predictors of impairment and disability in older adults following mild TBI. Older adults (55 years) with mild TBI are enrolled with three comparison groups: younger adults (21-54 years) with mild TBI, non-injured older adults (55 years) and non-injured young adults (21-54 years). For the primary analysis, we will assess the association between immune markers and Glasgow Outcome Scale-Extended at 6 months, using logistic regression. Predictors of interest will be inflammatory biomarkers. Multivariate linear regression will be used to evaluate associations between biomarkers and other outcomes (symptoms, function and quality of life) at 3 and 6 months. Exploratory analyses will investigate the utility of biomarkers to predict outcome using receiver-operating characteristic curves.
A better understanding of the recovery trajectory and biological rationale for disparate outcomes following TBI in older adults could allow for development of specific interventions aimed at reducing or eliminating symptoms. Such interventions could reduce impairment and healthcare costs.
老年人创伤性脑损伤（TBI）导致相当高的发病率和死亡率。与年轻人相比，老年人 TBI 的预后明显更差。受伤后的免疫反应差异可能至少是造成这种差异的部分原因。了解衰老如何对 TBI 的免疫反应产生不同影响，以及年龄增长和这些免疫变化如何影响 TBI 后的自然恢复过程，是本研究的目标。
设计/方法：本研究采用前瞻性多队列设计，评估衰老和 TBI 对免疫标志物的影响，并测试轻度 TBI 后老年人的损伤和残疾的预测因子。招募年龄在 55 岁及以上的轻度 TBI 老年人，与三个对照组进行比较：年龄在 21-54 岁的轻度 TBI 年轻人、无损伤的老年组（55 岁）和无损伤的年轻组（21-54 岁）。在主要分析中，我们将使用逻辑回归评估免疫标志物与 6 个月时格拉斯哥结局量表扩展（GOS-E）之间的关联。感兴趣的预测因子为炎症生物标志物。多元线性回归将用于评估 3 个月和 6 个月时生物标志物与其他结局（症状、功能和生活质量）之间的关联。探索性分析将使用接收者操作特征曲线评估生物标志物预测结局的效用。
更好地了解老年人 TBI 后恢复轨迹和不同结局的生物学原理，可能有助于开发针对减少或消除症状的特定干预措施。这些干预措施可以减少损伤和医疗保健成本。
