Body adipose content is independently associated with a higher risk of organ failure and nosocomial infection in the nonobese patient postinjury

Rebecca D. Edmonds, Joseph Cuschieri, Joseph P. Minei, Matthew R. Rosengart, Ronald V. Maier, Brian G. Harbrecht, Timothy R. Billiar, Andrew B. Peitzman, Ernest E. Moore, Jason L. Sperry

Research output: Contribution to journalArticle

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Abstract

Objective: Obesity defined by a body mass index (BMI) >30 kg/m is associated with increased morbidity and mortality following trauma. Evidence suggests that obesity represents a state of chronic inflammation and that the adipose tissue content may affect the intensity and resolution of inflammatory response. We sought to avoid the confounding effects attributable to obesity and determine the association of BMI and outcomes following injury in nonobese patients. Methods: Data were obtained from a multicenter prospective cohort study evaluating outcomes in blunt-injured adults with hemorrhagic shock. Only patients with a BMI ≥18.5 and <30 were analyzed. Those with isolated traumatic brain injury and cervical cord injury and those who survived <24 hours were excluded. Logistic regression was used to evaluate the effects of BMI on mortality, multiple organ failure (MOF, multiple organs dysfunction score [MODS] >5), and nosocomial infection (NI) after adjusting for differences in demographics, injury severity, early resuscitation needs, shock parameters, and comorbidities. Results: Overall mortality, MOF, and NI rates for the study cohort (n = 820) were 13%, 37%, and 46%, respectively. Median Injury Severity Score was 33 (interquartile range, 22-41). Median BMI for the study cohort was 25 (interquartile range, 23-27). As BMI increased, maximum organ dysfunction scores also significantly increased for cardiac, respiratory, and renal systems. Logistic regression revealed no significant association with mortality (odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.9-1.0); however, BMI was independently associated with a higher risk of MOF (OR = 1.09; 95% CI, 1.02-1.06) and NI (OR = 1.07; 95% CI, 1.01-1.13). For every single-point increase in BMI, the risk of MOF and NI increase by 9% and 7%, respectively. CONCLUSION:: The risk of MOF and NI increases as BMI increases in the nonobese injured patient. These results suggest that body adipose content may be associated with the magnitude of or extent of the inflammatory response postinjury. Further studies are needed to elucidate the mechanism responsible for this association.

Original languageEnglish (US)
Pages (from-to)292-298
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume70
Issue number2
DOIs
StatePublished - Feb 2011

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Cross Infection
Body Mass Index
Cohort Studies
Obesity
Odds Ratio
Confidence Intervals
Mortality
Wounds and Injuries
Organ Dysfunction Scores
Injury Severity Score
Hemorrhagic Shock
Resuscitation
Respiratory System
Adipose Tissue
Comorbidity
Shock
Logistic Models
Demography
Prospective Studies
Inflammation

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Body adipose content is independently associated with a higher risk of organ failure and nosocomial infection in the nonobese patient postinjury. / Edmonds, Rebecca D.; Cuschieri, Joseph; Minei, Joseph P.; Rosengart, Matthew R.; Maier, Ronald V.; Harbrecht, Brian G.; Billiar, Timothy R.; Peitzman, Andrew B.; Moore, Ernest E.; Sperry, Jason L.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 70, No. 2, 02.2011, p. 292-298.

Research output: Contribution to journalArticle

Edmonds, Rebecca D. ; Cuschieri, Joseph ; Minei, Joseph P. ; Rosengart, Matthew R. ; Maier, Ronald V. ; Harbrecht, Brian G. ; Billiar, Timothy R. ; Peitzman, Andrew B. ; Moore, Ernest E. ; Sperry, Jason L. / Body adipose content is independently associated with a higher risk of organ failure and nosocomial infection in the nonobese patient postinjury. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 70, No. 2. pp. 292-298.
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abstract = "Objective: Obesity defined by a body mass index (BMI) >30 kg/m is associated with increased morbidity and mortality following trauma. Evidence suggests that obesity represents a state of chronic inflammation and that the adipose tissue content may affect the intensity and resolution of inflammatory response. We sought to avoid the confounding effects attributable to obesity and determine the association of BMI and outcomes following injury in nonobese patients. Methods: Data were obtained from a multicenter prospective cohort study evaluating outcomes in blunt-injured adults with hemorrhagic shock. Only patients with a BMI ≥18.5 and <30 were analyzed. Those with isolated traumatic brain injury and cervical cord injury and those who survived <24 hours were excluded. Logistic regression was used to evaluate the effects of BMI on mortality, multiple organ failure (MOF, multiple organs dysfunction score [MODS] >5), and nosocomial infection (NI) after adjusting for differences in demographics, injury severity, early resuscitation needs, shock parameters, and comorbidities. Results: Overall mortality, MOF, and NI rates for the study cohort (n = 820) were 13{\%}, 37{\%}, and 46{\%}, respectively. Median Injury Severity Score was 33 (interquartile range, 22-41). Median BMI for the study cohort was 25 (interquartile range, 23-27). As BMI increased, maximum organ dysfunction scores also significantly increased for cardiac, respiratory, and renal systems. Logistic regression revealed no significant association with mortality (odds ratio [OR] = 0.95; 95{\%} confidence interval [CI], 0.9-1.0); however, BMI was independently associated with a higher risk of MOF (OR = 1.09; 95{\%} CI, 1.02-1.06) and NI (OR = 1.07; 95{\%} CI, 1.01-1.13). For every single-point increase in BMI, the risk of MOF and NI increase by 9{\%} and 7{\%}, respectively. CONCLUSION:: The risk of MOF and NI increases as BMI increases in the nonobese injured patient. These results suggest that body adipose content may be associated with the magnitude of or extent of the inflammatory response postinjury. Further studies are needed to elucidate the mechanism responsible for this association.",
author = "Edmonds, {Rebecca D.} and Joseph Cuschieri and Minei, {Joseph P.} and Rosengart, {Matthew R.} and Maier, {Ronald V.} and Harbrecht, {Brian G.} and Billiar, {Timothy R.} and Peitzman, {Andrew B.} and Moore, {Ernest E.} and Sperry, {Jason L.}",
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T1 - Body adipose content is independently associated with a higher risk of organ failure and nosocomial infection in the nonobese patient postinjury

