Williams Paul T
Donner Laboratory, Life Sciences Division, Ernest Orlando Lawrence Berkeley National Laboratory, Berkeley, California, United States of America.
PLoS One. 2013 Dec 4;8(12):e79344. doi: 10.1371/journal.pone.0079344. eCollection 2013.
Test whether inadequate exercise is related to sepsis mortality.
Mortality surveillance of an epidemiological cohort of 155,484 National Walkers' and Runners' Health Study participants residing in the United States. Deaths were monitored for an average of 11.6-years using the National Death index through December 31, 2008. Cox proportional hazard analyses were used to compare sepsis mortality (ICD-10 A40-41) to inadequate exercise (<1.07 METh/d run or walked) as measured on their baseline questionnaires. Deaths occurring within one year of the baseline survey were excluded.
Sepsis was the underlying cause in 54 deaths (sepsis(underlying)) and a contributing cause in 184 deaths (sepsis(contributing)), or 238 total sepsis-related deaths (sepsis(total)). Inadequate exercise was associated with 2.24-fold increased risk for sepsis(underlying) (95%CI: 1.21 to 4.07-fold, P = 0.01), 2.11-fold increased risk for sepsis(contributing) (95%CI: 1.51- to 2.92-fold, P<10(-4)), and 2.13-fold increased risk for sepsis(total) (95%CI: 1.59- to 2.84-fold, P<10(-6)) when adjusted for age, sex, race, and cohort. The risk increase did not differ significantly between runners and walkers, by sex, or by age. Sepsis(total) risk was greater in diabetics (P = 10(-5)), cancer survivors (P = 0.0001), and heart attack survivors (P = 0.003) and increased with waist circumference (P = 0.0004). The sepsis(total) risk associated with inadequate exercise persisted when further adjusted for diabetes, prior cancer, prior heart attack and waist circumference, and when excluding deaths with cancer, or cardiovascular, respiratory, or genitourinary disease as the underlying cause. Inadequate exercise also increased sepsis(total) risk in 2163 baseline diabetics (4.78-fold, 95%CI: 2.1- to 13.8-fold, P = 0.0001) when adjusted, which was significantly greater (P = 0.03) than the adjusted risk increase in non-diabetics (1.80-fold, 95%CI: 1.30- to 2.46-fold, P = 0.0006).
Inadequate exercise is a risk factor for sepsis mortality, particular in diabetics.
测试运动不足是否与脓毒症死亡率相关。
对居住在美国的155484名国家步行者和跑步者健康研究参与者的流行病学队列进行死亡率监测。通过国家死亡指数对死亡情况进行了平均11.6年的监测，直至2008年12月31日。使用Cox比例风险分析，将脓毒症死亡率（国际疾病分类第十版A40 - 41）与基线问卷中测量的运动不足（每天跑步或步行<1.07代谢当量）进行比较。排除基线调查后一年内发生的死亡病例。
脓毒症是54例死亡的根本原因（脓毒症（根本原因）），是184例死亡的促成原因（脓毒症（促成原因）），总计238例与脓毒症相关的死亡（脓毒症（总计））。在对年龄、性别、种族和队列进行调整后，运动不足与脓毒症（根本原因）风险增加2.24倍相关（95%置信区间：1.21至4.07倍，P = 0.01），与脓毒症（促成原因）风险增加2.11倍相关（95%置信区间：1.51至2.92倍，P<10⁻⁴），与脓毒症（总计）风险增加2.13倍相关（95%置信区间：1.59至2.84倍，P<10⁻⁶）。跑步者和步行者之间、按性别或按年龄划分，风险增加没有显著差异。糖尿病患者（P = 10⁻⁵）、癌症幸存者（P = 0.0001）和心脏病发作幸存者（P = 0.003）的脓毒症（总计）风险更高，且随腰围增加而增加（P = 0.0004）。在进一步对糖尿病、既往癌症、既往心脏病发作和腰围进行调整后，以及在排除以癌症、心血管、呼吸或泌尿生殖系统疾病为根本原因的死亡病例后，与运动不足相关的脓毒症（总计）风险仍然存在。在对2163名基线糖尿病患者进行调整后，运动不足也增加了脓毒症（总计）风险（4.78倍，95%置信区间：2.1至13.8倍，P = 0.0001），这显著高于非糖尿病患者调整后的风险增加（1.80倍，95%置信区间：1.30至2.46倍，P = 0.0006）（P = 0.03）。
运动不足是脓毒症死亡率的一个风险因素，尤其在糖尿病患者中。
