Abstract
Objectives In recent years; increasing evidence pointed out the clinical importance of adipose tissue (AT) distribution in various patient populations. In particular, visceral adipose tissue (VAT), when compared to subcutaneous adipose tissue (SAT), was found to play a pivotal role in the development of inflammatory reaction. The aim of the present study was to examine whether body fat distribution has an impact on the development of systemic inflammatory response syndrome (SIRS) in patients with polytrauma. Methods In our retrospective study; we filtered our institution records of the German Trauma Registry (Trauma Register DGU) from November 2018 to April 2021 and included 132 adult polytrauma patients with injury severity score (ISS) >16. Subsequently; we measured the visceral and subcutaneous adipose tissue area based on whole-body CT scan and calculated the ratio of VAT to SAT (VSr). Thereafter, the patient population was evenly divided into three groups; respectively VSr value less than 0.4 for the first group (low ratio), 0.4–0.84 for the second group (intermediate ratio), and greater than 0.84 for the third group (high ratio). Considering the other influencing factors; the groups were further divided into subgroups in the respective analysis according to gender (male/female), BMI (<25 or ≥25), and ISS (<26 or ≥26). Result VSr was an independent factor from body mass index (BMI) (r2 = 0.003; p = 0.553). VSr in male patients was significantly higher (p < 0.001). Patients with low VSr had higher ISS scores (p = 0.028). Polytrauma patients with higher VSr tended to have lower SIRS scores and significant differences of SIRS score were found on multiple days during the whole hospitalization period. In the low VAT/SAT group, male patients, and patients with BMI greater than 25, both exhibited higher SIRS scores during hospital stay (day 16: p = 0.01; day 22: p = 0.048 and p = 0.011; respectively). During hospitalization, patients with higher ISS score (≥26) in the low VSr group was found to have higher SIRS score (day 16; p = 0.007). Over the hospital stay; serum markers of CRP; CK; and leukocyte in patients with low VSr were higher than those in patients in the intermediate and high VSr groups; with significant difference discovered on multiple days (day 16: 0.014; day 22: p = 0.048). Conclusion Lower VSr is associated with increased inflammatory response and worse clinical outcome in patients with polytrauma. Furthermore; VSr is an independent factor providing additional information to BMI.
Highlights
Obesity has been identified as a vital risk factor for cardiovascular diseases [1] and various diseases involving an acute or a long-term chronic inflammatory response, such as asthma [2], Alzheimer’s disease [3], as well as in trauma [4,5] and postoperative patients [6].Despite an increasing number of studies reporting the positive relationship between obesity and multiple diseases, the link remains controversial
The patient cohort was divided into three groups as mentioned above, resulting in a low (n = 44), intermediate (n = 44), and high (n = 44) ratio group
We found that male patients with low VSr ratio had a higher systemic inflammatory response syndrome (SIRS) score, with significant differences found at day 16
Summary
Obesity has been identified as a vital risk factor for cardiovascular diseases [1] and various diseases involving an acute or a long-term chronic inflammatory response, such as asthma [2], Alzheimer’s disease [3], as well as in trauma [4,5] and postoperative patients [6].Despite an increasing number of studies reporting the positive relationship between obesity and multiple diseases, the link remains controversial. Obesity has been identified as a vital risk factor for cardiovascular diseases [1] and various diseases involving an acute or a long-term chronic inflammatory response, such as asthma [2], Alzheimer’s disease [3], as well as in trauma [4,5] and postoperative patients [6]. Obesity has been extensively studied by researchers using the body mass index (BMI) as the prevailing standard, the BMI is a raw reflection of the body total adiposity. It cannot distinguish body lean mass from fat mass or consider differently distributed regional adipose tissue, as in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) [12]. We postulate that the conflicting results of the previous studies may be attributed to utilizing BMI as the sole index
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