EASE-BIO
Funding: Technology Evaluation in the Elderly Networks (TVN) Catalyst Grant (2015-2016)
Background: Hospitalized elders – especially the frail elderly with multiple comorbidities and functional impairment – are known to have higher rates of surgical complications and hospital-acquired infections than younger patients. This can result in longer hospital stays, need for intensive care, greater resource expenditure, and increased risk of death. Evaluating patient-specific risk factors for postoperative complications in the emergency surgery setting is crucial for improving patient care and their outcomes. Research has shown that muscle is aggressively broken down during critical illness and it is expected that following surgery, older patients can experience dramatic muscle loss. Poor physical status in the frail elderly is associated with clinical, cognitive and functional deterioration. In fact, muscle loss can have long term repercussion by dramatically affecting older patients’ activities of daily living. Our group recently showed that elderly surgical patients who had severe muscle depletion (sarcopenia), measured by computerized tomography (CT) radiologic assessment, had higher rates of postoperative infections, required inpatient rehabilitation care more frequently, and had greater in-hospital mortality. Loss of muscle mass has also been linked to frailty.
Our collaborator, Dr. Baracos and colleagues have also shown that urinary metabolite profiles could determine whether a patient was experiencing muscle wasting. There is evidence that specific stem cell populations are altered during aging or myopathies, either by decreasing in number of stem cells or altering their normal myogenic program. Both chronic inflammation and surgery-induced inflammation in elderly patients has also been shown to significantly worsen muscle performance and mobilization, both immediately following surgery and a month after. Much of the work performed on skeletal muscle wasting has been on the cancer population, animal models and cell lines.
The Research Need: We identified two gaps in the emerging understanding of sarcopenia in relation to surgical outcomes:
- Limited knowledge in explaining how muscle wasting relates to clinically important postoperative outcomes in the frail elderly
- Lack of understanding of the underlying biology of the muscle, in relation to its potential reversibility.
Hypothesis: We hypothesize that biological characterization, via muscle biopsy and metabolomics, coupled with microbiota profiling can offer novel biomarker-based prognostic and/or diagnostic tools to identify frail elderly patients who are at risk for poor health outcomes.
Research Importance: This research addresses two biomarker approaches one with invasive examination using muscle biopsy which will then be correlated with non-invasive tools using blood, urine, and stool. Currently, no information exists on linking surgical outcomes in the elderly following emergency surgery to their biologic profiles. As such, this knowledge would not only identify high-risk patients, but also allow for future personalized treatment and preventative strategies (i.e. nutritional/diet modifications, post-surgical resistive muscle training, and prophylaxis antibiotics) to decrease the catabolic pathway leading to muscle breakdown and overall health.