*Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, and Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada †Shriners Hospitals for Children, and Department of Surgery, University of Texas Medical Branch, Galveston, TX ‡Sealy Center for Molecular Medicine and the Institute for Translational Science, University of Texas Medical Branch, Galveston, TX §Department of Surgery, Loyola University Stritch School of Medicine, Maywood, IL ¶Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA ‖Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX; and **Department of Surgery, Massachusetts General Hospital, Shriners Hospital for Children, and Harvard Medical School, Boston, MA.
Ann Surg. 2013 Dec;258(6):1119-29. doi: 10.1097/SLA.0b013e3182984d19.
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. (NCT00257244).
评估肥胖对严重烧伤患者发病率和死亡率的影响。
尽管肥胖人群不断增加，但对于肥胖对烧伤后结果的影响知之甚少。
一项多中心试验炎症和宿主对损伤胶拨款共有 405 例患者前瞻性纳入，纳入标准如下：0 至 89 岁，伤后 96 小时内入院，20%以上的体表总面积烧伤，需要至少 1 次手术干预。采用成人患者的体重指数（BMI），按照世界卫生组织（WHO）的定义分层：<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 BMI 超过 40（肥胖 III）。儿科患者（2 至 ≤18 岁）采用美国疾病控制与预防中心和世界卫生组织的 BMI-年龄生长图表进行分层，获得百分位排名，然后分为体重不足（<第 5 百分位）、正常体重（第 5 百分位至<第 95 百分位）和肥胖（≥第 95 百分位）。主要结局是死亡率，次要结局是患者恢复的临床指标，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 例体重不足；由于患者数量不足，体重不足的患者被排除在分析之外。与肥胖患者相比，正常体重患者的主要和次要结局无差异。在儿科和成人患者中进一步分层显示出相似的结果。然而，当成人患者按肥胖类别分层时，对数秩分析显示肥胖 I 组的生存率提高，肥胖 III 组的死亡率高于肥胖 I 组（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。（NCT00257244）。
