Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
Mayo Clin Proc. 2019 Oct;94(10):1960-1973. doi: 10.1016/j.mayocp.2019.04.035.
To investigate the impact of obesity and underweight on adverse in-hospital outcomes in pulmonary embolism (PE).
Patients diagnosed as having PE based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification code I26 in the German nationwide inpatient database were stratified for obesity, underweight, and normal weight/overweight (reference group) and compared regarding adverse in-hospital outcomes.
From January 1, 2011, through December 31, 2014, 345,831 inpatients (53.3% females) 18 years and older were included in this analysis; 8.6% were obese and 0.5% were underweight. Obese patients were younger (67.0 vs 73.0 years), were more frequently female (60.2% vs 52.7%), had a lower cancer rate (13.6% vs 20.5%), and were more often treated with systemic thrombolysis (6.4% vs 4.3%) and surgical embolectomy (0.3% vs 0.1%) vs the reference group (P<.001 for all). Overall, 51,226 patients (14.8%) died during in-hospital stay. Obese patients had lower mortality (10.9% vs 15.2%; P<.001) vs the reference group and a reduced odds ratio (OR) for in-hospital mortality (OR, 0.74; 95% CI, 0.71-0.77; P<.001) independent of age, sex, comorbidities, and reperfusion therapies. This survival benefit of obese patients was more pronounced in obesity classes I (OR, 0.56; 95% CI, 0.52-0.60; P<.001) and II (OR, 0.63; 95% CI 0.58-0.69; P<.001). Underweight patients had higher prevalence of cancer and higher mortality rates (OR, 1.15; 95% CI, 1.00-1.31; P=.04).
Obesity is associated with decreased in-hospital mortality rates in patients with PE. Although obese patients were more often treated with reperfusion therapies, the survival benefit of obese patients occurred independently of age, sex, comorbidities, and reperfusion treatment.
探讨肥胖和体重不足对肺栓塞（PE）住院不良结局的影响。
本研究纳入了德国全国住院患者数据库中根据国际疾病分类第十版德国修订版 I26 代码诊断为 PE 的患者，将其分为肥胖、体重不足和正常体重/超重（参考组），并比较了住院不良结局。
2011 年 1 月 1 日至 2014 年 12 月 31 日，共纳入 345831 名 18 岁及以上的住院患者（53.3%为女性）；其中 8.6%为肥胖患者，0.5%为体重不足患者。肥胖患者年龄较小（67.0 岁 vs 73.0 岁），女性更多（60.2% vs 52.7%），癌症发生率较低（13.6% vs 20.5%），更常接受全身溶栓治疗（6.4% vs 4.3%）和手术取栓治疗（0.3% vs 0.1%）。总的来说，51226 名患者（14.8%）在住院期间死亡。肥胖患者的死亡率较低（10.9% vs 15.2%；P<.001），与参考组相比，住院死亡率的比值比（OR）降低（OR，0.74；95%置信区间，0.71-0.77；P<.001），且独立于年龄、性别、合并症和再灌注治疗。肥胖患者的这种生存获益在肥胖 I 级（OR，0.56；95%置信区间，0.52-0.60；P<.001）和 II 级（OR，0.63；95%置信区间，0.58-0.69；P<.001）更为显著。体重不足患者癌症发生率较高，死亡率较高（OR，1.15；95%置信区间，1.00-1.31；P=.04）。
肥胖与 PE 患者住院死亡率降低相关。尽管肥胖患者更常接受再灌注治疗，但肥胖患者的生存获益独立于年龄、性别、合并症和再灌注治疗。
