Dept of Infection and Immunity, Imperial College, London, UK.
Eur Respir J. 2013 Jul;42(1):180-7. doi: 10.1183/09031936.00115312. Epub 2012 Dec 6.
Obesity has been identified as a risk factor for adverse outcomes of 2009 H1N1 influenza. However, the impact of obesity on outcomes of infection remains controversial. There are limited data investigating the effect of obesity on outcomes of community-acquired pneumonia (CAP). This prospective observational study included patients presenting with CAP who had body mass index (BMI) measured on admission. Outcome measures included 30-day mortality and need for mechanical ventilation or inotropic support (MV/IS). 1079 patients were included, with 21% classified as obese (BMI ≥30 kg·m(-2)). Obesity was independently associated with reduced 30-day mortality from CAP on multivariate analysis (HR 0.53, 95% CI 0.29-0.98). This was not explained by differences in severity of disease on admission or requirement for MV/IS between obese and nonobese groups. Obese patients had higher median C-reactive protein levels and a higher frequency of sepsis using the systemic inflammatory response syndrome criteria (72.4% versus 64.1%; p=0.03), than nonobese patients, suggesting greater systemic inflammation. Obesity was associated with reduced 30-day mortality in patients hospitalised with CAP.
肥胖已被确定为 2009 年 H1N1 流感不良结局的一个危险因素。然而，肥胖对感染结局的影响仍存在争议。关于肥胖对社区获得性肺炎（CAP）结局影响的研究数据有限。本前瞻性观察性研究纳入了入院时测量体重指数（BMI）的 CAP 患者。结局指标包括 30 天死亡率和需要机械通气或正性肌力支持（MV/IS）。共纳入 1079 例患者，其中 21%被归类为肥胖（BMI≥30kg·m(-2)）。多变量分析显示，肥胖与 CAP 患者 30 天死亡率降低独立相关（HR 0.53，95%CI 0.29-0.98）。这不能用肥胖和非肥胖组入院时疾病严重程度或需要 MV/IS 的差异来解释。与非肥胖患者相比，肥胖患者的 C 反应蛋白水平中位数更高，且符合全身炎症反应综合征标准的脓毒症发生率更高（72.4%比 64.1%；p=0.03），表明全身炎症反应更严重。肥胖与 CAP 住院患者的 30 天死亡率降低有关。
