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Diabetes increased polytrauma complications risk, including death
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Patients with diabetes have greater risk for complications, including mortality, after polytrauma than those without previous comorbidities, according to findings published in BMC Medicine.
Early identification and targeted monitoring of the subgroup of patients who have sustained three or more injuries to one anatomical region of the body could improve outcomes, researchers in the United Kingdom said.
“The systemic effect of polytrauma on patients with diabetes should not be underestimated,” Peter V. Giannoudis, MD, of the department of trauma and orthopedic surgery at University of Leeds in the United Kingdom, told Endocrine Today. “Endocrinologists need to be vigilant when monitoring their patients in a polytrauma setting.”
Giannoudis, along with James Tebby, MD, and colleagues used data from the Trauma Audit and Research Network to isolate patients who sustained polytrauma. The group was further filtered based on known outcomes, diabetes diagnosis or lack thereof and known past medical comorbidities (PMCs) or lack thereof.
The investigators identified 222 patients with diabetes; 2,558 with no PMCs and without diabetes; and 2,709 with PMC and without diabetes. Patients with diabetes were older than those in the other groups (P<.05). More men than women were involved in trauma overall (70% in the diabetes group; 78% in the no PMCs group).
All complication rates were higher with diabetes, including renal failure, myocardial infarction, acute respiratory distress syndrome, pulmonary embolism and deep vein thrombosis, according to the study.
“Diabetic patients have a high chance of developing common complications such as infection, renal failure or thromboembolic events after being involved in polytrauma, and once these complications occur, their outcomes are poor,” Giannoudis said. “They may also have a reduced capacity to compensate for their injuries even in the absence of any other comorbidities.”
The diabetes group also showed a higher mortality rate compared with the no PMC group (32.4% vs. 12.9%; P<.05).
“Complications should be anticipated based on injury patterns and intervention prompt,” Giannoudis said. “There should be further focus on good glycemic control, especially with the involvement of a head injury.” — by Allegra Tiver
For more information:
Giannoudis can be reached at the Academic Department of Trauma & Orthopedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, U.K.; email: pgiannoudi@aol.com.
Disclosure: The researchers reported no relevant financial disclosures.
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