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

Tracy, Brett M.; Wilson, Jacob M.; Staley, Christopher; Frias, Bernadette; Schenker, Mara L.; Gelbard, Rondi B.

doi:10.1016/j.jamcollsurg.2019.09.009

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…There were 18 studies 89,127–143 (1,415,697 participants) with critically ill populations (Table S3): 11 cohorts in North America, 3 each were in East Asia and in Europe, and 1 in the Pacific. Mean age of participants ranged from 41 to 87 years.…”

Section: Resultsmentioning

confidence: 99%

“…There were 18 studies 89,[127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143] (1,415,697 participants) with critically ill populations (Table S3): quadratic term for mean BMI with a linear term (Table 2) or when groups with mean BMIs <20 kg/m 2 were excluded. The interaction terms for Asian/non-Asian majority countries were non-significant.…”

Section: Critically Ill Populationsmentioning

confidence: 99%

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Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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SummaryFasting insulin and c‐reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non‐first order polynomials or splines. All‐cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid‐19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations. The associations for general, cancer, and non‐communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re‐examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

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Section: Resultsmentioning

confidence: 99%

Section: Critically Ill Populationsmentioning

confidence: 99%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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“…Five interventional studies were related to Objective 1 (Atrous et al, 2021; Ghezeljeh et al, 2017; Powers, 2016; Rose et al, 2022; Sutton et al, 2013). Five case studies (Dambaugh & Ecklund, 2016; Spike, 2018; Tammellero, 2011; Tatusov et al, 2017; Temple et al, 2017), two qualitative studies (Barakat‐Johnson et al, 2019; Hales et al, 2018) and two mixed methods studies (Tanneberger & Ciupitu‐Plath, 2018; Walker et al, 2019) were related to Objective 2 and 28 quantitative studies— to Objective 3 (Amini et al, 2022; Buffon et al, 2022; Capasso et al, 2022; Carson et al, 2018; Coyer et al, 2014; Ditillo et al, 2014; Drake et al, 2010; Gardiner et al, 2014; Grap et al, 2019; Großschädl & Bauer, 2022; Hobson et al, 2017; Hyun et al, 2014; Kayser et al, 2019; Kottner et al, 2011; Litcherfeld‐Kottner et al, 2020; Mananzo et al, 2014; Miller et al, 2016; Ness et al, 2018; O'Brien et al, 2014; Pokorny et al, 2014; Qaddumi & Almahmoud, 2019; Raff et al, 2016; Swanson et al, 2011; Tracy et al, 2020; VanGilder et al, 2010, 2021; Verekova et al, 2020; Workum et al, 2022).…”

Section: Resultsmentioning

confidence: 99%

“…Three further studies found significant associations, including Grap et al (2019) in their multivariate model with BMI ≥ 30, low Braden (Braden & Bergstrom, 1987) score and OR time. Tracy et al (2020) found patients with metabolic syndrome and a BMI range of 32.1 to 37.3 had higher pressure injury occurrence than those without metabolic syndrome and a BMI of 22.6 to 29.8. Kayser et al (2019) found a U‐shaped relationship with low and high BMIs at the greatest risk for pressure injury, with a BMI of 40 to 45 providing reduced risk.…”

Section: Resultsmentioning

confidence: 99%

Hospital‐acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review

Marshall,

Qiu,

Jones

et al. 2023

Journal of Advanced Nursing

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Aim(s)To: (1) explore current best practices for hospital‐acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury.DesignExploratory.MethodsScoping review.Data SourcesOvid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021).ResultsOverall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low‐quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese‐related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital‐acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3).ConclusionQuality of evidence was low for the interventional studies and best practice recommendations.Implications for the Profession and/or Patient CareCurrent (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations.Impact StatementThis study addressed hospital‐acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital‐acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment.Reporting MethodWe adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews.Patient or Public ContributionNo patient or public contribution.What Does this Paper Contribute to the Wider Global Clinical Community?Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people.Protocol RegistrationWound Practice and Research (https://doi.org/10.33235/wpr.29.3.133‐139).

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“…Cardiovascular risk factors such as pre-injury warfarin usage, congestive heart failure, and pre-injury beta-blocker use, as well as combinations of these conditions, which result in the greatest mortality rates, increase the chance of trauma death [ 41 , 42 ]. The ‘metabolic syndrome’ (combination of unfavorable factors diabetes, hypertension and BMI >30 kg/m 2 ) is strongly associated with increasing length of hospital stay, occurrence of cardiac arrest and myocardial infarction and is an independent death -predictor, which should be identified early in order to facilitate prompt multidisciplinary treatment [ 43 ]. Our findings that polytrauma patients with cardiac comorbidities have significantly higher concentrations of troponin T, IL-33R, higher BMI and initial sugar level are in accordance with this, and further emphasize the need for a specialized, multidisciplinary therapeutic strategy for patients with polytrauma and cardiac comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of IL-33R and Galectin-3 as New Biomarkers of Cardiac Damage after Polytrauma—Association with Cardiac Comorbidities and Risk Factors

Weber

Voth

Rottluff

et al. 2022

JCM

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Polytrauma is one of the disorders with the greatest economic impact on healthcare in society and one predictor for poor outcome is cardiac damage. Interleukin 33 receptors (IL-33R) and galectin-3 are two new potential cardiac trauma biomarkers that are the subjects of this investigation. Additionally, this study assesses pre-existing cardiac damage or risk factors as predictors of cardiac damage after polytrauma. This retrospective study includes 107 polytraumatized patients with an ISS ≥16 admitted in a Level 1 Trauma Centre. Plasma samples were taken at admission. IL-33R and galectin-3 concentrations were detected in plasma samples by ELISA. Both did not correlate with the cardiac damage measured by troponin. Next to troponin, IL-33R was increased in patients with pre-existing cardiac comorbidities. In the subgroup of patients with cardiac comorbidities, the BMI and the initial blood sugar level were significantly increased compared to patients without cardiac comorbidities. Galectin-3 and IL-33R were shown to not correlate with cardiac damage. However, our data suggests that IL-33R protein should be revised in future studies as a marker of cardiac comorbidities. Further, our data indicate that patients with cardiac comorbidities represent a separate group of polytrauma patients characterized by higher concentrations of troponin, IL-33R, BMI and initial sugar level.

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

Cited by 13 publications

References 20 publications

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Hospital‐acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review

Evaluation of IL-33R and Galectin-3 as New Biomarkers of Cardiac Damage after Polytrauma—Association with Cardiac Comorbidities and Risk Factors

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