危重成人创伤患者体重指数与严重脓毒症结局的关系：一项全国分析

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-05-15 DOI:10.1016/j.jss.2025.04.006

Sanjan Kumar BS , Hazem Nasef BS , Zackary Yates BS , Nickolas Hernandez BS , Brian Chin BS , Logan Rogers BS , Sarthak Kumar BS , Tracy Zito MD, FACS , Adel Elkbuli MD, MPH, MBA

{"title":"危重成人创伤患者体重指数与严重脓毒症结局的关系：一项全国分析","authors":"Sanjan Kumar BS , Hazem Nasef BS , Zackary Yates BS , Nickolas Hernandez BS , Brian Chin BS , Logan Rogers BS , Sarthak Kumar BS , Tracy Zito MD, FACS , Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.jss.2025.04.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study is to evaluate clinical outcomes of critically-ill adult trauma patients with severe sepsis and severe injuries by body mass index (BMI) classification.</div></div><div><h3>Methods</h3><div>This retrospective study utilized the American College of Surgeons Trauma Quality Improvement Program database from 2017 to 2021 to evaluate the relationship between BMI and severe sepsis outcomes. Patients included in this study included critically-ill adult (age ≥18 ys) trauma patients with severe injuries (injury severity score [ISS] ≥15) and a diagnosis of severe sepsis. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit length-of-stay, ventilation-free-days, and complications, including acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, ventilator-associated pneumonia, and acute kidney injury.</div></div><div><h3>Results</h3><div>There were a total of 3268 patients included in this analysis. There was no significant association between obesity and odds of in-hospital mortality (odds ratio [OR]: 0.811, 95% confidence interval [CI]: 0.410-1.601, <em>P</em> = 0.545), intensive care unit length-of-stay (B = 5.114, 95% CI: −4.041-14.328, <em>P</em> = 0.268), ventilation-free-days (B = −0.280, 95% CI: −8.558-7.999, <em>P</em> = 0.946), deep vein thrombosis (OR: 1.625, 95% CI: 0.368-7.174, <em>P</em> = 0.522), pulmonary embolism (OR: 5.4 × 10ˆ14, 95% CI: 0.000-N/A, <em>P</em> = 0.992), acute respiratory distress syndrome (OR: 1.858, 95% CI: 0.668-5.179, <em>P</em> = 0.235), ventilator-associated pneumonia (OR: 0.809, 95% CI: 0.312-2.099, <em>P</em> = 0.664), or acute kidney injury (OR: 0.984, 95% CI: 0.449-2.154, <em>P</em> = 0.967) when compared to being normal weight. There was also no significant association between the remaining BMI classifications and all study outcomes.</div></div><div><h3>Conclusions</h3><div>Obesity had no association with outcomes of severely injured critically ill adult trauma patients with severe sepsis as demonstrated through comparable clinical outcomes between study populations regardless of BMI classification.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 353-361"},"PeriodicalIF":1.8000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Body Mass Index With Severe Sepsis Outcomes in Critically-Ill Severely Injured Adult Trauma Patients: A National Analysis\",\"authors\":\"Sanjan Kumar BS , Hazem Nasef BS , Zackary Yates BS , Nickolas Hernandez BS , Brian Chin BS , Logan Rogers BS , Sarthak Kumar BS , Tracy Zito MD, FACS , Adel Elkbuli MD, MPH, MBA\",\"doi\":\"10.1016/j.jss.2025.04.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>The aim of this study is to evaluate clinical outcomes of critically-ill adult trauma patients with severe sepsis and severe injuries by body mass index (BMI) classification.</div></div><div><h3>Methods</h3><div>This retrospective study utilized the American College of Surgeons Trauma Quality Improvement Program database from 2017 to 2021 to evaluate the relationship between BMI and severe sepsis outcomes. Patients included in this study included critically-ill adult (age ≥18 ys) trauma patients with severe injuries (injury severity score [ISS] ≥15) and a diagnosis of severe sepsis. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit length-of-stay, ventilation-free-days, and complications, including acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, ventilator-associated pneumonia, and acute kidney injury.</div></div><div><h3>Results</h3><div>There were a total of 3268 patients included in this analysis. There was no significant association between obesity and odds of in-hospital mortality (odds ratio [OR]: 0.811, 95% confidence interval [CI]: 0.410-1.601, <em>P</em> = 0.545), intensive care unit length-of-stay (B = 5.114, 95% CI: −4.041-14.328, <em>P</em> = 0.268), ventilation-free-days (B = −0.280, 95% CI: −8.558-7.999, <em>P</em> = 0.946), deep vein thrombosis (OR: 1.625, 95% CI: 0.368-7.174, <em>P</em> = 0.522), pulmonary embolism (OR: 5.4 × 10ˆ14, 95% CI: 0.000-N/A, <em>P</em> = 0.992), acute respiratory distress syndrome (OR: 1.858, 95% CI: 0.668-5.179, <em>P</em> = 0.235), ventilator-associated pneumonia (OR: 0.809, 95% CI: 0.312-2.099, <em>P</em> = 0.664), or acute kidney injury (OR: 0.984, 95% CI: 0.449-2.154, <em>P</em> = 0.967) when compared to being normal weight. There was also no significant association between the remaining BMI classifications and all study outcomes.</div></div><div><h3>Conclusions</h3><div>Obesity had no association with outcomes of severely injured critically ill adult trauma patients with severe sepsis as demonstrated through comparable clinical outcomes between study populations regardless of BMI classification.</div></div>\",\"PeriodicalId\":17030,\"journal\":{\"name\":\"Journal of Surgical Research\",\"volume\":\"310 \",\"pages\":\"Pages 353-361\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-05-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Surgical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S002248042500215X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S002248042500215X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

