腹腔脓毒症危重症患者肌少症性肥胖对 30 天死亡率的影响。
Impact of sarcopenic obesity on 30-day mortality in critically ill patients with intra-abdominal sepsis.
机构信息
Surgical Intensive Care Unit, Department of General Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, China, 310009; Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, China, 310003.
Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, China, 310003.
出版信息
J Crit Care. 2018 Aug;46:50-54. doi: 10.1016/j.jcrc.2018.03.019. Epub 2018 Mar 16.
PURPOSE
This study aimed to investigate the association between sarcopenic obesity and 30-day mortality in critically ill patients with intra-abdominal sepsis.
MATERIAL AND METHODS
We analyzed 236 surgical ICU patients with sepsis due to intra-abdominal infection who underwent urgent surgical intervention. Sarcopenia, visceral obesity and sarcopenic obesity were analyzed by computed tomography scans using the third lumbar vertebrae skeletal muscle index and visceral adipose tissue area, using previously reported cutoff values.
RESULTS
The cohort was divided into 4 groups: 52 were diagnosed with sarcopenic obesity, 62 with sarcopenia only, 58 with visceral obesity only, and 64 with no sarcopenia or visceral obesity. 57 (24.2%) patients died within 30days. The frequency of 30-day mortality differed significantly among the groups. Multivariate analysis showed that only sarcopenic obesity was associated with increased risk for 30-day mortality. Sarcopenic patients were older than non-sarcopenic patients. To address this limitation, subgroup analyses stratified by age showed that the risk of 30-day mortality increased significantly in sarcopenic patients, both in patients with age≤70years and in those with age >70years.
CONCLUSION
Sarcopenic obesity is an independent risk factor for 30-day mortality in critically ill patients with intra-abdominal sepsis.
目的
本研究旨在探讨腹腔内感染导致脓毒症的危重症患者中，肌肉减少性肥胖与 30 天死亡率之间的关系。
材料和方法
我们分析了 236 例因腹腔内感染而行紧急外科手术干预的外科重症监护病房脓毒症患者。通过使用第 3 腰椎骨骼肌指数和内脏脂肪组织面积的计算机断层扫描，采用先前报道的临界值分析肌肉减少症、内脏肥胖和肌肉减少性肥胖。
结果
该队列分为 4 组：52 例诊断为肌肉减少性肥胖，62 例仅为肌肉减少症，58 例仅为内脏肥胖，64 例无肌肉减少症或内脏肥胖。57 例（24.2%）患者在 30 天内死亡。各组的 30 天死亡率差异有统计学意义。多变量分析显示，只有肌肉减少性肥胖与 30 天死亡率增加相关。肌肉减少症患者比非肌肉减少症患者年龄更大。为了解决这一局限性，按年龄分层的亚组分析显示，30 天死亡率在肌肉减少症患者中显著增加，无论年龄≤70 岁还是年龄>70 岁。
结论
肌肉减少性肥胖是腹腔内感染导致脓毒症的危重症患者 30 天死亡率的独立危险因素。
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