Retrospective Analysis of Long-Term Outcomes After Combat Injury A Hidden Cost of War
Retrospective Analysis of Long-Term Outcomes After Combat Injury A Hidden Cost of War
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DOI：
10.1161/circulationaha.115.016950
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发表时间：
2015-12-01
期刊：
影响因子：
37.8
通讯作者：
Chung, Kevin K.
中科院分区：
文献类型：
--
作者：
Stewart, Ian J.;Sosnov, Jonathan A.;Chung, Kevin K.
背景在伊拉克和阿富汗的冲突中，有52087名军人在战斗中受伤。这些损伤的长期后遗症尚未得到仔细研究。我们试图确定损伤严重程度的标志物和随后的高血压，冠状动脉疾病，糖尿病和慢性肾脏病的发展之间的关系，方法和结果回顾性队列研究，严重受伤的美国军事人员在伊拉克或阿富汗受伤，2002年2月1日至2011年2月1日。然后对患者进行随访，直至2013年1月18日。慢性病结局采用国际疾病分类第9版编码进行评估，死因通过尸检确认。从6011入院，记录被排除，因为缺失的数据，或者如果他们是一个人的第二次入院。还排除了在损伤日期之前具有感兴趣的疾病诊断的患者，产生了3846名受试者的队列用于分析。调整其他因素后，损伤严重程度评分每增加5分，高血压、冠状动脉疾病、糖尿病和慢性肾脏疾病的发病率分别增加6%、13%、13%和15%。急性肾损伤与高血压发病率增加66%和慢性肾脏病发病率增加近5倍有关。结论在伊拉克和阿富汗退伍军人中，战斗损伤的严重程度与高血压、冠状动脉疾病、糖尿病和慢性肾脏病的后续发展有关。
Background During the conflicts in Iraq and Afghanistan, 52087 service members have been wounded in combat. The long-term sequelae of these injuries have not been carefully examined. We sought to determine the relation between markers of injury severity and the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease.Methods and Results Retrospective cohort study of critically injured US military personnel wounded in Iraq or Afghanistan from February 1, 2002 to February 1, 2011. Patients were then followed until January 18, 2013. Chronic disease outcomes were assessed by International Classification of Diseases, 9th edition codes and causes of death were confirmed by autopsy. From 6011 admissions, records were excluded because of missing data or if they were for an individual's second admission. Patients with a disease diagnosis of interest before the injury date were also excluded, yielding a cohort of 3846 subjects for analysis. After adjustment for other factors, each 5-point increment in the injury severity score was associated with a 6%, 13%, 13%, and 15% increase in incidence rates of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease, respectively. Acute kidney injury was associated with a 66% increase in rates of hypertension and nearly 5-fold increase in rates of chronic kidney disease.Conclusions In Iraq and Afghanistan veterans, the severity of combat injury was associated with the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease.