Kelly Edward J, Reese Adam D, Carney Bonnie C, Keyloun John W, Palmieri Tina L, Moffatt Lauren T, Shupp Jeffrey W, Tejiram Shawn
The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia.
Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia.
J Surg Res. 2023 Oct;290:221-231. doi: 10.1016/j.jss.2023.05.005. Epub 2023 Jun 6.
Literature examining the connection between obesity and burn injuries is limited. This study is a secondary analysis of a multicenter trial data set to investigate the association between burn outcomes and obesity following severe burn injury.
Body mass index (BMI) was used to stratify patients as normal weight (NW; BMI 18.5-25), all obese (AO; any BMI>30), obese I (OI; BMI 30-34.9), obese II (OII; BMI 35-39.9), or obese III (OIII; BMI>40). The primary outcome examined was mortality. Secondary outcomes included hospital length of stay (LOS), number of transfusions, injury scores, infection occurrences, number of operations, ventilator days, intensive care unit LOS, and days to wound healing.
Of 335 patients included for study, 130 were obese. Median total body surface area (TBSA) was 31%, 77 patients (23%) had inhalation injury and 41 patients died. Inhalation injury was higher in OIII than NW (42.1% versus 20%, P = 0.03). Blood stream infections (BSI) were higher in OI versus NW (0.72 versus 0.33, P = 0.03). Total operations, ventilator days, days to wound healing, multiorgan dysfunction score, Acute Physiology and Chronic Health Evaluationscore, hospital LOS, and intensive care unit LOS were not significantly affected by BMI classification. Mortality was not significantly different between obesity groups. Kaplan-Meier survival curves did not significantly differ between the groups (χ = 0.025, P = 0.87). Multiple logistic regression identified age, TBSA, and full thickness burn as significant independent predictors (P < 0.05) of mortality; however, BMI classification itself was not predictive of mortality.
No significant association between obesity and mortality was seen after burn injury. Age, TBSA, and percent full- thickness burn were independent predictors of mortality after burn injury, while BMI classification was not.
关于肥胖与烧伤之间联系的文献有限。本研究是对多中心试验数据集的二次分析，旨在调查严重烧伤后烧伤结局与肥胖之间的关联。
采用体重指数（BMI）将患者分为正常体重（NW；BMI 18.5 - 25）、所有肥胖（AO；任何BMI>30）、肥胖I（OI；BMI 30 - 34.9）、肥胖II（OII；BMI 35 - 39.9）或肥胖III（OIII；BMI>40）。所检查的主要结局是死亡率。次要结局包括住院时间（LOS）、输血次数、损伤评分、感染发生率、手术次数、呼吸机使用天数、重症监护病房住院时间以及伤口愈合天数。
纳入研究的335例患者中，130例为肥胖患者。中位总体表面积（TBSA）为31%，77例患者（23%）有吸入性损伤，41例患者死亡。肥胖III组的吸入性损伤高于正常体重组（42.1%对20%，P = 0.03）。肥胖I组的血流感染（BSI）高于正常体重组（0.72对0.33，P = 0.03）。总手术次数、呼吸机使用天数、伤口愈合天数、多器官功能障碍评分、急性生理与慢性健康状况评估评分、住院LOS以及重症监护病房LOS不受BMI分类的显著影响。肥胖组之间的死亡率无显著差异。各组之间的Kaplan - Meier生存曲线无显著差异（χ = 0.025，P = 0.87）。多因素逻辑回归分析确定年龄、TBSA和全层烧伤是死亡率的显著独立预测因素（P < 0.05）；然而，BMI分类本身并不能预测死亡率。
烧伤后未发现肥胖与死亡率之间存在显著关联。年龄、TBSA和全层烧伤百分比是烧伤后死亡率的独立预测因素，而BMI分类则不是。
