Chen Zhaoxiong, Wittenberg Silvan, Auer Timo Alexander, Bashkuev Maxim, Gebert Pimrapat, Fehrenbach Uli, Geisel Dominik, Graef Frank, Maerdian Sven, Tsitsilonis Serafeim
Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany.
Clinic for Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany.
Life (Basel). 2021 Nov 16;11(11):1243. doi: 10.3390/life11111243.
Objectives In recent years; increasing evidence pointed out the clinical importance of adipose tissue (AT) distribution in various patient populations. In particular, visceral adipose tissue (VAT), when compared to subcutaneous adipose tissue (SAT), was found to play a pivotal role in the development of inflammatory reaction. The aim of the present study was to examine whether body fat distribution has an impact on the development of systemic inflammatory response syndrome (SIRS) in patients with polytrauma. Methods In our retrospective study; we filtered our institution records of the German Trauma Registry (Trauma Register DGU) from November 2018 to April 2021 and included 132 adult polytrauma patients with injury severity score (ISS) >16. Subsequently; we measured the visceral and subcutaneous adipose tissue area based on whole-body CT scan and calculated the ratio of VAT to SAT (VSr). Thereafter, the patient population was evenly divided into three groups; respectively VSr value less than 0.4 for the first group (low ratio), 0.4-0.84 for the second group (intermediate ratio), and greater than 0.84 for the third group (high ratio). Considering the other influencing factors; the groups were further divided into subgroups in the respective analysis according to gender (male/female), BMI (<25 or ≥25), and ISS (<26 or ≥26). Result VSr was an independent factor from body mass index (BMI) (r = 0.003; = 0.553). VSr in male patients was significantly higher ( < 0.001). Patients with low VSr had higher ISS scores ( = 0.028). Polytrauma patients with higher VSr tended to have lower SIRS scores and significant differences of SIRS score were found on multiple days during the whole hospitalization period. In the low VAT/SAT group, male patients, and patients with BMI greater than 25, both exhibited higher SIRS scores during hospital stay (day 16: = 0.01; day 22: = 0.048 and = 0.011; respectively). During hospitalization, patients with higher ISS score (≥26) in the low VSr group was found to have higher SIRS score (day 16; = 0.007). Over the hospital stay; serum markers of CRP; CK; and leukocyte in patients with low VSr were higher than those in patients in the intermediate and high VSr groups; with significant difference discovered on multiple days (day 16: 0.014; day 22: = 0.048). Conclusion Lower VSr is associated with increased inflammatory response and worse clinical outcome in patients with polytrauma. Furthermore; VSr is an independent factor providing additional information to BMI.
目的 近年来，越来越多的证据指出脂肪组织（AT）分布在各类患者群体中的临床重要性。特别是，与皮下脂肪组织（SAT）相比，内脏脂肪组织（VAT）在炎症反应的发展中起着关键作用。本研究的目的是探讨身体脂肪分布是否对多发伤患者全身炎症反应综合征（SIRS）的发生有影响。方法 在我们的回顾性研究中，我们筛选了2018年11月至2021年4月德国创伤登记处（创伤登记DGU）我们机构的记录，纳入了132例损伤严重程度评分（ISS）>16的成年多发伤患者。随后，我们基于全身CT扫描测量内脏和皮下脂肪组织面积，并计算VAT与SAT的比值（VSr）。此后，将患者群体平均分为三组，第一组（低比值）VSr值小于0.4，第二组（中等比值）为0.4 - 0.84，第三组（高比值）大于0.84。考虑到其他影响因素，在各自的分析中根据性别（男/女）、BMI（<25或≥25）和ISS（<26或≥26）将各组进一步分为亚组。结果 VSr是与体重指数（BMI）无关的独立因素（r = 0.003；P = 0.553）。男性患者的VSr显著更高（P < 0.001）。VSr低的患者ISS评分更高（P = 0.028）。VSr较高的多发伤患者SIRS评分往往较低，且在整个住院期间的多个时间点发现SIRS评分有显著差异。在低VAT/SAT组、男性患者以及BMI大于25的患者中，住院期间均表现出更高的SIRS评分（第16天：P = 0.01；第22天：P = 0.048和P = 0.011）。住院期间，低VSr组中ISS评分较高（≥26）的患者SIRS评分更高（第16天；P = 0.007）。在整个住院期间，低VSr组患者的血清CRP、CK和白细胞标志物高于中、高VSr组患者，在多个时间点发现有显著差异（第16天：P = 0.014；第22天：P = 0.048）。结论 较低的VSr与多发伤患者炎症反应增加及更差的临床结局相关。此外，VSr是一个独立因素，可为BMI提供额外信息。
