Key result
Higher injury severity score linked to ~13% more incident CAD per 5-point increase in veterans.
Why the study?
The long-term sequelae of combat injuries sustained during the Iraq and Afghanistan conflicts have not been carefully examined.
Does greater severity of combat injury increase the risk of developing hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease in critically injured military personnel?
Cohort (n=3,846)
Does greater severity of combat injury increase the risk of developing hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease in critically injured military personnel?
Greater severity of combat injuries and acute kidney injury are significantly associated with a higher long-term risk of developing cardiometabolic and renal diseases in military personnel.
Answers are grounded in this paper and cite their sources.
Combat injury severity was associated with higher cardiometabolic and CKD rates; leaves open whether targeted veteran surveillance improves outcomes.
BACKGROUND: During the conflicts in Iraq and Afghanistan, 52,087 service members have been wounded in combat. The long-term sequelae of these injuries have not been carefully examined. We sought to determine the relation between markers of injury severity and the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease. METHODS AND RESULTS: Retrospective cohort study of critically injured US military personnel wounded in Iraq or Afghanistan from February 1, 2002 to February 1, 2011. Patients were then followed until January 18, 2013. Chronic disease outcomes were assessed by International Classification of Diseases, 9th edition codes and causes of death were confirmed by autopsy. From 6011 admissions, records were excluded because of missing data or if they were for an individual's second admission. Patients with a disease diagnosis of interest before the injury date were also excluded, yielding a cohort of 3846 subjects for analysis. After adjustment for other factors, each 5-point increment in the injury severity score was associated with a 6%, 13%, 13%, and 15% increase in incidence rates of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease, respectively. Acute kidney injury was associated with a 66% increase in rates of hypertension and nearly 5-fold increase in rates of chronic kidney disease. CONCLUSIONS: In Iraq and Afghanistan veterans, the severity of combat injury was associated with the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease.
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Stewart et al. (2015) conducted a cohort in Combat injury (n=3,846). Higher combat injury severity (per 5-point increment in ISS) and acute kidney injury vs. Lower combat injury severity and absence of acute kidney injury was evaluated on Incidence of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease (6%, 13%, 13%, and 15% increase in incidence rates per 5-point ISS increment, respectively). In combat veterans, each 5-point increment in injury severity score was associated with increased incidence rates of hypertension (6%), coronary artery disease (13%), diabetes (13%), and CKD (15%).
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