Correlation Analysis Of Different Body Mass Indexes On Glucose And Lipid Metabolism,Inflammatory Response And Prognosis In Patients With Severe Burns

Objective:We reviewed the medical records of patients with severe burns in the burn center of the First Affiliated Hospital of Nanchang University,observed the differences in glucose metabolism,lipid metabolism and inflammatory response in patients with severe burns with different body mass index,analyzed the influence of obesity on the prognosis of patients with severe burns,and provided a reference basis for the clinical related prevention and treatment of patients with obese burns.Methods:1.Patients with severe burns who met the criteria(inclusion and exclusion criteria)in the burn center of the First Affiliated Hospital of Nanchang University between January 1,2018 and December 31,2021 were collected and divided into normal weight group,overweight group and obese group according to the Chinese version of adult BMI criteria.2.Clinical characteristics data of patient : admission time,post-injury admission time,gender,age,height,weight,burn type,TBSA,III° burn area,inhalation injury,APACHE II,ABSI.3.Substance metabolism indexes: glucose metabolism(FPG,Ty G index),lipid metabolism(TG,TC,HDL-C,LDL-C)and liver function(ALT,AST,γ-GT,ALP)were collected on days 1,3,7 and 14 after burn injury.4.Inflammatory response indicators: inflammatory indicators(WBC,LYM,NC,PCT)were collected on days 1,3,7 and 14 after burns;infection(number of positive trauma cultures,blood cultures,catheter-related cultures,sputum cultures and urine cultures).5.Patient prognosis-related indicators: length of mechanical ventilation and endotracheal intubation,complications,patient hospital outcomes,LOS,hospital costs,and costs of care.Results:1.Clinical characteristics of patient: A total of 232 patients with severe burns who met the criteria were included in the study,including 163 males and 69 females;median age was 47.5 years;median BMI was 24.5 kg/m2;burn type was 186 burns,21 electrical burns,9 chemical burns,and 16 other burns;median length of burn to admission was 4 h;mean TBSA was(51.98±23.65)%;median Ⅲ°burn area was21.5%;there were 143 patients with combined inhalation injury;overall median APACHE II and ABSI scores were 9 and 6.The three groups differed in BMI,gender and burn type(P < 0.05),while the rest of the indicators were not statistically defferent(P>0.05).2.Glucose metabolism: the FPG and Ty G indices in the overweight and obese groups were higher than those in the normal weight group on days 3,7 and 14 after burn injury(P < 0.05).3.Lipid metabolism: TC and HDL-C in the overweight group on days 1,3 and 7after burns were higher than those in the normal group(P < 0.05),while on day 14 they were lower than those in the normal group(P < 0.05);TG in the obese group on days 1,3,7 and 14 after burns was higher than that in the normal group(P < 0.05);and ALT,AST,γ-GT and ALP in the obese group were all higher than those in the normal group(P < 0.05).4.Inflammatory response situation: WBC and NC in the obese group were higher than the normal body group on days 1,3,7 and 14 after burn injury(P < 0.05);no significant differences were seen in LYM and PCT between the three groups except for day 1(P > 0.05).5.Infection status: the highest positive rate of normal body recombination in blood culture,the highest positive rate of super recombination in trauma culture and sputum culture,and the highest positive rate in the obese group in catheter-related culture and urine culture,but the differences in the positive rate and number of positives between the groups were not statistically significant(P > 0.05).6.Prognosis: the mortality rate of the overweight group was lower than that of the normal-body group(P < 0.05);the median LOS situation of the three groups was:normal-body group < overweight group < obese group(P < 0.05);the complication rates of the three groups were 43.0%,43.1%,and 63.3%,respectively,with statistical differences(P < 0.05);the median relationships of hospitalization and care costs among the three groups were: Obese group > overweight group > normal weight group(P < 0.05).7.Mortality risk factors: According to the multivariate logistic regression equation analysis,age,TBSA and III°burn area were shown to be the risk factors affecting mortality in burn patients(P < 0.05),and the effect of BMI on mortality in burn patients was unclear(P > 0.05).Conclusion:Through research and analysis,it is found that obesity causes changes in glucose metabolism,lipid metabolism and inflammatory response in patients with severe burns and affects the prognosis,the main conclusions are as follows:1.Overweight and obese patients with severe burns exhibit higher blood glucose levels and stronger insulin resistance,and attention should be paid to the monitoring and management of blood glucose in overweight and obese burn patients in clinical practice.2.Obese patients with severe burns have higher TG levels,which may lead to increased liver load and exacerbate liver damage,and attention should be paid to liver protection treatment for obese patients with severe burns.3.Stronger inflammatory response exists in obese patients with severe burns.4.Overweight may have a protective effect on the survival of patients with severe burns.5.Obesity may prolong the healing time of burn patients and increase the difficulty of treatment.