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Hodges ZH, Bright M, Carpenter AM, Neal DW, Vanzant EL, Johnson-Mann CN, Taylor JE. Obesity and Associated Outcomes for Blunt vs Penetrating Mechanism in Trauma Laparotomy Patients. Am Surg 2024:31348241241725. [PMID: 38565208 DOI: 10.1177/00031348241241725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Obesity in trauma patients is an established risk factor contributing to postoperative complications, but the relationship between body mass index (BMI) and trauma patient outcomes is not well-defined, especially when stratified by mechanism of injury. We surveyed the trauma laparotomy registry at an academic level 1 trauma center over a 3-year period to identify mortality, injury severity score, and hospital length of stay (hLOS) outcome measures across BMI classes, with further stratification by mechanism of injury: blunt vs penetrating trauma. A total of 442 patients were included with mean age 44.6 (SD = 18.7) and mean BMI 28.55 (SD = 7.37). These were subdivided into blunt trauma (n = 313) and penetrating trauma (n = 129). Within the blunt trauma subgroup, the hLOS among patients who survived hospitalization significantly increased 9% for each successive BMI class (P = .022, 95% CI = 1.29-17.5). We conclude that successive increase in BMI class is associated with longer hospital stay for blunt trauma patient survivors requiring laparotomy, though additional analysis is needed to establish this relationship to other outcome measures and among penetrating trauma patients.
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Affiliation(s)
- Zachary H Hodges
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael Bright
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anne-Marie Carpenter
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Daniel W Neal
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Erin L Vanzant
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Jessica E Taylor
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
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Rosenthal MD, Brown CJ, Loftus TJ, Vanzant EL, Croft CA, Martindale RG. Nutritional Management and Strategies for the Enterocutaneous Fistula. Curr Surg Rep 2020. [DOI: 10.1007/s40137-020-00255-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mira JC, Szpila BE, Nacionales DC, Lopez MC, Gentile LF, Mathias BJ, Vanzant EL, Ungaro R, Holden D, Rosenthal MD, Rincon J, Verdugo PT, Larson SD, Moore FA, Brakenridge SC, Mohr AM, Baker HV, Moldawer LL, Efron PA. Patterns of gene expression among murine models of hemorrhagic shock/trauma and sepsis. Physiol Genomics 2015; 48:135-44. [PMID: 26578697 DOI: 10.1152/physiolgenomics.00072.2015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/13/2015] [Indexed: 01/22/2023] Open
Abstract
Controversy remains whether the leukocyte genomic response to trauma or sepsis is dependent upon the initiating stimulus. Previous work illustrated poor correlations between historical models of murine trauma and sepsis (i.e., trauma-hemorrhage and lipopolysaccharide injection, respectively). The aim of this study is to examine the early genomic response in improved murine models of sepsis [cecal ligation and puncture (CLP)] and trauma [polytrauma (PT)] with and without pneumonia (PT+Pp). Groups of naïve, CLP, PT, and PT+Pp mice were killed at 2 h, 1 or 3 days. Total leukocytes were isolated for genome-wide expression analysis, and genes that were found to differ from control (false discovery rate adjusted P < 0.001) were assessed for fold-change differences. Spearman correlations were also performed. For all time points combined (CLP, PT, PT+Pp), there were 10,426 total genes that were found to significantly differ from naïve controls. At 2 h, the transcriptomic changes between CLP and PT showed a positive correlation (rs) of 0.446 (P < 0.0001) but were less positive thereafter. Correlations were significantly improved when we limited the analysis to common genes whose expression differed by a 1.5 fold-change. Both pathway and upstream analyses revealed the activation of genes known to be associated with pathogen-associated and damage-associated molecular pattern signaling, and early activation patterns of expression were very similar between polytrauma and sepsis at the earliest time points. This study demonstrates that the early leukocyte genomic response to sepsis and trauma are very similar in mice.