摘要

本研究的目的是通过体重指数（BMI）分类评估成人创伤重症脓毒症合并严重损伤的临床结局。方法本回顾性研究利用2017年至2021年美国外科医师学会创伤质量改善计划数据库，评估BMI与严重败血症结局的关系。本研究纳入的患者包括患有严重损伤（损伤严重程度评分[ISS]≥15）并诊断为严重脓毒症的危重成人（年龄≥18岁）创伤患者。主要终点是住院死亡率。次要结局包括重症监护病房的住院时间、无通气天数和并发症，包括急性呼吸窘迫综合征、深静脉血栓形成、肺栓塞、呼吸机相关性肺炎和急性肾损伤。结果共纳入3268例患者。没有明显肥胖和住院死亡率的可能性之间的联系(优势比[或]:0.811,95%可信区间[CI]: 0.410 - -1.601, P = 0.545),重症监护室住院时间(B = 5.114, 95% CI: -14.328−4.041,P = 0.268), ventilation-free-days (B =−0.280,95%置信区间CI: -7.999−8.558,P = 0.946),深静脉血栓形成(OR: 1.625, 95% CI: 0.368—-7.174,P = 0.522),肺栓塞(OR: 5.4×10ˆ14,95%置信区间CI: 0.000 - n / A, P = 0.992),急性呼吸窘迫综合征(或:1.858, 95% CI: 0.668-5.179, P = 0.235)，呼吸机相关肺炎（OR: 0.809, 95% CI: 0.312-2.099, P = 0.664），或急性肾损伤（OR: 0.984, 95% CI: 0.449-2.154, P = 0.967）。其余BMI分类与所有研究结果之间也没有显著关联。结论肥胖与严重脓毒症重症成人创伤患者的预后无相关性，无论BMI分类如何，均可通过研究人群的可比临床结果进行验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Association of Body Mass Index With Severe Sepsis Outcomes in Critically-Ill Severely Injured Adult Trauma Patients: A National Analysis

Introduction

The aim of this study is to evaluate clinical outcomes of critically-ill adult trauma patients with severe sepsis and severe injuries by body mass index (BMI) classification.

Methods

This retrospective study utilized the American College of Surgeons Trauma Quality Improvement Program database from 2017 to 2021 to evaluate the relationship between BMI and severe sepsis outcomes. Patients included in this study included critically-ill adult (age ≥18 ys) trauma patients with severe injuries (injury severity score [ISS] ≥15) and a diagnosis of severe sepsis. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit length-of-stay, ventilation-free-days, and complications, including acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, ventilator-associated pneumonia, and acute kidney injury.

Results

There were a total of 3268 patients included in this analysis. There was no significant association between obesity and odds of in-hospital mortality (odds ratio [OR]: 0.811, 95% confidence interval [CI]: 0.410-1.601, P = 0.545), intensive care unit length-of-stay (B = 5.114, 95% CI: −4.041-14.328, P = 0.268), ventilation-free-days (B = −0.280, 95% CI: −8.558-7.999, P = 0.946), deep vein thrombosis (OR: 1.625, 95% CI: 0.368-7.174, P = 0.522), pulmonary embolism (OR: 5.4 × 10ˆ14, 95% CI: 0.000-N/A, P = 0.992), acute respiratory distress syndrome (OR: 1.858, 95% CI: 0.668-5.179, P = 0.235), ventilator-associated pneumonia (OR: 0.809, 95% CI: 0.312-2.099, P = 0.664), or acute kidney injury (OR: 0.984, 95% CI: 0.449-2.154, P = 0.967) when compared to being normal weight. There was also no significant association between the remaining BMI classifications and all study outcomes.

Conclusions

Obesity had no association with outcomes of severely injured critically ill adult trauma patients with severe sepsis as demonstrated through comparable clinical outcomes between study populations regardless of BMI classification.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.