Critical Care Department, Hospital Universitario Joan XXIII-Centro de Investigación Biomédica en red Enfermedades Respiratorias, Universitat Rovira i Virgili (URV), and Institut d'Investigació Sanitària Pere Virgili (IISPV), Tarragona.
Critical Care Department, Hospital Universitario Joan XXIII-Centro de Investigación Biomédica en red Enfermedades Respiratorias, Universitat Rovira i Virgili (URV), and Institut d'Investigació Sanitària Pere Virgili (IISPV), Tarragona.
Chest. 2011 Feb;139(2):382-386. doi: 10.1378/chest.10-1160. Epub 2010 Aug 5.
A large proportion of patients infected with 2009 influenza A(H1N1) (A[H1N1]) are obese. Obesity has been proposed as a risk factor influencing outcome in these patients. However, its role remains unclear. We evaluate the outcome of patients who are obese and infected with A(H1N1) in the ICU, determining whether obesity is a risk factor for mortality.
This was a prospective, observational, and multicenter study performed in 144 ICUs in Spain. Data were obtained from the Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (GTEI/SEMICYUC) registry. Adult patients with A(H1N1) that was confirmed by real-time polymerase chain reaction were included in the analysis. Patients who were obese (BMI > 30) were compared with patients who were nonobese. Cox regression analysis was used to determine adjusted mortality. Differences of P < .05 were considered significant.
In January 2010, the GTEI/SEMICYUC registry had complete records for 416 patients. One hundred and fifty patients (36.1%) were obese, of whom 67 (44.7%) were morbidly obese (BMI > 40). Mechanical ventilation (MV) was more frequently applied in patients who were obese (64% vs 52.4%, P < .01) Patients with obesity remained on MV longer than patients who were nonobese (6.5 ± 10.3 days vs 9.3 ± 9.7 days, P = .02), had longer ICU length of stay (10.8 ± 12.1 days vs 13.7 ± 11.7 days, P = .03), and had longer hospitalization (18.2 ± 14.6 days vs 22.2 ± 16.5 days, P = .02). Mortality adjusted by severity and potential confounders identified that obesity was not significantly associated with ICU mortality (hazard ratio, 1.1; 95% CI, 0.69-1.75; P = .68).
In our cohort, patients who were obese and infected with A(H1N1) did not have increased mortality. However, there was an association between obesity and higher ICU resource consumption.
很大比例的 2009 年甲型 H1N1 流感（A[H1N1]）感染者为肥胖者。肥胖已被认为是影响此类患者预后的一个危险因素。然而，其作用仍不明确。我们评估了感染 A（H1N1）的肥胖患者在重症监护病房（ICU）的转归，以确定肥胖是否为死亡的危险因素。
这是在西班牙 144 家 ICU 中进行的一项前瞻性、观察性、多中心研究。数据来自西班牙重症监护医学、危重病和冠状动脉小组传染病工作组（GTEI/SEMICYUC）登记处。纳入的分析对象为经实时聚合酶链反应（PCR）证实的甲型 H1N1 成年患者。将肥胖（BMI＞30）患者与非肥胖患者进行比较。采用 Cox 回归分析确定校正死亡率。P＜0.05 为差异有统计学意义。
2010 年 1 月，GTEI/SEMICYUC 登记处完整记录了 416 例患者的数据。其中 150 例（36.1%）患者肥胖，其中 67 例（44.7%）为病态肥胖（BMI＞40）。肥胖患者接受机械通气（MV）的比例更高（64%比 52.4%，P＜0.01），MV 时间长于非肥胖患者（6.5±10.3 天比 9.3±9.7 天，P=0.02），ICU 住院时间长于非肥胖患者（10.8±12.1 天比 13.7±11.7 天，P=0.03），住院时间长于非肥胖患者（18.2±14.6 天比 22.2±16.5 天，P=0.02）。经严重程度和潜在混杂因素校正的 ICU 死亡率分析显示，肥胖与 ICU 死亡率无显著相关性（危险比，1.1；95%可信区间，0.69-1.75；P=0.68）。
在我们的队列中，肥胖且感染 A（H1N1）的患者死亡率并未增加。然而，肥胖与 ICU 资源消耗增加有关。
