The Effect of Fat Distribution on the Inflammatory Response of Multiple Trauma Patients—A Retrospective Study
Abstract
:1. Introduction
2. Methods
2.1. Patient Population
2.2. Image Post-Processing—Measurement of the Adipose Tissue Distribution
2.3. Body Composition
2.4. Evaluation of Inflammatory Response
2.5. Evaluation of Physiological Parameters
2.6. Statistical Analysis
3. Results
3.1. Patient Cohort
3.2. Baseline Characteristics
3.3. Association between Ratio of Visceral Adipose Tissue to Subcutaneous Adipose Tissue (VSr) and Body Mass Index (BMI)
3.4. Injury Pattern and Physiological Situation upon Admission
3.5. Analysis of Systemic Inflammatory Response Syndrome (SIRS) Scores and Clinical Outcomes
3.6. Measurement of Creatine Kinase (CK), C-Reactive Protein (CRP) and Leukocyte Count
3.7. Analysis of SIRS Scores Stratified by Injury Severity Score (ISS), BMI, and Gender
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Total | VSr < 0.4 | VSr 0.4–0.84 | VSr > 0.84 | p |
---|---|---|---|---|---|
Number of patients | 132 | 44 | 44 | 44 | |
Gender (male/female)—n (%) | 96/36 (72.7%, 27.3%) | 20/24 (45.5%, 54.5%) | 34/10 (77.3%, 22.7%) | 42/2 (95.5%, 4.5%) | <0.001 |
Age (years) * | 55.4 (20.7) | 40.5 (21.3) | 59.5 (20.9) | 53.8 (12.2) | <0.001 |
Survived—n (%) | 122 (92.4%) | 42 (31.8%) | 41 (31.1%) | 39 (29.5%) | 0.469 |
VSr ** | 0.61 (0.36, 1.04) | 0.24 (0.13, 0.37) | 0.61 (0.51, 0.72) | 1.27 (1.03, 1.77) | <0.001 |
AIS head | 3.0 (2.0, 4.0) | 3.0 (1.0, 4.0) | 3.0 (2.0, 4.0) | 4.0 (3.0, 4.0) | 0.170 |
AIS face | 0 (0, 1.0) | 0 (0, 1.5) | 0 (0, 2.0) | 0 (0, 0) | 0.099 |
AIS thorax | 3.0 (0, 4.0) | 3.0 (0, 4.0) | 3.0 (0, 4.0) | 2.0 (0, 3.0) | 0.153 |
AIS abdomen | 0 (0, 2.0) | 0 (0, 3.0) | 0.5 (0, 2.5) | 0 (0, 2.0) | 0.396 |
AIS extremities | 2.0 (0, 3.0) | 2.0 (2.0, 4.0) | 2.0 (0, 3.0) | 0 (0, 2.0) | <0.001 |
AIS external | 0 (0, 0) | 0 (0, 0.5) | 0 (0, 0) | 0 (0, 0) | 0.380 |
ISS | 27.0 (20.0, 36.0) | 29.0 (21.5, 43.5) | 28.0 (23.0, 37.0) | 21.5 (17.0, 34.0) | 0.045 |
Glasgow coma scale (GCS) | 3.0 (3.0, 9.0) | 3.0 (3.0, 10.0) | 3.0 (3.0, 5.0) | 3.0 (3.0, 10.0) | 0.764 |
Shock (yes/no) | 97/35 | 30/14 | 32/12 | 35/9 | 0.478 |
Systolic pressure (mmHg) | 90.4 (17.1) | 90.3 (17.8) | 91.9 (17.6) | 88.9 (16.3) | 0.720 |
Diastolic pressure (mmHg) | 50.1 (11.2) | 46.8 (11.9) | 51.7 (10.1) | 51.8 (11.1) | 0.058 |
Heart rate (/min) | 105.1 (21.7) | 103.6 (18.6) | 105.7 (22.4) | 105.9 (24.2) | 0.856 |
Haemoglobin (g/dL) | 11.2 (2.3) | 10.8 (2.2) | 11.3 (2.2) | 11.6 (2.5) | 0.313 |
Platelet count (/nL) | 201.2 (83.3) | 211.2 (90.3) | 200.9 (89.0) | 191.4 (69.6) | 0.539 |
Prothrombin time (%) | 63.3 (25.4) | 62.1 (25.2) | 62.2 (25.1) | 66.2 (26.9) | 0.820 |
