Patel Abhilasha, Zhang MengQi, Liao Gary, Karkache Wassim, Montroy Joshua, Fergusson Dean A, Khadaroo Rachel G, Tran Diem T T, McIsaac Daniel I, Lalu Manoj M
From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Clinical Epidemiology Program.
Anesth Analg. 2022 Apr 1;134(4):751-764. doi: 10.1213/ANE.0000000000005832.
Dysregulation of immune responses to surgical stress in older patients and those with frailty may manifest as differences in inflammatory biomarkers. We conducted a systematic review and meta-analysis to examine differences in perioperative inflammatory biomarkers between older and younger patients, and between patients with and without frailty.
MEDLINE, Embase, Cochrane, and CINAHL databases were searched (Inception to June 23, 2020). Observational or experimental studies reporting the perioperative level or activity of biomarkers in surgical patients stratified by age or frailty status were included. The primary outcome was inflammatory biomarkers (grouped by window of ascertainment: pre-op; post-op: <12 hours, 12-24 hours, 1-3 days, 3 days to 1 week, and >1 week). Quality assessment was conducted using the Newcastle-Ottawa Scale. Inverse-variance, random-effects meta-analysis was conducted.
Forty-five studies (4263 patients) were included in the review, of which 36 were pooled for meta-analysis (28 noncardiac and 8 cardiac studies). Two studies investigated frailty as the exposure, while the remaining investigated age. In noncardiac studies, older patients had higher preoperative levels of interleukin (IL)-6 and C-reactive protein (CRP), lower preoperative levels of lymphocytes, and higher postoperative levels of IL-6 (<12 hours) and CRP (12-24 hours) than younger patients. In cardiac studies, older patients had higher preoperative levels of IL-6 and CRP and higher postoperative levels of IL-6 (<12 hours and >1 week).
Our findings demonstrate a paucity of frailty-specific studies; however, the presence of age-associated differences in the perioperative inflammatory response is consistent with age-associated states of chronic systemic inflammation and immunosenescence. Additional studies assessing frailty-specific changes in the systemic biologic response to surgery may inform the development of targeted interventions.
老年患者和体弱患者对手术应激的免疫反应失调可能表现为炎症生物标志物的差异。我们进行了一项系统评价和荟萃分析，以研究老年患者与年轻患者之间以及体弱患者与非体弱患者之间围手术期炎症生物标志物的差异。
检索了MEDLINE、Embase、Cochrane和CINAHL数据库（从数据库建立至2020年6月23日）。纳入了按年龄或体弱状态分层报告手术患者围手术期生物标志物水平或活性的观察性或实验性研究。主要结局是炎症生物标志物（按确定时间窗分组：术前；术后：<12小时、12 - 24小时、1 - 3天、3天至1周以及>1周）。使用纽卡斯尔 - 渥太华量表进行质量评估。进行了逆方差随机效应荟萃分析。
该评价纳入了45项研究（4263例患者），其中36项进行了荟萃分析（28项非心脏手术研究和8项心脏手术研究）。两项研究将体弱作为暴露因素进行调查，其余研究则调查年龄。在非心脏手术研究中，老年患者术前白细胞介素（IL）-6和C反应蛋白（CRP）水平较高，术前淋巴细胞水平较低，术后IL - 6（<12小时）和CRP（12 - 24小时）水平高于年轻患者。在心脏手术研究中，老年患者术前IL - 6和CRP水平较高，术后IL - 6（<12小时和>1周）水平较高。
我们发现针对体弱的特异性研究较少；然而，围手术期炎症反应中存在与年龄相关的差异，这与慢性全身炎症和免疫衰老的年龄相关状态一致。评估手术全身生物学反应中体弱特异性变化的更多研究可能为针对性干预措施的制定提供依据。
