Effect of Oral Taurine on Morbidity and Mortality in Elderly Hip Fracture Patients: A Randomized Trial
Abstract
:1. Introduction
2. Results and Discussion
2.1. Results
2.1.1. Patients
Parameter | Taurine | Placebo | p-Value |
---|---|---|---|
Male/Female | 33/80 | 30/93 | 0.41 |
Age (years) | 84.4 ± 5.4 | 84.4 ± 4.9 | 0.95 |
BMI (kg/m2) | 24.1 ± 4.0 | 24.5 ± 3.8 | 0.35 |
Barthel ADL index (max. 20 points) | 17 ± 3 | 18 ± 3 | 0.20 |
Hemoglobin (mmol/L) | 7.7 ± 0.9 | 7.8 ± 0.9 | 0.43 |
Creatinine clearance * (mL/min) | 56 ± 19 | 55 ± 23 | 0.90 |
Vitamin B6 (nmol/L) | 83.7 ± 73.4 | 80.1 ± 51.6 | 0.67 |
Albumin (g/L) | 34.5 ± 4.7 | 35.1 ± 3.6 | 0.35 |
Mini Nutritional Assessment | |||
Screening score (max. 14 points) | 11.6 ± 2.7 | 11.9 ± 2.8 | 0.39 |
Assessment (max. 16 points) | 12.5 ± 1.7 | 12.7 ± 1.9 | 0.52 |
Total Assessment (max. 30 points) | 24.2 ± 3.8 | 24.6 ± 4.3 | 0.39 |
Nutritional Status ** | 0.40 | ||
Malnourished, n/N (%) | 6/109 (5) | 7/122 (6) | |
At risk of malnutrition, n/N (%) | 29/109 (27) | 24/122 (20) | |
Well nourished, n/N (%) | 74/109 (68) | 91/122 (74) | |
Medical comorbidities (quantity) | 2.1 ± 1.6 | 2.1 ± 1.3 | 0.93 |
0, n/N (%) | 14/113 (12) | 12/123 (10) | |
1n/N (%) | 33/113 (29) | 33/123 (27) | |
2, n/N (%) | 29/113 (26) | 32/123 (26) | |
≥3, n/N (%) | 37/113 (33) | 46/123 (37) | |
Cardiovascular disease, n/N (%) | 108/113 (95) | 113/123 (92) | 0.76 |
Cerebral vascular disease, n/N (%) | 20/113 (18) | 17/123 (14) | 0.41 |
Respiratory disease, n/N (%) | 11/113 (10) | 11/123 (9) | 0.83 |
Diabetes, n/N (%) | 24/113 (21) | 24/123 (19) | 0.74 |
Musculoskeletal, n/N (%) | 34/113 (30) | 27/123 (22) | 0.24 |
Other, n/N (%) | 40/113 (35) | 64/123 (52) | 0.04 |
Concomitant Medication (quantity) | 5 ± 4 | 5 ± 4 | 0.61 |
0–1, n/N (%) | 23/113 (20) | 24/123 (20) | |
2–5, n/N (%) | 45/113 (40) | 60/123 (49) | |
6–10, n/N (%) | 37/113 (33) | 30/123 (24) | |
>10, n/N (%) | 8/113 (7) | 9/123 (7) | |
ASA Score | |||
1, n/N (%) | 19/113 (17) | 22/123 (18) | 0.17 |
2, n/N (%) | 50/113 (44) | 67/123 (54) | |
3, n/N (%) | 44/113 (39) | 34/123 (28) | |
Type of Surgery | |||
Hemiarthroplasty, n/N (%) | 48/110 (44) | 65/122 (53) | 0.08 |
Cannulated screws, n/N (%) | 4/110 (4) | 7/122 (6) | |
Sliding hip screw, n/N (%) | 7/110 (6) | 7/122 (6) | |
Gamma nail, n/N (%) | 51/110 (46) | 43/122 (35) | |
Type of Anesthesia | |||
Spinal, n/N (%) | 89/110 (81) | 93/122 (76) | 0.33 |
Spinal + general, n/N (%) | 2/110 (2) | 1/122 (1) | |
General, n/N (%) | 19/110 (17) | 28/122 (23) | |
Time of Admission to Surgery (h) | 20.2 ± 15.0 | 21.4 ± 20.6 | 0.61 |
Duration of surgery (min) | 49 ± 25 | 48 ± 18 | 0.69 |
Group | Preoperative | Postoperative | Beta (95% CI) p * | ||
---|---|---|---|---|---|
