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Metabolic Syndrome: Major Risk Factor for Morbidity and Mortality in Severely Injured Trauma Patients.

Abstract：

BACKGROUND:Metabolic syndrome (MetS) increases cardiovascular risk and is associated with poor patient outcomes. We hypothesized that MetS confers an increased risk of morbidity and mortality in severely injured trauma patients. STUDY DESIGN:We performed a retrospective review of trauma patients from 2014 through 2018, excluding patients younger than 16 years, with Injury Severity Score <16, and with incomplete height and/or weight documentation. Metabolic syndrome was defined as the presence of diabetes, hypertension, and BMI ≥30 kg/m2. Outcomes included length of stay (LOS), complications, discharge location, and mortality. RESULTS:There were 4,489 patients meeting criteria, of which 100 (2.2%) had MetS. Patients with MetS were older (64.0 vs 38.6 years; p < 0.0001), but with similar Injury Severity Scores (22 vs 22; p = 0.7). Hospital LOS was significantly longer with MetS (16.5 vs 11 days; p < 0.0001), as was ICU LOS (9 vs 5 days; p = 0.0002). MetS correlated with higher rates of acute kidney injury (19% vs 3.6%; p < 0.0001), ARDS (11.0% vs 4.6%; p = 0.01), cardiac arrest (10.0% vs 4.0%; p = 0.01), MI (2.0% vs 0.3%; p = 0.05), severe sepsis (8.0% vs 3.3%; p = 0.03), unplanned intubation (11.0% vs 5.0%; p = 0.02), unplanned ICU admission (13.0% vs 6.1%; p = 0.02), and non-home discharge (51.0% vs 30.2%; p = 0.0007). After controlling for age, Glasgow Coma Scale, Injury Severity Score, sex, and mechanism, MetS remained an independent predictor of mortality (odds ratio 2.5; 95% CI 1.33 to 4.7; p = 0.004). CONCLUSIONS:MetS occurs infrequently in our severely injured trauma population, but is strongly associated with increasing LOS, as well as cardiac, pulmonary, infectious, and renal complications. MetS also significantly and independently predicts death and should be identified early to facilitate prompt multidisciplinary treatment.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Tracy BM,Wilson JM,Staley C,Frias B,Schenker ML,Gelbard RB

doi

10.1016/j.jamcollsurg.2019.09.009

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

145-150

issue

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(19)32112-X

journal_volume

230

pub_type

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Metabolic Syndrome: Major Risk Factor for Morbidity and Mortality in Severely Injured Trauma Patients.