AU - Edmonds, Rebecca D.

AU - Cuschieri, Joseph

AU - Minei, Joseph P.

AU - Rosengart, Matthew R.

AU - Maier, Ronald V.

AU - Harbrecht, Brian G.

AU - Billiar, Timothy R.

AU - Peitzman, Andrew B.

AU - Moore, Ernest E.

AU - Sperry, Jason L.

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N2 - Objective: Obesity defined by a body mass index (BMI) >30 kg/m is associated with increased morbidity and mortality following trauma. Evidence suggests that obesity represents a state of chronic inflammation and that the adipose tissue content may affect the intensity and resolution of inflammatory response. We sought to avoid the confounding effects attributable to obesity and determine the association of BMI and outcomes following injury in nonobese patients. Methods: Data were obtained from a multicenter prospective cohort study evaluating outcomes in blunt-injured adults with hemorrhagic shock. Only patients with a BMI ≥18.5 and <30 were analyzed. Those with isolated traumatic brain injury and cervical cord injury and those who survived <24 hours were excluded. Logistic regression was used to evaluate the effects of BMI on mortality, multiple organ failure (MOF, multiple organs dysfunction score [MODS] >5), and nosocomial infection (NI) after adjusting for differences in demographics, injury severity, early resuscitation needs, shock parameters, and comorbidities. Results: Overall mortality, MOF, and NI rates for the study cohort (n = 820) were 13%, 37%, and 46%, respectively. Median Injury Severity Score was 33 (interquartile range, 22-41). Median BMI for the study cohort was 25 (interquartile range, 23-27). As BMI increased, maximum organ dysfunction scores also significantly increased for cardiac, respiratory, and renal systems. Logistic regression revealed no significant association with mortality (odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.9-1.0); however, BMI was independently associated with a higher risk of MOF (OR = 1.09; 95% CI, 1.02-1.06) and NI (OR = 1.07; 95% CI, 1.01-1.13). For every single-point increase in BMI, the risk of MOF and NI increase by 9% and 7%, respectively. CONCLUSION:: The risk of MOF and NI increases as BMI increases in the nonobese injured patient. These results suggest that body adipose content may be associated with the magnitude of or extent of the inflammatory response postinjury. Further studies are needed to elucidate the mechanism responsible for this association.

AB - Objective: Obesity defined by a body mass index (BMI) >30 kg/m is associated with increased morbidity and mortality following trauma. Evidence suggests that obesity represents a state of chronic inflammation and that the adipose tissue content may affect the intensity and resolution of inflammatory response. We sought to avoid the confounding effects attributable to obesity and determine the association of BMI and outcomes following injury in nonobese patients. Methods: Data were obtained from a multicenter prospective cohort study evaluating outcomes in blunt-injured adults with hemorrhagic shock. Only patients with a BMI ≥18.5 and <30 were analyzed. Those with isolated traumatic brain injury and cervical cord injury and those who survived <24 hours were excluded. Logistic regression was used to evaluate the effects of BMI on mortality, multiple organ failure (MOF, multiple organs dysfunction score [MODS] >5), and nosocomial infection (NI) after adjusting for differences in demographics, injury severity, early resuscitation needs, shock parameters, and comorbidities. Results: Overall mortality, MOF, and NI rates for the study cohort (n = 820) were 13%, 37%, and 46%, respectively. Median Injury Severity Score was 33 (interquartile range, 22-41). Median BMI for the study cohort was 25 (interquartile range, 23-27). As BMI increased, maximum organ dysfunction scores also significantly increased for cardiac, respiratory, and renal systems. Logistic regression revealed no significant association with mortality (odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.9-1.0); however, BMI was independently associated with a higher risk of MOF (OR = 1.09; 95% CI, 1.02-1.06) and NI (OR = 1.07; 95% CI, 1.01-1.13). For every single-point increase in BMI, the risk of MOF and NI increase by 9% and 7%, respectively. CONCLUSION:: The risk of MOF and NI increases as BMI increases in the nonobese injured patient. These results suggest that body adipose content may be associated with the magnitude of or extent of the inflammatory response postinjury. Further studies are needed to elucidate the mechanism responsible for this association.

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