Day 1 | Day 5 | ||||
WBC (109/L) | T | 8.0 (3.4–16.9) | 9.8 (4.5–16.1) | 8.1 (2.7–11.4) | −0.13 (−1.07–0.81) 0.78 |
P | 9.2 (4.4–18.2) | 9.9 (5.2–15.9) | 7.4 (3.5–13.7) | ||
CRP (mg/L) | T | 4 (1–25) | 85 (19–229) | 66 (22–218) | −1.2 (−27.0–24.5) 0.93 |
P | 4 (1–117) | 103 (8–209) | 83 (5–207) | ||
IL-6 (pg/mL) | T | 29.1 (5.5–415.0) | 104.5 (11.9–335.3) | 21.7 (6.7–360.0) | 6.8 (−17.8–31.4) 0.59 |
P | 39.6 (4.5–116.7) | 91.4 (31.5–622.7) | 18.1 (3.8–57.7) | ||
Taurine (µmol/L) | T | 102 (49–474) | 689 (169–1629) | 685 (97–1561) | 701 (578–824) 0.00 |
P | 96 (64–142) | 86 (57–152) | 74 (53–137) | ||
Vitamin C (µmol/L) | T | 56 (27–135) | 53 (15–104) | 56 (18–92) | 2.2 (−5.5–10.1) 0.57 |
P | 54 (26–107) | 52 (26–79) | 55 (26–97) | ||
Vitamin E (µmol/L) | T | 35 (15–52) | 26 (12–40) | 28 (22–40) | −1.3 (−3.9–1.2) 0.31 |
P | 34 (18–56) | 27 (16–48) | 30 (17–45) | ||
β-carotene (µmol/L) | T | 0.29 (0.08–1.07) | 0.24 (0.07–0.70) | 0.22 (0.08–0.81) | −0.02 (−0.06–0.02) 0.27 |
P | 0.28 (0.12–0.89) | 0.23 (0.07–0.71) | 0.27 (0.11–1.04) | ||
Glutathione (µmol/L) | T | 767 (256–1350) | 683 (223–1195) | 651 (161–1035) | 2.5 (−59.8–64.9) 0.94 |
P | 745 (505–1228) | 696 (455–1006) | 637 (336–998) | ||
Ox. LDL/apoB100 ratio (U/g) | T | 94 (76–130) | 100 (81–145) | 117 (96–146) | 2.39 (−2.39–7.17) 0.33 |
P | 100 (69–126) | 106 (80–139) | 117 (84–150) | ||
Malondialdehyde (µmol/L) ‡ | T | 7.0 (4.3–10.8) | 9.3 (6.1–19.1) | 7.6 (5.4–12.7) | −0.45 (−1.64–0.74) 0.46 |
P | 7.3 (4.6–24.0) | 10.8 (6.4–23.3) | 7.5 (4.8–11.6) | ||
F2-Isoprostane (pmol/mmol creatinine) | T | 106.2 (23.8–359.3) | 76.7 (11.5–184.6) | 115.9 (47.2–184.2) | −1.62 (−18.5–15.2) 0.85 |
P | 113.7 (25.1–434.1) | 82.0 (21.9–233.9) | 109.0 (46.7–275.9) | ||
8OHdG (nmol/mmol creatinine) | T | 2.4 (1.0–7.4) | 1.9 (0.7–6.8) | 2.5 (0.3–5.5) | −0.54 (−1.07–−0.01) 0.04 |
P | 2.0 (0.8–10.4) | 2.3 (0.8–12.8) | 2.2 (1.1–8.8) | ||
Lactate (µmol/L) | T | 833 (323–1540) | 1211 (744–4797) | 1257 (632–3347) | −44 (−347–258) 0.77 |
P | 912 (467–2861) | 1568 (738–6787) | 1159(647–2092) | ||
Pyruvate (µmol/L) | T | 48 (25–113) | 81 (50–242) | 86 (49–164) | 0.63 (−16.7–17.9) 0.94 |
P | 52 (20–200) | 86 (49–275) | 75 (35–138) | ||
Lactate/Pyruvate Ratio | T | 18 (12–29) | 16 (10–20) | 14 (10–20) | −1.10 (−2.33–0.12) 0.08 |
P | 18 (9–33) | 14 (12–25) | 16 (10–22) |
Group | Day 1 n/N (%) | Day 2 n/N (%) | Day 3 n/N (%) | Day 4 n/N (%) | Day 5 n/N (%) | * p-Value | |
---|---|---|---|---|---|---|---|
Nutrition Day Breakfast | |||||||
All eaten | T | 57/77 (74) | 55/73 (75) | 65/75 (87) | 55/70 (79) | 48/57 (84) | 0.42 |
P | 62/93 (67) | 73/93 (78) | 80/93 (86) | 61/77 (79) | 56/64 (87) | ||
50% Eaten | T | 12/77 (16) | 9/73 (12) | 7/75 (9) | 10/70 (14) | 5/57 (9) | |