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Affiliation(s)
- Juan C Mira
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Benjamin E Szpila
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Dina C Nacionales
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Maria-Cecilia Lopez
- Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida
| | - Lori F Gentile
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Brittany J Mathias
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Erin L Vanzant
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Ricardo Ungaro
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - David Holden
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Martin D Rosenthal
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Jaimar Rincon
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Patrick T Verdugo
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Shawn D Larson
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Frederick A Moore
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Scott C Brakenridge
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Alicia M Mohr
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Henry V Baker
- Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida
| | - Lyle L Moldawer
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Philip A Efron
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
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Vanzant EL, Ozrazgat-Baslanti T, Liu H, Malik S, Davis R, Lanz J, Miggins MV, Gentile LF, Cuenca A, Cuenca AG, Lottenberg L, Moore FA, Ang DN, Bihorac A, Efron PA. Clostridium difficile Infections after Blunt Trauma: A Different Patient Population? Surg Infect (Larchmt) 2015. [PMID: 26207402 DOI: 10.1089/sur.2013.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The epidemiology of Clostridium difficile-associated infection (CDI) has changed, and it is evident that susceptibility is related not only to exposures and bacterial potency, but host factors as well. Several small studies have suggested that CDI after trauma is associated with a different patient phenotype. The purpose of this study was to examine and describe the epidemiologic factors associated with C. difficile in blunt trauma patients without traumatic brain injury using the Trauma-Related Database as a part of the "Inflammation and Host Response to Injury" (Glue Grant) and the University of Florida Integrated Data Repository. METHODS Previously recorded baseline characteristics, clinical data, and outcomes were compared between groups (67 C. difficile and 384 uncomplicated, 813 intermediate, and 761 complicated non-C. difficile patients) as defined by the Glue Grant on admission and at days seven and 14. RESULTS The majority of CDI patients experienced complicated or intermediate clinical courses. The mean ages of all cohorts were less than 65 y and CDI patients were significantly older than uncomplicated patients without CDI. The CDI patients had increased days in the hospital and on the ventilator, as well as significantly higher new injury severity scores (NISS), and a greater percentage of patients with NISS >34 points compared with non-CDI patients. They also had greater Marshall and Denver multiple organ dysfunction scores than non-CDI uncomplicated patients, and greater creatinine, alkaline phosphatase, neutrophil count, lactic acid, and PiO2:FiO2 compared with all non-CDI cohorts on admission. In addition, the CDI patients had higher glucose concentrations and base deficit from uncomplicated patients and greater leukocytosis than complicated patients on admission. Several of these changes persisted to days seven and 14. CONCLUSION Analysis of severe blunt trauma patients with C. difficile, as compared with non-CDI patients, reveals evidence of increased inflammation, immunosuppression, worse acute kidney injury, higher NISS, greater days in the hospital and on the ventilator, higher organ injury scores, and prolonged clinical courses. This supports reports of an increased prevalence of CDI in a younger population not believed previously to be at risk. This unique population may have specific genomic or inflammation-related risk factors that may play more important roles in disease susceptibility. Prospective analysis may allow early identification of at-risk patients, creation of novel therapeutics, and improved understanding of how and why C. difficile colonization transforms into infection after severe blunt trauma.
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Affiliation(s)
- Erin L Vanzant
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Tezcan Ozrazgat-Baslanti
- 2 Department of Anesthesiology, College of Medicine, University of Florida , Gainesville, Florida
| | - Huazhi Liu
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Seemab Malik
- 2 Department of Anesthesiology, College of Medicine, University of Florida , Gainesville, Florida
| | - Ruth Davis
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Jennifer Lanz
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Makesha V Miggins
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Lori F Gentile
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Angela Cuenca
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Alex G Cuenca
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Lawrence Lottenberg
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Frederick A Moore
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Darwin N Ang
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
| | - Azra Bihorac
- 2 Department of Anesthesiology, College of Medicine, University of Florida , Gainesville, Florida
| | - Philip A Efron
- 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida
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Vanzant EL, Hilton RE, Lopez CM, Zhang J, Ungaro RF, Gentile LF, Szpila BE, Maier RV, Cuschieri J, Bihorac A, Leeuwenburgh C, Moore FA, Baker HV, Moldawer LL, Brakenridge SC, Efron PA. Advanced age is associated with worsened outcomes and a unique genomic response in severely injured patients with hemorrhagic shock. Crit Care 2015; 19:77. [PMID: 25880307 PMCID: PMC4404112 DOI: 10.1186/s13054-015-0788-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 02/04/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We wished to characterize the relationship of advanced age to clinical outcomes and to transcriptomic responses after severe blunt traumatic injury with hemorrhagic shock. METHODS We performed epidemiological, cytokine, and transcriptomic analyses on a prospective, multi-center cohort of 1,928 severely injured patients. RESULTS We found that there was no difference in injury severity between the aged (age ≥55, n = 533) and young (age <55, n = 1395) cohorts. However, aged patients had more comorbidities. Advanced age was associated with more severe organ failure, infectious complications, ventilator days, and intensive care unit length of stay, as well as, an increased likelihood of being discharged to skilled nursing or long-term care facilities. Additionally, advanced age was an independent predictor of a complicated recovery and 28-day mortality. Acutely after trauma, blood neutrophil genome-wide expression analysis revealed an attenuated transcriptomic response as compared to the young; this attenuated response was supported by the patients' plasma cytokine and chemokine concentrations. Later, these patients demonstrated gene expression changes consistent with simultaneous, persistent pro-inflammatory and immunosuppressive states. CONCLUSIONS We concluded that advanced age is one of the strongest non-injury related risk factors for poor outcomes after severe trauma with hemorrhagic shock and is associated with an altered and unique peripheral leukocyte genomic response. As the general population's age increases, it will be important to individualize prediction models and therapeutic targets to this high risk cohort.
