Mukhopadhyay Amartya, Kowitlawakul Yanika, Henry Jeyakumar, Ong Venetia, Leong Claudia Shu-Fen, Tai Bee Choo
Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System and National University of Singapore, Singapore.
Alice Lee Centre for Nursing Studies, National University Health System and National University of Singapore, Singapore.
Clin Nutr ESPEN. 2018 Dec;28:165-170. doi: 10.1016/j.clnesp.2018.08.009. Epub 2018 Sep 27.
BACKGROUND & AIMS: Asians with similar body mass index (BMI) as the Caucasians are at higher health risk as compared to their counterparts. Although the mean weight of patients admitted to the intensive care unit (ICU) is increasing but the relation between BMI with 28-day mortality and length of stay (LOS) following ICU discharge in Asian patients is not well studied.
We included all adult patients admitted to the ICU of a tertiary hospital who received mechanical ventilation (MV) for at least 48 hours between October 2013 and September 2014. Demographics, BMI, MV, comorbidities, ICU scores (Acute Physiology And Chronic Health Evaluation (APACHE) II and sequential organ failure assessment (SOFA)), use of vasopressor, renal replacement therapy and calorie supplementation were collected from the ICU database. BMI was categorized into four groups according to the World Health Organization's Asian BMI recommendation. Post-ICU LOS (days) was calculated from ICU discharge to hospital discharge in hospital survivors. We used multivariable logistic regression to identify factors associated with 28-day mortality and post-ICU LOS of more than 7 days.
In a cohort of 273 patients (male 62%, mean age 58.4 ± 17 years), the prevalence of overweight/obesity was 53%. In the bivariate analysis, 28-day mortality was lower (p = 0.014) and post-ICU LOS longer (p = 0.01) in the overweight/obese groups. In the multivariable logistic regression analysis, APACHE II (Odds ratio, OR 1.10, CI 1.05-1.16), SOFA (OR 1.17, CI 1.05-1.31), duration of MV (days, OR 1.14, CI 1.05-1.25) were associated with increased and higher BMI groups (p < 0.001) with decreased 28-day mortality. Further analysis of 196 hospital survivors showed age (OR 1.04, CI 1.02-1.06), duration of MV (days, OR 1.14, CI 1.02-1.27) and higher Asian BMI (p = 0.042) were associated with longer post-ICU LOS. The odds of longer post-ICU LOS amongst overweight and obese patients were 1.27 (CI 0.59-2.73) and 1.62 (CI 0.69-3.81) times that of those with normal BMI respectively.
In multiethnic critically ill Asian patients, the prevalence of overweight/obesity was high. Although higher BMI was associated with reduced risk of 28-day mortality, obese patients stayed significantly longer in the hospital following ICU discharge.
与白种人相比，体重指数（BMI）相似的亚洲人健康风险更高。尽管重症监护病房（ICU）收治患者的平均体重在增加，但亚洲患者的BMI与28天死亡率及ICU出院后的住院时间（LOS）之间的关系尚未得到充分研究。
我们纳入了2013年10月至2014年9月期间在一家三级医院ICU接受至少48小时机械通气（MV）的所有成年患者。从ICU数据库中收集人口统计学资料、BMI、MV、合并症、ICU评分（急性生理与慢性健康评估（APACHE）II和序贯器官衰竭评估（SOFA））、血管升压药的使用、肾脏替代治疗和热量补充情况。根据世界卫生组织的亚洲BMI推荐将BMI分为四组。医院幸存者的ICU后住院时间（天）从ICU出院计算至出院。我们使用多变量逻辑回归来确定与28天死亡率及ICU后住院时间超过7天相关的因素。
在273例患者队列中（男性占62%，平均年龄58.4±17岁），超重/肥胖患病率为53%。在双变量分析中，超重/肥胖组的28天死亡率较低（p = 0.014），ICU后住院时间较长（p = 0.01）。在多变量逻辑回归分析中，APACHE II（比值比，OR 1.10，CI 1.05 - 1.16）、SOFA（OR 1.17，CI 1.05 - 1.31）、MV持续时间（天，OR 1.14，CI 1.05 - 1.25）与28天死亡率增加相关，而较高的BMI组（p < 0.001）死亡率降低。对196例医院幸存者的进一步分析显示，年龄（OR 1.04，CI 1.02 - 1.06）、MV持续时间（天，OR 1.14，CI 1.02 - 1.27）和较高的亚洲BMI（p = 0.042）与ICU后住院时间较长相关。超重和肥胖患者ICU后住院时间较长的几率分别是BMI正常患者的1.27（CI 0.59 - 2.73）倍和1.62（CI 0.69 - 3.81）倍。
在多民族危重症亚洲患者中，超重/肥胖患病率较高。尽管较高的BMI与28天死亡率风险降低相关，但肥胖患者在ICU出院后在医院停留的时间明显更长。
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