Obesity increases risk of organ failure after severe trauma
Obesity increases risk of organ failure after severe trauma
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DOI：
10.1016/j.jamcollsurg.2006.06.029
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发表时间：
2006-10-01
影响因子：
5.2
通讯作者：
Sauaia, Angela
中科院分区：
文献类型：
--
作者：
Ciesla, David J.;Moore, Ernest E.;Sauaia, Angela
背景技术背景：肥胖是多种疾病的独立危险因素，包括损伤后发病率和死亡率。肥胖与促炎状态相关，其可影响损伤后炎症反应并增加器官功能障碍的风险。本研究的目的是确定肥胖和伤后多器官功能衰竭（MOF）之间的关系。研究设计：一项前瞻性的观察性研究，对有伤后多器官功能衰竭风险的患者。入选标准为年龄大于15岁，损伤严重度评分> 15，损伤后24小时内入住ICU，损伤后生存时间超过48小时。排除了单独的头部损伤。器官功能障碍进行了评估，使用丹佛多器官功能衰竭score.Results：数据收集了716例严重受伤的患者，70%是男性和83%的受害者钝性创伤。体重指数与受伤严重程度或受伤后12小时内输血量之间没有关系。在564名非肥胖患者中的123名（22%）和152名肥胖患者中的56名（37%）中观察到损伤后MOF。在调整患者年龄、损伤严重程度和复苏期间输血量后，肥胖与MOF独立相关（比值比，1.8; 95%CI，1.2-2.7）。在这项研究中，肥胖也与ICU和住院时间的增加有关，但与死亡无关。研究肥胖相关的炎症特征可以为器官功能障碍的发病机制提供额外的见解，并确定肥胖和非肥胖患者的治疗靶点。肥胖创伤患者发病率和住院时间的增加意味着为这一人群分配更多的资源。
BACKGROUND: Obesity is an independent risk factor for a variety of diseases, including postinjury morbidity and mortality Obesity is associated with a proinflammatory state that could affect the postinjury inflammatory response and increase risk of organ dysfunction. The purpose of this study was to determine the relationship between obesity and postinjury multiple organ failure (MOF).STUDY DESIGN: A prospective observational study of patients at risk for postinjury MOF. Inclusion criteria were age older than 15 years, Injury Severity Score > 15, ICU admission within 24 hours of injury, and survival longer than 48 hours after injury. Isolated head injuries were excluded. Organ dysfunction was assessed using the Denver multiple organ failure score.RESULTS: Data were collected on 716 severely injured patients, 70% were men and 83% were victims of blunt trauma. There was no relationship between body mass index and injury severity or the amount of blood transfused within 12 hours of injury. Postinjury MOF was observed in 123 of 564 (22%) nonobese patients and 56 of 152 (37%) obese patients. Obesity was independently associated with MOF (odds ratio, 1.8; 95% Cl, 1.2-2.7) after adjusting for patient age, injury severity, and amount of blood transfused during resuscitation. In this study population, obesity was also associated with increased length of ICU and hospital stay but not death.CONCLUSIONS: Obese patients are at increased risk of postinjury MOF. Study of the obesity-related inflammatory profile could provide additional insight into the pathogenesis of organ dysfunction and identify therapeutic targets for both obese and nonobese patients. Increased morbidity and length of stay in obese trauma patients implies greater resource allocation for this population.