Mild obesity is protective after severe burn injury.
Mild obesity is protective after severe burn injury.
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DOI：
10.1097/sla.0b013e3182984d19
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发表时间：
2013-12
影响因子：
9
通讯作者：
Herndon DN
中科院分区：
文献类型：
--
作者：
Jeschke MG;Finnerty CC;Emdad F;Rivero HG;Kraft R;Williams FN;Gamelli RL;Gibran NS;Klein MB;Arnoldo BD;Tompkins RG;Herndon DN
评估肥胖对严重烧伤患者发病率和死亡率的影响。尽管越来越多的人患有肥胖症，但人们对肥胖对烧伤后结果的影响知之甚少。共有405例患者前瞻性入选作为多中心试验炎症和宿主对损伤的反应Glue Grant的一部分，入选标准如下：0至89岁，在受伤后96小时内入院，超过20%的总体表面积烧伤需要至少1次手术干预。根据世界卫生组织的定义，在成人患者中使用体重指数进行分层：小于18.5（体重不足），18.5至29.9（正常体重），30至34.9（肥胖I），35至39.9（肥胖II）和体重指数大于40（肥胖III）。通过使用疾病控制和预防中心和世界卫生组织体重指数年龄增长图表对儿科患者（2至≤18岁）进行分层，以获得百分位数排名，然后将其分组为体重不足（<第5百分位数）、正常体重（第5百分位数至<第95百分位数）和肥胖（≥第95百分位数）。主要结局是死亡率，次要结局是患者恢复的临床标志物，例如多器官功能、感染、败血症和住院时间。共有273例患者体重正常，116例肥胖，16例体重过轻;由于患者数量不足，体重过轻患者被排除在分析之外。正常体重患者与肥胖患者相比，主要和次要结局无差异。儿童和成人患者的进一步分层显示了相似的结果。然而，当将成人患者按肥胖分类分层时，对数秩分析显示，与肥胖I组相比，肥胖I组的生存率提高，肥胖III组的死亡率升高（P < 0.05）。总体而言，肥胖与发病率和死亡率的增加无关。亚组分析显示，轻度肥胖患者的生存率最高，而病态肥胖患者的死亡率最高。
To assess the impact of obesity on morbidity and mortality in severely burned patients. Despite the increasing number of people with obesity, little is known about the impact of obesity on postburn outcomes. A total of 405 patients were prospectively enrolled as part of the multicenter trial Inflammation and the Host Response to Injury Glue Grant with the following inclusion criteria: 0 to 89 years of age, admitted within 96 hours after injury, and more than 20% total body surface area burn requiring at least 1 surgical intervention. Body mass index was used in adult patients to stratify according to World Health Organization definitions: less than 18.5 (underweight), 18.5 to 29.9 (normal weight), 30 to 34.9 (obese I), 35 to 39.9 (obese II), and body mass index more than 40 (obese III). Pediatric patients (2 to ≤18 years of age) were stratified by using the Centers for Disease Control and Prevention and World Health Organization body mass index-for-age growth charts to obtain a percentile ranking and then grouped as underweight (<5th percentile), normal weight (5th percentile to <95th percentile), and obese (≥95th percentile). The primary outcome was mortality and secondary outcomes were clinical markers of patient recovery, for example, multiorgan function, infections, sepsis, and length of stay. A total of 273 patients had normal weight, 116 were obese, and 16 were underweight; underweight patients were excluded from the analyses because of insufficient patient numbers. There were no differences in primary and secondary outcomes when normal weight patients were compared with obese patients. Further stratification in pediatric and adult patients showed similar results. However, when adult patients were stratified in obesity categories, log-rank analysis showed improved survival in the obese I group and higher mortality in the obese III group compared with obese I group (P < 0.05). Overall, obesity was not associated with increased morbidity and mortality. Subgroup analysis revealed that patients with mild obesity have the best survival, whereas morbidly obese patients have the highest mortality.