Citation

Winfield RD, Delano MJ, Cuenca AG, Cendan JC, Lottenberg LL, Efron PA, Maier RV, Remick DG, Moldawer LL, Cuschieri J. Shock 2012; 37(3): 253-256.

Affiliation

1Laboratory of Inflammation Biology and Surgical Science, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, 2Department of Clinical Sciences, University of Central Florida College of Medicine, 3Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, 4Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, 5Department of Pathology, Boston University Medical Center, Boston, Massachusetts.

Copyright

(Copyright © 2012, The Shock Society, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/SHK.0b013e3182449c0e

PMID

22266966

Abstract

OBJECTIVE: We hypothesized that severely injured obese patients would display increased concentrations of pro-inflammatory cytokines when compared to patients of normal body mass index (BMI), and that this would be associated with multiple organ failure (MOF). DESIGN: Retrospective review of prospectively collected data in the "Inflammation and the Host Response to Injury" trauma-related database. SETTING: Data was collected prospectively from United States Level I trauma centers PATIENTS: Severely injured adult blunt trauma patients MEASUREMENTS: Cytokine concentrations obtained within 12 hrs of injury and on days one and four were compared between subjects on the basis of BMI (Normal, 18.5-24.9 kg/m and Obese, ≥ 30 kg/m). Demographic measures, injury severity, cytokine concentrations, and outcome measures were compared between groups. MAIN RESULTS: 74 adult blunt trauma victims were evaluated. Relative to patients of normal BMI (n=34), obese patients (n=40) demonstrated an overall depressed cytokine response to severe injury, with significantly lower concentrations of several cytokines. Obese patients showed greater incidences of nosocomial infection (60 vs. 45%, NS) and MOF (63% vs. 44%, NS) and a later onset of maximum MOF score (5 days vs. 3, pπ.04) when compared to those of normal BMI. CONCLUSIONS: Despite prior reports suggesting a pro-inflammatory cytokine profile in obese individuals, obese patients sustaining severe injury show a depressed early cytokine response when compared to patients of normal BMI. This may confer increased susceptibility to nosocomial infection and later MOF. Further study of immune dysfunction in the post-injury obese patient should assess the possibility of early immune suppression.

Language: en