Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Pediatr Pulmonol. 2018 Apr;53(4):461-466. doi: 10.1002/ppul.23949. Epub 2018 Jan 23.
Associations between weight status and manifestations of respiratory syncytial virus infections remain unclear, especially in infants.
This study investigated the dose-response relationships between weight status and clinical outcomes among infants hospitalized with respiratory syncytial virus infections.
We obtained hospital discharge records for inpatients aged <12 months with diagnoses of bronchitis/pneumonia and respiratory syncytial virus infections, using a Japanese national inpatient database. The patients were classified into underweight, normal-weight, or overweight/obese groups using weight-for-length according to World Health Organization criteria. We compared need for intensive care, 30-day readmission, mean total hospitalization costs, and length of hospital stay across the three groups using multivariable mixed-effects regression models and restricted cubic spline functions.
Overall, 42 698 patients were identified, comprising 3697 underweight, 35 849 normal-weight, 3152 overweight/obese patients. The underweight group had significantly higher risk of intensive care (adjusted odds ratio, 1.35; 95% confidence interval, 1.18-1.82) and longer length of stay (adjusted difference, 0.12 days; 95% confidence interval, 0.04-0.20 days) than the normal-weight group. No significant differences in 30-day readmission or hospitalization costs were observed among the three groups. The lower and upper thresholds for a significant association between weight status and intensive care were weight-for-length z-scores of -0.64 (26th percentile) and 2.08 (98th percentile), respectively.
These findings demonstrate that abnormal weight status is an independent risk factor for greater illness severity among infants hospitalized with respiratory syncytial virus infections.
体重状况与呼吸道合胞病毒感染表现之间的关联尚不清楚，尤其是在婴儿中。
本研究调查了体重状况与因呼吸道合胞病毒感染住院的婴儿临床结局之间的剂量-反应关系。
我们使用日本国家住院患者数据库，获取了年龄<12 个月且患有支气管炎/肺炎和呼吸道合胞病毒感染的住院患者的住院记录。根据世界卫生组织标准，将患者按照体重与身长的比值分为体重不足、正常体重或超重/肥胖组。我们使用多变量混合效应回归模型和限制立方样条函数，比较了三组患者对重症监护的需求、30 天再入院率、平均总住院费用和住院时间。
共纳入 42698 例患者，包括 3697 例体重不足、35849 例正常体重、3152 例超重/肥胖患者。与正常体重组相比，体重不足组接受重症监护的风险显著更高（校正比值比，1.35；95%置信区间，1.18-1.82），住院时间也更长（校正差异，0.12 天；95%置信区间，0.04-0.20 天）。三组间 30 天再入院率或住院费用无显著差异。体重状况与重症监护之间存在显著关联的下限和上限阈值分别为体重与身长比值的 z 分数为-0.64（第 26 百分位数）和 2.08（第 98 百分位数）。
这些发现表明，异常体重状况是因呼吸道合胞病毒感染住院的婴儿疾病严重程度增加的一个独立危险因素。