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Affiliation(s)
- Erin L Vanzant
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA.
| | - Rachael E Hilton
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA.
| | - Cecilia M Lopez
- Department of Surgery, Anesthesia, University of Florida, PO Box 100254, Gainesville, FL, 32610-0254, USA.
| | - Jianyi Zhang
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA.
| | - Ricardo F Ungaro
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA.
| | - Lori F Gentile
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA.
| | - Benjamin E Szpila
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA.
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Center, University of Washington, PO Box 356410, Seattle, WA, 98195-6410, USA.
| | - Joseph Cuschieri
- Department of Surgery, Harborview Medical Center, University of Washington, PO Box 356410, Seattle, WA, 98195-6410, USA.
| | - Azra Bihorac
- Department of Surgery, Aging and Geriatrics, University of Florida, PO Box 100107, Gainesville, FL, 32610, USA.
| | - Christiaan Leeuwenburgh
- Department of Surgery, University of Florida College of Medicine, PO Box 10019, Gainesville, FL, 32610-0019, USA.
| | - Frederick A Moore
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA.
| | - Henry V Baker
- Department of Surgery, Anesthesia, University of Florida, PO Box 100254, Gainesville, FL, 32610-0254, USA.
| | - Lyle L Moldawer
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA.
| | - Scott C Brakenridge
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA.
| | - Philip A Efron
- Department of Surgery, Molecular Genetics and Microbiology, University of Florida, PO Box 100245, Gainesville, FL, 32610-0245, USA. .,Department of Surgery, University of Florida College of Medicine, PO Box 10019, Gainesville, FL, 32610-0019, USA.
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Rosenthal MD, Vanzant EL, Martindale RG, Moore FA. Evolving paradigms in the nutritional support of critically ill surgical patients. Curr Probl Surg 2015; 52:147-82. [PMID: 25946621 DOI: 10.1067/j.cpsurg.2015.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/29/2015] [Accepted: 02/11/2015] [Indexed: 12/12/2022]
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Gentile LF, Cuenca AG, Vanzant EL, Efron PA, McKinley B, Moore F, Moldawer LL. Is there value in plasma cytokine measurements in patients with severe trauma and sepsis? Methods 2013; 61:3-9. [PMID: 23669589 DOI: 10.1016/j.ymeth.2013.04.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/18/2013] [Accepted: 04/30/2013] [Indexed: 12/29/2022] Open
Abstract
For the past thirty years, since IL-1β and TNFα were first cloned, there have been efforts to measure plasma cytokine concentrations in patients with severe sepsis and trauma, and to use these measurements to predict clinical outcome and response to therapies. The numbers of cytokines and chemokines that have been measured in the plasma have literally exploded with the development of multiplex immune approaches. Dozens of relatively small cohort studies have shown plasma cytokine concentrations correlating with outcome in sepsis and trauma. Despite what appears to be a consensus that plasma cytokine concentrations should be useful in the clinical setting, only two cytokines, IL-6 and procalcitonin, have approached routine clinical use. IL-6 has been used as a research tool for entry into sepsis-intervention trials, while procalcitonin is being used clinically at a large number of institutions to distinguish sepsis from other inflammatory processes. For most cytokines, the relative lack of sensitivity and specificity of individual or multiplex cytokine measurements has hindered their utility to predict clinical trajectory in individual patients. The problem rests with a general misunderstanding of cytokine biology, failing to appreciate the general paracrine nature of these mediators, the presence of binding proteins, chaperones and inhibitors in the plasma, and the rapid clearance of these proteins by binding to cell receptors and clearance predominantly by the kidney. The future of using plasma cytokine measurements as an indicator of sepsis/trauma severity or predicting outcome is generally behind us, although there is optimism that procalcitonin measurements may ultimately prove to have utility in the diagnosis of severe sepsis.
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Affiliation(s)
- Lori F Gentile
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610-0019, USA
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