Czorlich Patrick, Dreimann Marc, Emami Pedram, Westphal Manfred, Lefering Rolf, Hoffmann Michael
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Division of Spine Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
World Neurosurg. 2017 Nov;107:515-521. doi: 10.1016/j.wneu.2017.08.010. Epub 2017 Aug 18.
Severe traumatic brain injury (TBI) has a major influence on polytrauma outcome. The aim of this study was to evaluate the impact of body mass index (BMI) on mortality and early neurologic outcome in patients suffering from severe TBI with a special focus on obesity classes II and III (BMI ≥35).
A retrospective cohort analysis of patients suffering from a leading, at least severe TBI and registered in the TraumaRegister DGU was conducted. Patients alive on admission with full status documentation on Glasgow Coma Scale, height, and weight were classified into 4 BMI subgroups. Early neurologic outcome was classified using the Glasgow Outcome Scale.
A total of 1634 patients met the inclusion criteria. Lowest mortality was documented for BMI group 1 (15.2%, BMI 25.0-29.9918.5). Highest mortality was found in BMI group 5 (25.6%, BMI ≥35). BMI ≥35 was an independent predictor of mortality with an odds ratio of 3.15 (95% confidence interval [1.06-9.36], P = 0.039). Further independent mortality predictors were >65 years of age, a Glasgow Coma Scale of ≤13, an Abbreviated Injury Scale ≥5, prehospital cardiopulmonary resuscitation, and a prehospital blood pressure of <90 mm Hg. In terms of good early neurologic outcomes, no differences were recorded between the BMI groups (range 59.0%-62.6%, P = 0.087).
In this study a BMI ≥35 is an independent predictor of mortality and is associated with an inferior early functional neurologic outcome.
重度创伤性脑损伤（TBI）对多发伤的预后有重大影响。本研究的目的是评估体重指数（BMI）对重度TBI患者死亡率和早期神经功能预后的影响，特别关注II级和III级肥胖（BMI≥35）患者。
对在创伤注册数据库DGU中登记的至少患有重度TBI的患者进行回顾性队列分析。入院时存活且有格拉斯哥昏迷量表、身高和体重完整状态记录的患者被分为4个BMI亚组。早期神经功能预后采用格拉斯哥预后量表进行分类。
共有1634例患者符合纳入标准。BMI第1组的死亡率最低（15.2%，BMI 25.0 - 29.99），BMI第5组的死亡率最高（25.6%，BMI≥35）。BMI≥35是死亡率的独立预测因素，比值比为3.15（95%置信区间[1.06 - 9.36]，P = 0.039）。其他独立的死亡预测因素包括年龄>65岁、格拉斯哥昏迷量表≤13、简明损伤定级标准≥5、院前心肺复苏以及院前血压<90 mmHg。在早期神经功能良好的预后方面，各BMI组之间未记录到差异（范围为59.0% - 62.6%，P = 0.087）。
在本研究中，BMI≥35是死亡率的独立预测因素，且与早期神经功能预后较差相关。