P | 7/93 (7) | 10/93 (11) | 8/93 (9) | 10/77 (13) | 5/64 (8) | ||
25% Eaten | T | 6/77 (8) | 5/73 (7) | 2/75 (3) | 4/70 (6) | 4/57 (7) | |
P | 14/93(15) | 4/93 (4) | 4/93 (4) | 1/77 (1) | 2/64 (3) | ||
Nothing | T | 2/77 (2) | 4/73 (6) | 1/75 (1) | 1/70 (1) | 0/57 (0) | |
P | 10/93 (11) | 6/93 (7) | 1/93 (1) | 5/77 (7) | 1/64 (2) | ||
Nutrition Day Lunch | |||||||
All eaten | T | 48/73 (66) | 57/72 (79) | 52/68 (77) | 48/67 (72) | 36/44 (82) | 0.83 |
P | 57/89 (64) | 67/87 (77) | 69/80 (86.5) | 54/69 (78) | 51/58 (88) | ||
50% Eaten | T | 15/73 (21) | 8/73 (11) | 9/68 (13) | 15/67 (22) | 5/44 (11) | |
P | 16/89 (18) | 6/87 (7) | 5/80 (6) | 8/69 (12) | 4/58 (7) | ||
25% Eaten | T | 9/73 (12) | 5/72 (7) | 3/68 (4) | 2/67 (3) | 1/44 (2) | |
P | 7/89 (8) | 8/87 (9) | 5/80 (6) | 3/69 (4) | 1/58 (2) | ||
Nothing | T | 1/73 (1) | 2/72 (3) | 4/68 (6) | 2/67 (3) | 2/44 (5) | |
P | 9/89 (10) | 6/87 (7) | 1/80 (1.5) | 4/69 (6) | 2/58 (3) | ||
Nutrition Day Dinner | |||||||
All eaten | T | 30/65 (46) | 33/62 (53) | 34/64 (53) | 29/58 (50) | 26/40 (65) | 0.38 |
P | 29/74 (39) | 37/72 (51.5) | 45/71 (63) | 43/66 (65) | 31/48 (65) | ||
50% eaten | T | 17/65 (65) | 16/62 (26) | 16/64 (25) | 21/58 (36) | 5/40 (13) | |
P | 27/74 (37) | 21/72 (29) | 19/71 (27) | 15/66 (23) | 12/48 (25) | ||
25% eaten | T | 15/65 (23) | 11/62 (18) | 12/64 (19) | 6/58 (10) | 8/40 (20) | |
P | 12/74 (16) | 13/72 (18) | 5/71 (7) | 5/66 (8) | 3/48 (6) | ||
Nothing | T | 3/65 (5) | 2/62 (3) | 2/64 (3) | 2/58 (4) | 1/40 (2) | |
P | 6/74 (8) | 1/72 (1.5) | 2/71 (3) | 3/66 (4) | 2/48 (4) |
2.1.2. Postoperative Morbidity and Mortality
Parameter | Taurine | Placebo | p-Value |
---|---|---|---|
Intake Supplement (grams) | 33.0 ± 9.7 | 33.3 ± 9.5 | 0.82 |
Length of Hospital Stay (days) | 13 ± 10 | 13 ± 11 | 0.83 |
In-Hospital Morbidity (quantity) | 1.0 ± 1.1 | 1.0 ± 1.1 | 0.95 |
0, n/N (%) | 45/110 (41) | 55/122 (45) | |
1, n/N (%) | 38/110 (34) | 30/122 (25) | |
2, n/N (%) | 15/110 (14) | 25/122 (20) | |
≥3, n/N (%) | 12/110 (11) | 12/122 (10) | |
Infectious, n/N (%) | 11/110 (10) | 18/122 (15) | 0.54 |
Cardiovascular event, n/N (%) | 5/110 (5) | 13/122 (11) | 0.12 |
Cerebral vascular accident, n/N (%) | 1/110 (1) | 2/122 (2) | 0.62 |
Delirium, n/N (%) | 26/110 (24) | 27/122 (22) | 0.79 |
Blood transfusion, n/N (%) | 19/110 (17) | 20/122 (16) | 0.86 |
Reoperation or surgery otherwise, n/N (%) | 6/110 (5) | 6/122 (5) | 0.91 |
Other, n/N (%) | 40/110 (36) | 35/122 (29) | 0.33 |
Barthel ADL index (max. 20 points) | 0.90 * | ||
3 months follow-up | 16 ± 4 | 17 ± 4 | 0.83 ‡ |
6 months follow-up | 17 ± 4 | 17 ± 3 | 0.95 ‡ |
9 months follow-up | 17 ± 3 | 17 ± 4 | 0.53 ‡ |
12 months follow-up | 17 ± 4 | 17 ± 4 | 0.58 ‡ |
