TTP8.12 Novel frailty biomarkers in emergency laparotomy patients

Aims Increasing frailty has been shown to predict poorer post-operative outcomes in emergency laparotomy (EmLap) patients. Assessing frailty in this time-pressured environment can be challenging. Frailty-related metabolites have been studied as blood biomarkers in the ageing community. This study aims to identify frailty-related metabolites in EmLap patients through metabolomic analysis.

Methods Prospective data was collected from EmLap patients age ≥40 years (May'22- July'23, including 3-month follow-up). Frailty was assessed with Clinical Frailty Scale (score >4 was frail). Serial blood sampling at 5 timepoints (pre- and post-EmLap) was processed and analysed via liquid chromatography-mass spectrometry (LCMS)-based metabolomics. Associated univariate (marginal means-hierarchical clustering analysis, MM-HCA) and multivariate (Least Absolute Shrinkage and Selection Operator, LASSO) regression chemometric analysis were performed. Results 150 patients were recruited, (55%/45% female/male; median age 69 years) 10% were living with frailty. 90-day mortality rate was 13.0% and 11.7% became frail post-EmLap. A panel of metabolites significantly associated with frailty was identified (p <0.05). Across the 5 peri-EmLap timepoints, distinct metabolites were observed between frail and non-frail groups, with the frail group exhibiting greater metabolite variability. MM-HCA revealed discreet clusters of metabolites that indicated post-EmLap metabolic dysregulation. LASSO-regression detected 15 metabolites that, from the pre-EmLap blood sample, could be used to predict response to EmLap.

Conclusion Frailty-related metabolites were identified in EmLap patients using LCMS-based metabolomics. The identification of frailty biomarkers offers a promising approach for assessing frailty and future therapeutic development in emergency setting. Further studies with larger patient cohorts are required to validate these findings.