Direct peritoneal resuscitation improves obesity-induced hepatic dysfunction after trauma

Area of Science:

• Trauma and Metabolic Disease Research
• Organ Perfusion and Resuscitation Strategies

Background:

• Metabolic syndrome and fatty liver disease are linked to adverse outcomes in trauma patients.
• Obesity is known to compromise liver blood flow, potentially worsening trauma-related complications.
• Existing research suggests a need to explore interventions for obesity-related liver dysfunction in trauma.

Purpose of the Study:

• To correlate obesity, injury severity, and liver dysfunction with trauma patient outcomes.
• To investigate the potential of direct peritoneal resuscitation (DPR) to mitigate obesity-related liver dysfunction.

Main Methods:

• Clinical arm: Case-controlled retrospective analysis of 72 obese and 187 nonobese ICU trauma patients.
• Experimental arm: Hemorrhagic shock model in obese rats to evaluate DPR's effect on liver blood flow, function, and inflammatory mediators.

Main Results:

• Clinical analysis showed increased mortality, septic complications, liver dysfunction, and renal impairment with higher BMI and injury severity scores.
• Obese rats exhibited impaired liver blood flow, function, renal function, and elevated inflammatory markers (IL-1β, IL-6, HMGB-1).
• Direct peritoneal resuscitation (DPR) in rats restored liver blood flow, improved organ function, and reduced systemic inflammation.

Conclusions:

• Obesity exacerbates trauma outcomes and intensifies liver and renal dysfunction, irrespective of injury severity.
• Direct peritoneal resuscitation (DPR) effectively abrogated trauma-induced liver, renal, and inflammatory responses in an obese rat model.
• The addition of DPR to clinical resuscitation regimens is proposed to benefit obese trauma patients.