Medical Comorbidities in First Year (quantity) | 0.8 ± 0.9 | 0.8 ± 0.8 | 0.82 |
0, n/N (%) | 48/107 (44) | 51/117 (44) | |
1, n/N (%) | 36/107 (34) | 46/117 (39) | |
2, n/N (%) | 19/107 (18) | 14/117 (12) | |
≥3, n/N (%) | 4/107 (4) | 6/117 (5) | |
Infectious, n/N (%) | 30/107 (28) | 29/117 (25) | 0.69 |
Cardiovascular event, n/N (%) | 7/107 (7) | 8/117 (7) | 0.93 |
Cerebral vascular accident, n/N (%) | 0/107 (0) | 2/117 (2) | 0.17 |
Thromboembolic event, n/N (%) | 1/107 (1) | 2/117 (2) | 0.61 |
Reoperation or surgery otherwise, n/N (%) | 16/107 (15) | 15/117 (13) | 0.64 |
Anemia with medical intervention, n/N (%) | 2/107 (2) | 7/117 (6) | 0.12 |
Cognitive impairment, n/N (%) | 7/107 (7) | 8/117 (7) | 0.93 |
Other, n/N (%) | 24/107 (22) | 21/117 (18) | 0.40 |
Mortality Overall, n/N (%) | 23/107 (21) | 27/116 (23) | 0.75 |
In-hospital, n/N (%) | 11/111 (10) | 11/123 (9) | 0.80 |
At 3 months follow-up, n/N (%) | 16/108 (15) | 16/119 (13) | 0.77 |
At 6 months follow-up, n/N (%) | 20/108 (18) | 22/119 (18) | 0.99 |
At 9 months follow-up, n/N (%) | 22/108 (20) | 23/119 (19) | 0.84 |
At 12 months follow-up, n/N (%) | 23/107 (21) | 27/116 (23) | 0.75 |
2.1.3. Postoperative Surgical Stress Response
2.2. Discussion
3. Materials and Methods
3.1. Patients
3.2. Randomization, Blinding and Nutritional Intervention
3.3. Study Outcomes
3.4. Laboratory Measurements
3.4.1. Inflammatory Parameters
3.4.2. Antioxidant/Oxidant Parameters
3.5. Statistical Analysis
4. Conclusions
Acknowledgments
Author Contributions
Appendix
Conflicts of Interest
References
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Van Stijn, M.F.M.; Bruins, A.A.; Vermeulen, M.A.R.; Witlox, J.; Teerlink, T.; Schoorl, M.G.; De Bandt, J.P.; Twisk, J.W.R.; Van Leeuwen, P.A.M.; Houdijk, A.P.J. Effect of Oral Taurine on Morbidity and Mortality in Elderly Hip Fracture Patients: A Randomized Trial. Int. J. Mol. Sci. 2015, 16, 12288-12306. https://doi.org/10.3390/ijms160612288
Van Stijn MFM, Bruins AA, Vermeulen MAR, Witlox J, Teerlink T, Schoorl MG, De Bandt JP, Twisk JWR, Van Leeuwen PAM, Houdijk APJ. Effect of Oral Taurine on Morbidity and Mortality in Elderly Hip Fracture Patients: A Randomized Trial. International Journal of Molecular Sciences. 2015; 16(6):12288-12306. https://doi.org/10.3390/ijms160612288
Chicago/Turabian StyleVan Stijn, Mireille F. M., Arnoud A. Bruins, Mechteld A. R. Vermeulen, Joost Witlox, Tom Teerlink, Margreet G. Schoorl, Jean Pascal De Bandt, Jos W. R. Twisk, Paul A. M. Van Leeuwen, and Alexander P. J. Houdijk. 2015. "Effect of Oral Taurine on Morbidity and Mortality in Elderly Hip Fracture Patients: A Randomized Trial" International Journal of Molecular Sciences 16, no. 6: 12288-12306. https://doi.org/10.3390/ijms160612288