Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Ann Am Thorac Soc. 2018 Feb;15(2):184-191. doi: 10.1513/AnnalsATS.201706-485OC.
Obesity is relatively common among individuals with chronic obstructive pulmonary disease (COPD). However, little is known about the association of obesity with severity of acute exacerbation of COPD and in-hospital mortality.
To examine the association of obesity with markers of severity of acute exacerbation of COPD and in-hospital mortality.
This is a population-based, retrospective cohort study using the 2012-2013 State Inpatient Databases of seven U.S. states (Arkansas, Florida, Iowa, Nebraska, New York, Utah, and Washington). We included adults (aged ≥40 yr) hospitalized for acute exacerbation of COPD. Obesity, use of noninvasive positive pressure ventilation (NIPPV), and use of invasive mechanical ventilation were determined by International Classification of Diseases, Ninth Revision codes. To examine associations between obesity and each outcome (NIPPV, invasive mechanical ventilation, hospital length of stay (LOS), and in-hospital mortality), we fit unadjusted and adjusted logistic regression models using generalized estimating equations to account for patient clustering within hospitals. We adjusted for age, sex, race/ethnicity, primary payer, median household income, patient residence, hospitalization year, chronic comorbidities, and hospital state. In the sensitivity analysis, we used stabilized inverse probability weighting to estimate the causal relation of obesity with outcomes in this observational study.
Of 187,647 patients hospitalized for an acute exacerbation of COPD, 17% were obese. Obesity was associated with increased use of both NIPPV (12.0% vs. 6.5%; adjusted odds ratio [OR] = 1.86; 95% confidence interval [CI] = 1.77-1.95; P < 0.001) and invasive mechanical ventilation (3.5% vs. 2.8%; adjusted OR = 1.13; 95% CI = 1.04-1.22; P = 0.003). Similarly, obese patients were more likely to have a hospital LOS of 4 days or longer (57.9% vs. 50.3%; adjusted OR = 1.37; 95% CI = 1.33-1.41; P < 0.001). In contrast, obesity was associated with a lower in-hospital mortality (0.9% vs. 1.4%; unadjusted OR = 0.63; 95% CI = 0.56-0.72; P < 0.001). After adjusting for potential confounders, this association was no longer statistically significant (adjusted OR = 0.86; 95% CI = 0.75-1.00; P = 0.06). Results were similar in sensitivity analyses using stabilized inverse probability weighting.
In this population-based study of adults hospitalized with an acute exacerbation of COPD, obesity was associated with increased use of noninvasive and invasive ventilation, increased hospital LOS, but was not associated with increased in-hospital mortality.
肥胖在慢性阻塞性肺疾病（COPD）患者中较为常见。然而，关于肥胖与 COPD 急性加重严重程度和院内死亡率之间的关联知之甚少。
探讨肥胖与 COPD 急性加重严重程度和院内死亡率标记物之间的关系。
这是一项基于人群的回顾性队列研究，使用了美国七个州（阿肯色州、佛罗里达州、爱荷华州、内布拉斯加州、纽约州、犹他州和华盛顿州）的 2012-2013 年州住院患者数据库。我们纳入了因 COPD 急性加重而住院的成年人（年龄≥40 岁）。肥胖、使用无创正压通气（NIPPV）和使用有创机械通气通过国际疾病分类第九修订版（ICD-9）代码确定。为了研究肥胖与每种结局（NIPPV、有创机械通气、住院时间（LOS）和院内死亡率）之间的关系，我们使用广义估计方程拟合了未经调整和调整后的逻辑回归模型，以解释医院内患者的聚类。我们调整了年龄、性别、种族/民族、主要支付人、中位数家庭收入、患者居住地、住院年份、慢性合并症和医院所在州。在敏感性分析中，我们使用稳定逆概率加权来估计在这项观察性研究中肥胖与结局之间的因果关系。
在因 COPD 急性加重而住院的 187647 名患者中，有 17%为肥胖患者。肥胖与 NIPPV（12.0% vs. 6.5%；调整后的优势比[OR] = 1.86；95%置信区间[CI] = 1.77-1.95；P < 0.001）和有创机械通气（3.5% vs. 2.8%；调整后的 OR = 1.13；95% CI = 1.04-1.22；P = 0.003）的使用率增加有关。同样，肥胖患者的住院时间（LOS）达到或超过 4 天的可能性更高（57.9% vs. 50.3%；调整后的 OR = 1.37；95% CI = 1.33-1.41；P < 0.001）。相比之下，肥胖与院内死亡率降低相关（0.9% vs. 1.4%；未调整的 OR = 0.63；95% CI = 0.56-0.72；P < 0.001）。在调整了潜在混杂因素后，这种关联不再具有统计学意义（调整后的 OR = 0.86；95% CI = 0.75-1.00；P = 0.06）。使用稳定逆概率加权的敏感性分析结果相似。
在这项基于人群的 COPD 急性加重住院成人研究中，肥胖与 NIPPV 和有创通气的使用增加、住院时间延长有关，但与院内死亡率增加无关。
