Differences in outcome between obese and nonobese patients following severe blunt trauma are not consistent with an early inflammatory genomic response.
OBJECTIVE
Obesity has been demonstrated to alter a number of acute and chronic medical conditions. The effect of obesity on severely injured patients, however, remains incompletely defined. We sought to unravel potential physiologic and genomic alterations induced by obesity in severely injured blunt trauma patients.


METHODS
A retrospective review of clinical and genomic information contained in the Inflammation and the Host Response to Injury multicenter trauma-related database examining the relationship between body mass index and the early genomic response from peripheral blood leukocytes to patient outcome following severe blunt trauma was performed.


METHODS
Multicenter collaboration between university-based academic trauma centers.


METHODS
Severely injured blunt trauma patients enrolled in the database.


METHODS
None.


RESULTS
Univariate analysis of 455 severely injured trauma patients using the National Institutes of Health/World Health Organization body mass index classification system revealed significant increases in morbidity, including longer intensive care unit stays and a greater number of ventilator days, cardiac arrests, episodes of acute renal failure, and patients developing multiple organ failure. Regression modeling identified body mass index class as being independently associated with adverse outcomes and increased morbidity but an inverse relationship with mortality in patients who suffered severe blunt traumatic injury. Initial leukocyte genomic expression patterns between 163 patients in the four different body mass index groupings did not differ; however, analysis of gene differences between body mass index classes occurring over time demonstrated significant changes in 513 probe sets with significant pathway differences being related to cellular metabolism.


CONCLUSIONS
Increasing body mass index is associated with increased morbidity following severe blunt trauma. The initial blood leukocyte inflammatory response to blunt trauma does not appear to differ significantly between patients despite increasing body mass index. Resolution of the inflammatory response may differ between patients on the basis of body mass index; however, additional work is needed to clarify the potential causality of this finding.
Winfield
Robert D
RD
Department of Surgery, Laboratory of Inflammation Biology and Surgical Science, University of Florida College of Medicine, Gainesville, FL, USA.
Delano
Matthew J
MJ
Dixon
David J
DJ
Schierding
William S
WS
Cendan
Juan C
JC
Lottenberg
Lawrence
L
Lopez
M Cecilia
MC
Baker
Henry V
HV
Cobb
J Perren
JP
Moldawer
Lyle L
LL
Maier
Ronald V
RV
Cuschieri
Joseph
J
D000046:Academic Medical Centers; D000328:Adult; D000704:Analysis of Variance; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D016208:Databases, Factual; D005260:Female; D023281:Genomics; D006801:Humans; D007249:Inflammation / Q000235:genetics / Q000503:physiopathology*; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000235:genetics* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States; D014949:Wounds, Nonpenetrating / Q000235:genetics / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult