Artikel
Impact of Obesity in Traumatic Brain Injury
Suche in Medline nach
Autoren
Veröffentlicht: | 9. Juni 2017 |
---|
Gliederung
Text
Objective: Mortality and outcome in patients suffering from traumatic brain injury (TBI) is effected by many factors. One of these factors is the Body-Mass-Index (BMI) even if data on BMI and TBI are limited and for a severe obesity °II (BMI > 35 kg/m2) no data at all are existing. Aim of this study was to evaluate the impact of obesity in patients suffering from TBI.
Methods: A retrospective cohort analysis of patients suffering from severe TBI registered in the TraumaRegister DGU® of the German Trauma Society (DGU) from 2002 to 2009 was conducted. TBI was defined as an Abbreviated Injury Scale (AIS) in head of ≥3 and AIS in any other part of the body not exceeding the AIS of the head. The BMI was categorized in accordance with the WHO definition of obesity: Group: 1: BMI < 18.5 kg/m2, 2: BMI ≥ 18.5 kg/m2 - < 25 kg/m2, 3: BMI ≥ 25 kg/m2 - <30 kg/m2, 4: BMI ≥ 30 kg/m2 - < 35 kg/m2 (Obesity° I) and 5: BMI ≥ 35 kg/m2 (Obesity °II). The evaluation included preclinical data, initial treatment in the emergency room (ER), clinical course and mortality in relation to the BMI.
Results: 1714 patients with complete datasets fulfilled the inclusion criteria. In 49 patients the BMI was lower than 18.5 kg/m2, 885 patients presented with a normal weight (BMI ≥ 18.5 kg/m2 - < 25 kg/m2), 604 patients presented with overweight (≥ 25 kg/m2 - <30 kg/m2), while 137 patients suffered from obesity °I (BMI ≥ 30 kg/m2 - < 35 kg/m2) and 39 patients from a severe obesity ≥ °II (BMI > 35 kg/m2). Patients with obesity °I und °II were predominately male (75.9%, respectively 74.4%, p<0.001), older (p<0.001) and TBI was associated with traffic accidents (p<0.001). A Glasgow Coma Scale (GCS) ≤ 8 was less often recorded in obesity °I and II (p=0.005). Multivariate logistic regression analysis demonstrated that a BMI > 35 kg/m2 was associated with a higher mortality risk (Odds ratio (OR) 3.219; 95% Confidence interval (95%CI) [1.073-9.655)], p=0.037). A GCS 3-8 (OR 5.802; 95%CI [3.007-11.196] p<0.001), preclinical cardiopulmonary resuscitation (OR 10.815; 95%CI [4.455-26.257] p<0.001), a systolic blood pressure < 90mmHg (OR 1.976; 95%CI [1.268-3.079] p=0.003) and an increasing severity of the TBI were associated with a higher mortality. A BMI of ≥ 25 kg/m2 - <30 kg/m2 had no impact on the mortality rate (OR 0.788; 95%CI [0.531-1.170] p=0.238).
Conclusion: A BMI > 35 kg/m2 in patients suffering from TBI seems to be associated with a higher mortality.