超重与 ICU 患者的存活率增加相关：来自重症监护多国审计的结果。

Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit.

机构信息

1Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany. 2Department of Medicine, Medical College of Wisconsin, Milwaukee, WI. 3Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 4Intensive Care Unit, Santa Maria degli Angeli, Pordenone, Italy. 5Critical Care Department, Cliniques Universitaires St Luc, UCL, Brussels, Belgium. 6St. James's University Hospitals, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Center for Health Sciences, Dublin, Ireland. 7Critical Care Center, Corporacion Sanitaria Parc Taulí, CIBER Enfermedades Respiratorias, Parc Tauli, University Institute, Sabadell, Spain. 8Service de Réanimation Polyvalente, CHU Dupuytren, Limoges cedex, France. 9Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France. 10Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.

出版信息

Crit Care Med. 2015 Dec;43(12):2623-32. doi: 10.1097/CCM.0000000000001310.

DOI:10.1097/CCM.0000000000001310

PMID:26427591

Abstract

OBJECTIVE

To assess the effect of body mass index on ICU outcome and on the development of ICU-acquired infection.

DESIGN

A substudy of the Intensive Care Over Nations audit.

SETTING

Seven hundred thirty ICUs in 84 countries.

PATIENTS

All adult ICU patients admitted between May 8 and 18, 2012, except those admitted for less than 24 hours for routine postoperative monitoring (n = 10,069). In this subanalysis, only patients with complete data on height and weight (measured or estimated) on ICU admission in order to calculate the body mass index were included (n = 8,829).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Underweight was defined as body mass index less than 18.5 kg/m, normal weight as body mass index 18.5-24.9 kg/m, overweight as body mass index 25-29.9 kg/m, obese as body mass index 30-39.9 kg/m, and morbidly obese as body mass index greater than or equal to 40 kg/m. The mean body mass index was 26.4 ± 6.5 kg/m. The ICU length of stay was similar among categories, but overweight and obese patients had longer hospital lengths of stay than patients with normal body mass index (10 [interquartile range, 5-21] and 11 [5-21] vs 9 [4-19] d; p < 0.01 pairwise). ICU mortality was lower in morbidly obese than in normal body mass index patients (11.2% vs 16.6%; p = 0.015). In-hospital mortality was lower in morbidly obese and overweight patients and higher in underweight patients than in those with normal body mass index. In a multilevel Cox proportional hazard analysis, underweight was independently associated with a higher hazard of 60-day in-hospital death (hazard ratio, 1.32; 95% CI, 1.05-1.65; p = 0.018), whereas overweight was associated with a lower hazard (hazard ratio, 0.79; 95% CI, 0.71-0.89; p < 0.001). No body mass index category was associated with an increased hazard of ICU-acquired infection.

CONCLUSIONS

In this large cohort of critically ill patients, underweight was independently associated with a higher hazard of 60-day in-hospital death and overweight with a lower hazard. None of the body mass index categories as independently associated with an increased hazard of infection during the ICU stay.

摘要

目的

评估体重指数对 ICU 结局和 ICU 获得性感染的影响。

设计

Intensive Care Over Nations 审计的子研究。

设置

84 个国家的 730 个 ICU。

患者

2012 年 5 月 8 日至 18 日入住的所有成年 ICU 患者，除外因常规术后监测而入住不足 24 小时的患者（n = 10069）。在本次亚分析中，仅纳入了在 ICU 入院时具有完整身高和体重数据（测量或估计）以计算体重指数的患者（n = 8829）。

干预

无。

测量和主要结果

体重不足定义为体重指数<18.5kg/m，正常体重定义为体重指数 18.5-24.9kg/m，超重定义为体重指数 25-29.9kg/m，肥胖定义为体重指数 30-39.9kg/m，病态肥胖定义为体重指数≥40kg/m。平均体重指数为 26.4±6.5kg/m。各分类的 ICU 住院时间相似，但超重和肥胖患者的住院时间长于正常体重指数患者（10[四分位距，5-21]和 11[5-21]与 9[4-19]d；p<0.01 两两比较）。病态肥胖患者的 ICU 死亡率低于正常体重指数患者（11.2%比 16.6%；p=0.015）。住院死亡率在病态肥胖和超重患者中较低，在体重不足患者中较高，高于正常体重指数患者。在多水平 Cox 比例风险分析中，体重不足与 60 天院内死亡的风险增加独立相关（风险比，1.32；95%CI，1.05-1.65；p=0.018），而超重与风险降低相关（风险比，0.79；95%CI，0.71-0.89；p<0.001）。没有体重指数类别与 ICU 获得性感染的风险增加相关。