Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery?

Abstract

BackgroundPatients with MetS or SIRS experience higher rates of mortality and morbidity, across both cardiac and noncardiac surgery. Frailty assessment has acquired increasing importance in recent years as it predisposes elderly patients to a worse outcome. The aim of our study was to investigate the influence of MetS, SIRS, and with or without frailty on elderly patients undergoing emergency surgical procedures.MethodsWe analyzed data of all patients with nonmalignant diseases requiring an emergency surgical procedure from January 2017 to December 2020. The occurrence of MetS was identified using modified definition criteria used by the NCEP-ATP III Expert Panel: obesity, hypertension, diabetes, or if medication for high triglycerides or for low HDL cholesterol was taken. Systemic inflammatory response syndrome (SIRS) was evaluated according to the original consensus study (Sepsis-1). The frailty profile was investigated by the 5-modified Frailty Index (5-mFI) and the Emergency Surgery Frailty Index (EmSFI). Postoperative complications have been reported and categorized according to the Clavien–Dindo (C–D) classification system. Morbidity and mortality have been mainly considered as the 30-day standard period definition.ResultsOf the 2,318 patients included in this study, 1,010 (43.6%) fulfilled the criteria for MetS (MetsG group). Both 5-Items score and EmsFI showed greater fragility in patients with MetS. All patients with MetS showed more frequently a CACI index greater than 6. The occurrence of SIRS was higher in MetSG. LOS was longer in patients with MetS (MetSG 11.4 ± 12 days vs. n-MetSG 10.5 ± 10.2 days, p = 0.046). MetSG has a significantly higher rate of morbidity (353 (35.%) vs. 385 (29.4%), p = 0.005). The mortality rate in patients with MetS (98/1010, 10%) was similar to that in patients without it (129/1308, 10%). Considering patients with MetS who developed SIRS and those who had frailty or both, the occurrence of these conditions was associated with a higher rate of morbidity and mortality.ConclusionImpact of MetS and SIRS on elderly surgical patient outcomes has yet to be fully elucidated. The present study showed a 43.6% incidence of MetS in the elderly population. In conclusion, age per se should be not considered anymore as the main variable to estimate patient outcomes, while MetS and Frailty should have always a pivotal role.

The Emergency Surgery Frailty Index (EmSFI) in Elderly Patients with Acute Appendicitis: An External Validation of Prognostic Score

“…The score above 3 points identifies a group of more frail patients, more prone to postoperative complication, and appears a feasible and easy‐to‐use marker in the emergency setting. Indeed, a recent study [41] applied the EmSFI score to a court of patients with nonmalignant diseases requiring an emergency surgical procedure, adopting a value of at least 4 as a cutoff to define a patient as frail.…”

Antimicrobial Challenge in Acute Care Surgery

“…According to a multidisciplinary task force of experts, procalcitonin may be considered as an excellent parameter for guiding treatment and duration of antibiotic therapy in general and emergency surgery [ 85 ]. Further, the use of an early warning score, namely quick SOFA (qSOFA) [ 41 , 79 , 86 , 87 , 88 ], SIRS [ 89 , 90 , 91 ], Modified Early Warning Score (MEWS), and National Early Warning Score (NEWS) [ 92 ], can facilitate the stratification of risk in patients with suspected infection. Churpek et al compared the accuracy of qSOFA, SIRS, MEWS, and NEWS, by analyzing a cohort of 30,677 non-ICU patients with suspicion of infection in emergency department and hospital wards.…”

Therapeutic potential of mesenchymal stromal/stem cells in critical‐care patients with systemic inflammatory response syndrome

“…In contrast to patients without SIRS, patients who develop it are more likely to be admitted to the ICU, to require a higher level of care and to experience a higher mortality rate at 28 days. 4 , 5 , 6 Sepsis is the primary cause of death from infection, which mortality reaches levels of 25%–30% and increases with the shock and multiorgan failure progression. 1 , 7 This makes SIRS be among the most common causes of mortality.…”