Departments of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
Departments of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, 37 Gue Xue Xiang, Chengdu, 610041, Sichuan, China.
Crit Care. 2017 Feb 22;21(1):36. doi: 10.1186/s13054-017-1615-3.
The effects of body mass index (BMI) on the prognosis of acute respiratory distress syndrome (ARDS) are controversial. We aimed to further determine the relationship between BMI and the acute outcomes of patients with ARDS.
We searched the Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and ISI Web of Science for trials published between 1946 and July 2016, using "BMI" or "body mass index" or "overweight" or "obese" and "ARDS" or "ALI" or "acute respiratory distress syndrome" or "acute lung injury", without limitations on publication type or language. Heterogeneity and sensitivity analyses were conducted, and a random-effects model was applied to calculate the odds ratio (OR) or mean difference (MD). Review Manager (RevMan) was used to test the hypothesis using the Mann-Whitney U test. The primary outcome was unadjusted mortality, and secondary outcomes included mechanical ventilation (MV)-free days and length of stay (LOS) in the intensive care unit (ICU) and in hospital.
Five trials with a total of 6268 patients were pooled in our final analysis. There was statistical heterogeneity between normal-weight and overweight patients in LOS in the ICU (I = 71%, χ = 10.27, P = 0.02) and in MV-free days (I = 89%, χ = 18.45, P < 0.0001). Compared with normal weight, being underweight was associated with higher mortality (OR 1.59, 95% confidence interval (CI) 1.22, 2.08, P = 0.0006), while obesity and morbid obesity were more likely to result in lower mortality (OR 0.68, 95% CI 0.57, 0.80, P < 0.00001; OR 0.72, 95% CI 0.56, 0.93, P = 0.01). MV-free days were much longer in patients with morbid obesity (MD 2.64, 95% CI 0.60, 4.67, P = 0.01), but ICU and hospital LOS were not influenced by BMI. An important limitation of our analysis is the lack of adjustment for age, sex, illness severity, comorbid illness, and interaction of outcome parameters.
Obesity and morbid obesity are associated with lower mortality in patients with ARDS.
体重指数（BMI）对急性呼吸窘迫综合征（ARDS）预后的影响存在争议。我们旨在进一步确定 BMI 与 ARDS 患者急性结局之间的关系。
我们检索了 1946 年至 2016 年 7 月期间发表的 Pubmed、Embase、Medline、Cochrane 对照试验中心注册库（CENTRAL）和 ISI Web of Science 中的试验，使用“BMI”或“体重指数”或“超重”或“肥胖”和“ARDS”或“ALI”或“急性呼吸窘迫综合征”或“急性肺损伤”，对发表类型或语言没有限制。进行了异质性和敏感性分析，并应用随机效应模型计算比值比（OR）或均数差（MD）。使用 Review Manager（RevMan）使用 Mann-Whitney U 检验检验假设。主要结局为未调整的死亡率，次要结局包括机械通气（MV）无天数和 ICU 及住院的住院时间（LOS）。
共有 5 项试验，共纳入 6268 例患者，最终纳入我们的分析。在 ICU 中 LOS（I²=71%，χ²=10.27，P=0.02）和 MV 无天数（I²=89%，χ²=18.45，P<0.0001）方面，正常体重和超重患者之间存在统计学异质性。与正常体重相比，体重不足与死亡率升高相关（OR 1.59，95%置信区间（CI）1.22-2.08，P=0.0006），而肥胖和病态肥胖更可能导致死亡率降低（OR 0.68，95%CI 0.57-0.80，P<0.00001；OR 0.72，95%CI 0.56-0.93，P=0.01）。病态肥胖患者的 MV 无天数明显更长（MD 2.64，95%CI 0.60-4.67，P=0.01），但 BMI 对 ICU 和住院 LOS 没有影响。我们分析的一个重要局限性是缺乏对年龄、性别、疾病严重程度、合并症和结局参数相互作用的调整。
肥胖和病态肥胖与 ARDS 患者的死亡率降低相关。
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