Division of Critical Care Medicine, Jay B. Langner Critical Care Service, Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
Crit Care Med. 2012 Sep;40(9):2601-8. doi: 10.1097/CCM.0b013e3182591ed9.
Obesity is increasingly encountered in intensive care units but the relationship between obesity and acute kidney injury is unclear. We aimed to evaluate whether body mass index was associated with acute kidney injury in the acute respiratory distress syndrome and to examine the association between acute kidney injury and mortality in patients with and without obesity.
Retrospective study.
Massachusetts General Hospital and Beth Israel Deaconess Medical Center.
Seven hundred fifty-one patients with acute respiratory distress syndrome.
None.
Acute kidney injury was defined as meeting the "Risk" category according to modified Risk, Injury, Failure, Loss, End-stage criteria based on creatinine and glomerular filtration rate because urine output was only available on the day of intensive care unit admission. Body mass index was calculated from height and weight at intensive care unit admission. The prevalence of acute kidney injury increased significantly with increasing weight (p = .01). The odds of acute kidney injury were twice in obese and severely obese patients compared to patients with normal body mass index, after adjusting for predictors of acute kidney injury (age, diabetes, Acute Physiology and Chronic Health Evaluation III, aspiration, vasopressor use, and thrombocytopenia [platelets ≤ 80,000/mm]). After adjusting for the same predictors, body mass index was significantly associated with acute kidney injury (odds ratio(adj) 1.20 per 5 kg/m increase in body mass index, 95% confidence interval 1.07-1.33). On multivariate analysis, acute kidney injury was associated with increased acute respiratory distress syndrome mortality (odds ratio(adj) 2.76, 95% confidence interval 1.72-4.42) whereas body mass index was associated with decreased mortality (odds ratio(adj) 0.81 per 5 kg/m increase in body mass index, 95% confidence interval 0.71-0.93) after adjusting for mortality predictors.
In acute respiratory distress syndrome patients, obesity is associated with increased development of acute kidney injury, which is not completely explained by severity of illness or shock. Although increased body mass index is associated with decreased mortality, acute kidney injury remained associated with higher mortality even after adjusting for body mass index.
肥胖在重症监护病房中越来越常见，但肥胖与急性肾损伤之间的关系尚不清楚。我们旨在评估肥胖患者的体重指数与急性呼吸窘迫综合征患者的急性肾损伤之间是否存在相关性，并检查肥胖患者与非肥胖患者急性肾损伤与死亡率之间的关系。
回顾性研究。
马萨诸塞州综合医院和贝斯以色列女执事医疗中心。
751 例急性呼吸窘迫综合征患者。
无。
急性肾损伤根据改良的 Risk, Injury, Failure, Loss, End-stage（RIFLE）标准，根据肌酐和肾小球滤过率定义为“风险”类别，因为仅在重症监护病房入院当天获取尿液输出量。体重指数根据入院时的身高和体重计算。随着体重的增加，急性肾损伤的患病率显著增加（p=0.01）。与体重指数正常的患者相比，肥胖和重度肥胖患者发生急性肾损伤的几率增加了一倍，调整了急性肾损伤的预测因素（年龄、糖尿病、急性生理学和慢性健康评估 III、误吸、血管加压素使用和血小板减少症[血小板计数≤80,000/ mm]）。调整相同的预测因素后，体重指数与急性肾损伤显著相关（体重指数每增加 5kg/m，比值比（adj）为 1.20，95%置信区间为 1.07-1.33）。在多变量分析中，急性肾损伤与急性呼吸窘迫综合征死亡率增加相关（比值比（adj）为 2.76，95%置信区间为 1.72-4.42），而体重指数与死亡率降低相关（体重指数每增加 5kg/m，比值比（adj）为 0.81，95%置信区间为 0.71-0.93），调整死亡率预测因素后。
在急性呼吸窘迫综合征患者中，肥胖与急性肾损伤的发展有关，这不能完全用疾病严重程度或休克来解释。尽管体重指数增加与死亡率降低相关，但即使调整体重指数后，急性肾损伤仍与更高的死亡率相关。
