腹部肥胖与体重指数预测重症监护病房死亡率的价值。

Predictive value of abdominal obesity vs. body mass index for determining risk of intensive care unit mortality.

机构信息

Pôle Anesthésie et Réanimation, Unités de Réanimation Polyvalente de Purpan et de Rangueil, GRCB 48, IFR 31, Université Paul Sabatier, Toulouse, France.

出版信息

Crit Care Med. 2010 May;38(5):1308-14. doi: 10.1097/CCM.0b013e3181d8cd8b.

DOI:10.1097/CCM.0b013e3181d8cd8b

PMID:20228682

Abstract

OBJECTIVE

To explore whether sagittal abdominal diameter as a marker of abdominal obesity is a risk factor for death and morbidity in patients in the intensive care unit and a better outcome determinant for obese patients than body mass index.

DESIGN

Prospective, observational study from April 2008 to January 2009.

SETTING

Two general intensive care units, both in Toulouse University Hospitals, France.

PARTICIPANTS

All adult patients admitted in the two intensive care units except those routinely discharged within 48 hrs or those having conditions with possible effect on anthropometric indices.

INTERVENTIONS

Measurement of the sagittal abdominal diameter at admission allowed us to divide the studied population into abdominally obese, underweight, and control groups.

MEASUREMENTS AND RESULTS

The primary outcome measure was mortality in the intensive care unit until day 60 after admission. Secondary outcomes were morbidity and length of stay in the intensive care unit. Among 503 patients admitted, 403 were included. At admission, age, diabetes, dyslipidemia, hypertension, Simplified Acute Physiology Score II, and McCabe scores were higher in the abdominally obese group (n = 109) than in the control group (n = 277). The rate of death was higher in the abdominally obese group compared to control (44% vs. 25.3%; p < .01). After adjustment for age, simplified acute physiology score, II and McCabe score, a multivariate analysis showed an increased risk of death in the abdominally obese group (adjusted odds ratio, 2.12; 95% confidence interval, 1.25-3.60). A body mass index >30 kg/m2 was not an independent risk factor for death. During the stay in the intensive care unit, incidence of acute renal failure and abdominal compartment syndrome were higher in the abdominally obese group.

CONCLUSION

A high sagittal abdominal diameter, and not a high body mass index, is an independent risk factor of death in critically ill patients.

摘要

目的

探讨腹部肥胖标志物矢状腹径是否是重症监护病房患者死亡和发病的危险因素，以及它是否比身体质量指数更能预测肥胖患者的预后。

设计

前瞻性、观察性研究，于 2008 年 4 月至 2009 年 1 月进行。

地点

法国图卢兹大学医院的两个普通重症监护病房。

对象

除了通常在 48 小时内出院或有影响人体测量指数的情况的患者外，所有入住两个重症监护病房的成年患者。

干预措施

入院时测量矢状腹径，将研究人群分为腹型肥胖、消瘦和对照组。

测量和结果

主要观察指标为入院后 60 天内重症监护病房的死亡率。次要观察指标为发病率和重症监护病房的住院时间。在 503 名入住患者中，403 名患者被纳入研究。入院时，腹型肥胖组（n = 109）的年龄、糖尿病、血脂异常、高血压、简化急性生理学评分Ⅱ和 McCabe 评分均高于对照组（n = 277）。与对照组相比，腹型肥胖组的死亡率更高（44% vs. 25.3%；p <.01）。调整年龄、简化急性生理学评分Ⅱ和 McCabe 评分后，多变量分析显示腹型肥胖组死亡风险增加（调整优势比，2.12；95%置信区间，1.25-3.60）。身体质量指数 >30 kg/m2 不是死亡的独立危险因素。在重症监护病房住院期间，腹型肥胖组急性肾衰竭和腹腔间隔室综合征的发生率更高。