体外膜肺氧合支持下肺炎患者的肥胖生存悖论：全国登记分析。

Obesity survival paradox in pneumonia supported with extracorporeal membrane oxygenation: Analysis of the national registry.

机构信息

Department of Pulmonology and Critical Care Medicine, Pusan National University Yangsan Hospital, Republic of Korea.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Republic of Korea.

出版信息

J Crit Care. 2018 Dec;48:453-457. doi: 10.1016/j.jcrc.2018.08.003.

DOI:10.1016/j.jcrc.2018.08.003

PMID:30409352

Abstract

PURPOSE

To investigate whether the obesity survival paradox, where obesity is associated with improved survival, exists for pneumonia supported with extracorporeal membrane oxygenation (ECMO).

MATERIALS AND METHODS

Between January 2014 and December 2015, 223 patients with acute respiratory failure who underwent ECMO in 11 hospitals in South Korea were enrolled retrospectively, and data relating to pneumonia cases were analyzed. Patients were divided into groups according to their pre-treatment body mass index (BMI): obese (BMI ≥ 25 kg/m) and non-obese (BMI < 25 kg/m). The BMI cut-off was adopted from the World Health Organization for Asian populations.

RESULTS

In total, 84 patients had pneumonia: obese group, 26; non-obese group, 58 (mean BMI, 27.8 vs. 21.4, p < 0.001). Pre-ECMO parameters and rescue therapy did not differ between the groups. The rate of successful weaning from ECMO was not different between the groups (76.9% vs. 72.4%, p = 0.753), but survival-to-discharge (73.1% vs. 36.2%, p = 0.002) and 6-month survival (69.2% vs. 36.2%, p = 0.005) rates were higher in the obese group. After adjusting for age and the pre-treatment PaO/FiO ratio, low BMI was significantly associated with 6-month mortality (odds ratio 3.28, 95% confidence interval: 1.06-11.03, p = 0.044).

CONCLUSIONS

An obesity survival paradox exists in pneumonia supported with ECMO.

摘要

目的

探讨体外膜肺氧合（ECMO）支持下肺炎患者的肥胖生存悖论是否存在，即肥胖与改善生存相关。

材料和方法

回顾性纳入 2014 年 1 月至 2015 年 12 月期间韩国 11 家医院接受 ECMO 的 223 例急性呼吸衰竭患者，并分析与肺炎病例相关的数据。根据治疗前体重指数（BMI）将患者分为肥胖组（BMI≥25kg/m²）和非肥胖组（BMI<25kg/m²）：肥胖组 26 例，非肥胖组 58 例（平均 BMI 分别为 27.8 和 21.4，p<0.001）。BMI 截止值采用世界卫生组织针对亚洲人群的标准。

结果

共有 84 例患者患有肺炎：肥胖组 26 例，非肥胖组 58 例（平均 BMI 分别为 27.8 和 21.4，p<0.001）。两组患者的 ECMO 前参数和抢救治疗无差异。两组 ECMO 成功撤机率无差异（76.9% vs. 72.4%，p=0.753），但存活出院率（73.1% vs. 36.2%，p=0.002）和 6 个月存活率（69.2% vs. 36.2%，p=0.005）较高。在校正年龄和 ECMO 前 PaO/FiO 比值后，低 BMI 与 6 个月死亡率显著相关（优势比 3.28，95%置信区间：1.06-11.03，p=0.044）。