Trauma outcomes worse with risk factors for heart disease and stroke

(Reuters Health) – Severely injured patients are more likely to have complications or die if they have a cluster of cardiovascular risk factors like high blood pressure, diabetes and obesity, a recent study suggests.

This collection of health problems, called “metabolic syndrome,” has long been linked to an increased risk of events like heart attacks and strokes, but less is known about how it might impact outcomes for trauma patients.

For the current analysis, researchers examined data on 4,491 patients age 16 and older with severe injuries, including 100 people with metabolic syndrome, who were treated from 2014 to 2018.

Compared to patients without metabolic syndrome, individuals with this issue were 2.5 times more likely to die during the study.

“Our data show that metabolic syndrome has a significant impact on mortality and outcomes of trauma patients,” Dr. Brett Tracy of Emory University School of Medicine in Atlanta and colleagues write. “Not only were there increased rates of cardiovascular (complications) associated with metabolic syndrome, but also significantly longer lengths of hospital and ICU stays, and more time on mechanical ventilation.”

Patients with metabolic syndrome in the study were much older: 64, on average, compared to an average age of about 39 for the other trauma patients. And everyone with metabolic syndrome was obese, while the other patients tended to have a healthy weight or be slightly overweight.

They all had similarly severe injuries, however.

Hospital stays averaged 16.5 days for patients with metabolic syndrome, versus 11 days for the other patients. And ICU stays averaged 9 days with metabolic syndrome, versus 5 days without it, according to the study, which was presented at the American College of Surgeon’s Clinical Congress in San Francisco and published in the Journal of the American College of Surgery.

People with metabolic syndrome needed mechanical ventilation to help them breathe for an average of 12 days, compared to 5 days for other patients.

Mortality rates were 14% for patients with metabolic syndrome and 7.1% for other trauma patients in the study.

In addition, 51% of people with metabolic syndrome couldn’t go directly home from the hospital and were sent to rehab facilities or other institutional settings instead, compared with just 30% of the other trauma patients.

Because the study wasn’t a controlled experiment, it can’t prove metabolic syndrome was the cause of worse outcomes for trauma patients.

Another drawback of the analysis is that researchers lacked data on several factors typically considered part of metabolic syndrome like cholesterol levels, waist-to-hip ratio, or high blood sugar without a diagnosis of diabetes, the study team notes.

Researchers also lacked data on patients’ racial or ethnic background or their socioeconomic status, both of which can impact outcomes for trauma patients.

Even so, the results highlight the importance of considering metabolic syndrome among the risk factors for worse trauma outcomes, the study team concludes. And the results also suggest that people should do what they can to reduce factors that contribute to metabolic syndrome.

“Moving forward, early identification of metabolic syndrome with individualized, targeted management strategies may help to improve outcomes in this rapidly expanding population,” the study team writes.

SOURCE: bit.ly/2qxAMjw Journal of the American College of Surgeons, online October 28, 2019.

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