PH | 7.31 (0.11) | 7.32 (0.12) | 7.30 (0.10) | 7.31 (0.11) | 0.627 |
Base excess | −4.4 (4.0) | −3.1 (3.9) | −4.7 (3.6) | −5.5 (4.1) | 0.013 |
INR | 1.17 (1.08, 1.36) | 1.19 (1.08, 1.35) | 1.16 (1.06, 1.42) | 1.17 (1.10, 1.34) | 0.958 |
APTT | 35.4 (30.8, 45.2) | 36.25 (30.80, 45.40) | 35.30 (30.90, 49.80) | 33.70 (30.60, 42.20) | 0.815 |
Criteria * | Primary Criteria | Alternative Criteria |
---|---|---|
Leukocyte count | >12,000 or <4000/mL | 10% immature forms or bands |
Heart rate | >90/min | N/A |
Respiratory rate | >20/min | partial pressure of CO2 < 32mmHg |
Body temperature | >38 °C or <36 °C | N/A |
Total | VSr < 0.4 | VSr 0.4–0.84 | VSr > 0.84 | p | |
---|---|---|---|---|---|
Mean SIRS score—Mean (SD) | 2.16 (0.57) | 2.26 (0.59) | 2.11 (0.57) | 2.11 (0.56) | 0.354 |
Max SIRS score—Mean (SD) | 3.48 (0.71) | 3.57 (0.73) | 3.39 (0.75) | 3.48 (0.66) | 0.494 |
Days of max SIRS score(d)—Median (IQR) * | 3.0 (1.0, 4.0) | 2.0 (1.0, 4.0) | 3.0 (2.0, 4.0) | 3.0 (1.5, 4.0) | 0.387 |
Hospitalization(d)—Median (IQR) * | 20.0 (14.0, 28.0) | 18.5 (12.0, 27.0) | 22.0 (16.0, 28.0) | 19.0 (13.0, 28.0) | 0.335 |
ICU stay(d)—Median (IQR) * | 14.0 (10.0, 25.0) | 14.0 (10.0, 25.0) | 15.5 (11.5, 24.5) | 14.0 (10.0, 26.5) | 0.686 |
Ventilator duration(d)—Median (IQR) * | 11.0 (5.0, 22.0) | 7.5 (4.0, 21.5) | 11.0 (7.0, 21.0) | 12.0 (5.0, 23.0) | 0.352 |
Female | Male | p | |
---|---|---|---|
VAT (pixel count) | 4287.5 (2121.5, 13,278.0) | 14,460.0 (7282.0, 26,344.5) | <0.001 |
SAT (pixel count) | 16,087.5 (9099.5, 31,848.5) | 18,618.0 (10,488.0, 24,650.0) | 0.85 |
VSr | 0.29 (0.14, 0.51) | 0.74 (0.46, 1.19) | <0.001 |
Muscle (pixel count) | 13,003.0 (11,837.0, 15,573.5) | 17,322.0 (15,584.5, 21,016.5) | <0.001 |
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Chen, Z.; Wittenberg, S.; Auer, T.A.; Bashkuev, M.; Gebert, P.; Fehrenbach, U.; Geisel, D.; Graef, F.; Maerdian, S.; Tsitsilonis, S. The Effect of Fat Distribution on the Inflammatory Response of Multiple Trauma Patients—A Retrospective Study. Life 2021, 11, 1243. https://doi.org/10.3390/life11111243
Chen Z, Wittenberg S, Auer TA, Bashkuev M, Gebert P, Fehrenbach U, Geisel D, Graef F, Maerdian S, Tsitsilonis S. The Effect of Fat Distribution on the Inflammatory Response of Multiple Trauma Patients—A Retrospective Study. Life. 2021; 11(11):1243. https://doi.org/10.3390/life11111243
Chicago/Turabian StyleChen, Zhaoxiong, Silvan Wittenberg, Timo Alexander Auer, Maxim Bashkuev, Pimrapat Gebert, Uli Fehrenbach, Dominik Geisel, Frank Graef, Sven Maerdian, and Serafeim Tsitsilonis. 2021. "The Effect of Fat Distribution on the Inflammatory Response of Multiple Trauma Patients—A Retrospective Study" Life 11, no. 11: 1243. https://doi.org/10.3390/life11111243