Department of Surgery, University of California, Irvine, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
Department of Surgery, University of California, Irvine, Division of Gastrointestinal Surgery, Orange, CA, USA.
Am Surg. 2023 Nov;89(11):4734-4739. doi: 10.1177/00031348221078986. Epub 2022 Mar 2.
The prevalence of obesity in the United States is up to 40% in adults. Obese patients with severe sepsis have a lower mortality rate compared with normal body mass index (BMI) patients. We hypothesized that trauma patients with severe sepsis and obese BMI will have a decreased mortality risk in comparison with normal BMI patients.
The Trauma Quality Improvement Program (2017) was queried for adult trauma patients with documented BMI and severe sepsis. Patients were grouped based on BMI: non-obese trauma patients (nOTP) BMI <30 kg/m and obese trauma patients (OTP) ≥30 kg/m. A multivariable logistic regression model was used for analysis of mortality.
From 1246 trauma patients with severe sepsis, 566 (42.4%) were nOTP and 680 (57.6%) were OTP. OTP had increased length of stay (LOS) (19 vs 21 days, < .001), intensive care unit (ICU) LOS (13 vs 18 days, < .001) and ventilator days (10 vs 11 days, < .001). After adjusting for covariates, when compared to normal BMI patients, patients who were overweight (OR 1.11 CI .875-1.41 = .390), obese (OR .797 CI .59-1.06 = .126), severely obese (OR .926 CI .63-1.36 = .696) and morbidly obese (OR 1.448 CI 1.01-2.07 = .04) all had a similar associated risk for mortality compared to patients with normal BMI.
In adult trauma patients with severe sepsis, this national analysis demonstrated OTP had increased LOS, ICU LOS, and ventilator days compared to nOTP. However, patients with increasing degrees of obesity had similar associated risk of mortality compared to trauma patients with severe sepsis and a normal BMI.
在美国，成年人肥胖的患病率高达 40%。与正常体重指数（BMI）患者相比，患有严重败血症的肥胖患者的死亡率较低。我们假设，与正常 BMI 患者相比，患有严重败血症和肥胖 BMI 的创伤患者的死亡率风险会降低。
查询 2017 年创伤质量改进计划（Trauma Quality Improvement Program）中记录 BMI 和严重败血症的成年创伤患者。根据 BMI 将患者分为两组：非肥胖创伤患者（nOTP）BMI<30kg/m 和肥胖创伤患者（OTP）≥30kg/m。使用多变量逻辑回归模型分析死亡率。
在 1246 名患有严重败血症的创伤患者中，566 名（42.4%）是非肥胖创伤患者（nOTP），680 名（57.6%）是肥胖创伤患者（OTP）。OTP 的住院时间（LOS）（19 天比 21 天，<0.001）、重症监护病房（ICU）LOS（13 天比 18 天，<0.001）和呼吸机使用天数（10 天比 11 天，<0.001）更长。在调整了协变量后，与正常 BMI 患者相比，超重患者（OR 1.11，CI.875-1.41，=0.390）、肥胖患者（OR.797，CI.59-1.06，=0.126）、重度肥胖患者（OR.926，CI.63-1.36，=0.696）和病态肥胖患者（OR 1.448，CI 1.01-2.07，=0.04）的死亡率风险相似。
在患有严重败血症的成年创伤患者中，这项全国性分析表明，与 nOTP 相比，OTP 的 LOS、ICU LOS 和呼吸机使用天数更长。然而，与患有严重败血症和正常 BMI 的创伤患者相比，肥胖程度增加的患者的死亡率风险相似。
