TY - JOUR
T1 - Direct peritoneal resuscitation improves obesity-induced hepatic dysfunction after trauma
AU - Matheson, Paul J.
AU - Franklin, Glen A.
AU - Hurt, Ryan T.
AU - Downard, Cynthia D.
AU - Smith, Jason W.
AU - Garrison, Richard N.
PY - 2012/4
Y1 - 2012/4
N2 - Background: The metabolic syndrome and associated fatty liver disease are thought to contribute to poor outcomes in trauma patients. Experimentally, obesity compromises liver blood flow. We sought to correlate the effect of obesity, injury severity, and liver dysfunction with trauma outcomes. We hypothesized that obesity-related liver dysfunction could be mitigated with the novel technique of adjunctive direct peritoneal resuscitation (DPR). Study Design: This study has clinical and experimental arms. The clinical study was a case-controlled retrospective analysis of ICU trauma patients (n = 72 obese, n = 187 nonobese). The experimental study was a hemorrhagic shock model in obese rats to assess the effect of DPR on liver blood flow, liver function, and inflammatory mediators. Results: In trauma patients, univariate and multivariate analyses demonstrated increasing mortality (p < 0.05), septic complications (p < 0.05), liver dysfunction (p < 0.001), and renal impairment (p < 0.05) with increasing body mass index and injury severity score. Obesity in rats impairs liver blood flow, liver function, renal function, and inflammation (interleukin [IL]-1β, IL-6, high mobility group protein B1[HMGB-1]). The addition of DPR to shock resuscitation restores liver blood flow, improves organ function, and reverses the systemic proinflammatory response. Conclusions: Our clinical review substantiates that obesity worsens trauma outcomes regardless of injury severity. Obesity-related liver and renal dysfunction is aggravated by injury severity. In an obese rat model of resuscitated hemorrhagic shock, the addition of DPR abrogates trauma-induced liver, renal, and inflammatory responses. We conclude that the addition of DPR to the clinical resuscitation regimen will benefit the obese trauma patient.
AB - Background: The metabolic syndrome and associated fatty liver disease are thought to contribute to poor outcomes in trauma patients. Experimentally, obesity compromises liver blood flow. We sought to correlate the effect of obesity, injury severity, and liver dysfunction with trauma outcomes. We hypothesized that obesity-related liver dysfunction could be mitigated with the novel technique of adjunctive direct peritoneal resuscitation (DPR). Study Design: This study has clinical and experimental arms. The clinical study was a case-controlled retrospective analysis of ICU trauma patients (n = 72 obese, n = 187 nonobese). The experimental study was a hemorrhagic shock model in obese rats to assess the effect of DPR on liver blood flow, liver function, and inflammatory mediators. Results: In trauma patients, univariate and multivariate analyses demonstrated increasing mortality (p < 0.05), septic complications (p < 0.05), liver dysfunction (p < 0.001), and renal impairment (p < 0.05) with increasing body mass index and injury severity score. Obesity in rats impairs liver blood flow, liver function, renal function, and inflammation (interleukin [IL]-1β, IL-6, high mobility group protein B1[HMGB-1]). The addition of DPR to shock resuscitation restores liver blood flow, improves organ function, and reverses the systemic proinflammatory response. Conclusions: Our clinical review substantiates that obesity worsens trauma outcomes regardless of injury severity. Obesity-related liver and renal dysfunction is aggravated by injury severity. In an obese rat model of resuscitated hemorrhagic shock, the addition of DPR abrogates trauma-induced liver, renal, and inflammatory responses. We conclude that the addition of DPR to the clinical resuscitation regimen will benefit the obese trauma patient.
KW - ALT
KW - BMI
KW - DPR
KW - EHBF
KW - HEM
KW - IL
KW - ISS
KW - Injury Severity Score
KW - MAP
KW - NAFLD
KW - NASH
KW - RES
KW - alanine aminotransferase
KW - body mass index
KW - direct peritoneal resuscitation
KW - effective hepatic blood flow
KW - hemorrhagic shock
KW - interleukin
KW - mean arterial pressure
KW - nonalcoholic fatty liver disease
KW - nonalcoholic steatohepatitis
KW - resuscitation
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U2 - 10.1016/j.jamcollsurg.2011.12.016
DO - 10.1016/j.jamcollsurg.2011.12.016
M3 - Article
C2 - 22342791
AN - SCOPUS:84862807957
SN - 1072-7515
VL - 214
SP - 517
EP - 528
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 4
ER -