Dynamics of Carbohydrate Metabolism Markers in Patients with Increased Body Mass Index with Polytrauma

It is known that the results of treatment of patients with an increased body mass index (hereinafter – IBMI) depend on the initial indicators of the general reactivity of the organism, especially with destructive stress factors such as polytrauma. The data on metabolic syndrome (MS) shows that it is necessary to study its possible influence on the course of traumatic disease (TD) and the development of complications in patients with IBMI in polytrauma. The purpose of the study was to analyze the dynamics of carbohydrate metabolism markers in patients with an IBMI with polytrauma. Material and methods. We analyzed the dynamics of glucose (G), endogenous insulin (EI), NOMA-IR and HOMA-FV indexes in 224 patients with IBMI during the month of hospital stay with a diagnosis of polytrauma and on the three hundred and sixtieth control day of the outpatient visit. Results and discussion. The patients had the same severity at the time of admission on the APACHE II scale 14 ± 5.8 points and were divided into 3 groups depending on the starting BMI numbers. Group I patients had BMI to 29.9, group II patients were with BMI 30.0-39.9 and group III patients' BMI was over 40.0. The patients with BMI ≤ 29.9 had the following features: maximum G figures on admission, probably overstepping control on the thirtieth day, a gradual decrease in the level of G from the third to the fourteenth day, excess of control by 7% on the three hundred and sixtieth day; fluctuations in the level of EI during the entire survey period around control values, a decrease from control by 8% at three hundred and sixtieth day; a gradual decrease in the average figures of the NOMA-FB index during the early period of polytrauma; a decrease from control by 5% on the three hundred and sixtieth day; fluctuations in the HOMA-IR index during the entire study period in the range of control values. Patients with II-III degree of obesity with BMI of 30.0-39.9 were identified with the following features: the control of G abnormal numbers were likely to be exceeded on the third day, further gradual decrease with minimum values on the fourteenth day, followed by an increase from the control on the thirtieth day and exceeding it by 10% for three hundred and sixtieth day; probable exceeding the control level of EI by 40% on admission, exceeding it by 1.5 times on the third day of treatment, followed by wavy fluctuations and exceeding the average values on the seventh, fourteenth, thirtieth and three hundred and sixtieth days; a gradual decrease in the average figures of the NOMA-FB index during the early period, a further significant increase on the thirtieth and three hundred and sixtieth days; achievement of the NOMA-IR index on the third day of control with the subsequent upward trend to the 30th day and returning to the initial level on the three hundred and sixtieth day. We observed that patients with morbid obesity with BMI more than 40.0 had the following features: the control of G abnormalities was likely to be exceeded from day 1 to day 7, but with a decrease in control even by three hundred and sixtieth day; the EI level of the control values was exceeded during the entire examination period; a decrease in the HOMA-FB index from day 1 to day 30 and a significant decrease from the start and control for the three hundred and sixtieth day; during the year, the NOMA-IR index was exceeded.