Authors: Brett M. Tracy MD et al
American College of Surgeons 105th Annual Clinical Congress, Scientific Forum, San Francisco, CA, October 2019.
Metabolic syndrome (MetS) increases cardiovascular risk and is associated with poor patient outcomes. We hypothesized that MetS confers an increased risk of morbidity and mortality in severely injured trauma patients.
We performed a retrospective review of trauma patients from 2014 through 2018, excluding patients younger than 16 years, with Injury Severity Score <16, and with incomplete height and/or weight documentation. Metabolic syndrome was defined as the presence of diabetes, hypertension, and BMI ≥30 kg/m2. Outcomes included length of stay (LOS), complications, discharge location, and mortality.
There were 4,489 patients meeting criteria, of which 100 (2.2%) had MetS. Patients with MetS were older (64.0 vs 38.6 years; p < 0.0001), but with similar Injury Severity Scores (22 vs 22; p = 0.7). Hospital LOS was significantly longer with MetS (16.5 vs 11 days; p < 0.0001), as was ICU LOS (9 vs 5 days; p = 0.0002). MetS correlated with higher rates of acute kidney injury (19% vs 3.6%; p < 0.0001), ARDS (11.0% vs 4.6%; p = 0.01), cardiac arrest (10.0% vs 4.0%; p = 0.01), MI (2.0% vs 0.3%; p = 0.05), severe sepsis (8.0% vs 3.3%; p = 0.03), unplanned intubation (11.0% vs 5.0%; p = 0.02), unplanned ICU admission (13.0% vs 6.1%; p = 0.02), and non-home discharge (51.0% vs 30.2%; p = 0.0007). After controlling for age, Glasgow Coma Scale, Injury Severity Score, sex, and mechanism, MetS remained an independent predictor of mortality (odds ratio 2.5; 95% CI 1.33 to 4.7; p = 0.004).
MetS occurs infrequently in our severely injured trauma population, but is strongly associated with increasing LOS, as well as cardiac, pulmonary, infectious, and renal complications. MetS also significantly and independently predicts death and should be identified early to facilitate prompt multidisciplinary treatment.