肥胖与 2019 冠状病毒病患者插管或死亡的风险。
Obesity and the Risk of Intubation or Death in Patients With Coronavirus Disease 2019.
机构信息
Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA.
Department of Medicine, Massachusetts General Hospital, Boston, MA.
出版信息
Crit Care Med. 2020 Nov;48(11):e1097-e1101. doi: 10.1097/CCM.0000000000004553.
OBJECTIVES
To characterize the impact of obesity on disease severity in patients with coronavirus disease 2019.
DESIGN
This was a retrospective cohort study designed to evaluate the association between body mass index and risk of severe disease in patients with coronavirus disease 2019. Data were abstracted from the electronic health record. The primary endpoint was a composite of intubation or death.
SETTING
Two hospitals in Massachusetts (one quaternary referral center and one affiliated community hospital).
PATIENTS
Consecutive patients hospitalized with confirmed coronavirus disease 2019 admitted between March 13, 2020, and April 3, 2020.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
A total of 305 patients were included in this study. We stratified patients by body mass index category: < 25 kg/m (54 patients, 18%), ≥ 25 kg/m to < 30 kg/m (124 patients, 41%), ≥ 30 kg/m to < 35 kg/m (58 patients, 19%), and ≥ 35 kg/m (69 patients, 23%). In total, 128 patients (42%) had a primary endpoint (119 patients [39%] were intubated and nine died [3%] without intubation). Sixty-five patients (51%) with body mass index greater than or equal to 30 kg/m were intubated or died. Adjusted Cox models demonstrated that body mass index greater than or equal to 30 kg/m was associated with a 2.3-fold increased risk of intubation or death (95% CI, 1.2-4.3) compared with individuals with body mass index less than 25 kg/m. Diabetes was also independently associated with risk of intubation or death (hazard ratio, 1.8; 95% CI, 1.2-2.7). Fifty-six out of 127 patients (44%) with body mass index greater than or equal to 30 kg/m had diabetes, and the combination of both diabetes and body mass index greater than or equal to 30 kg/m was associated with a 4.5-fold increased risk of intubation or death (95% CI, 2.0-10.2) compared with patients without diabetes and body mass index less than 25 kg/m.
CONCLUSIONS
Among consecutive patients hospitalized with coronavirus disease 2019, obesity was an independent risk factor for intubation or death.
目的
描述肥胖对 2019 冠状病毒病患者疾病严重程度的影响。
设计
本研究是一项回顾性队列研究，旨在评估体重指数与 2019 冠状病毒病患者发生严重疾病的风险之间的关系。数据从电子健康记录中提取。主要终点是插管或死亡的复合终点。
地点
马萨诸塞州的两家医院（一家四级转诊中心和一家附属社区医院）。
患者
2020 年 3 月 13 日至 4 月 3 日期间连续住院的确诊 2019 冠状病毒病患者。
干预措施
无。
测量和主要结果
这项研究共纳入 305 例患者。我们按体重指数类别对患者进行分层：<25kg/m（54 例，18%）、≥25kg/m 至<30kg/m（124 例，41%）、≥30kg/m 至<35kg/m（58 例，19%）和≥35kg/m（69 例，23%）。共有 128 例患者（42%）出现主要终点（119 例患者[39%]接受插管治疗，9 例死亡[3%]未接受插管治疗）。65 例（51%）体重指数大于或等于 30kg/m 的患者接受了插管或死亡。校正后的 Cox 模型显示，体重指数大于或等于 30kg/m 与插管或死亡的风险增加 2.3 倍相关（95%CI，1.2-4.3），与体重指数<25kg/m 的患者相比。糖尿病也与插管或死亡的风险独立相关（危险比，1.8；95%CI，1.2-2.7）。127 例体重指数大于或等于 30kg/m 的患者中有 56 例患有糖尿病，糖尿病和体重指数大于或等于 30kg/m 的组合与插管或死亡的风险增加 4.5 倍相关（95%CI，2.0-10.2）相比，无糖尿病和体重指数<25kg/m 的患者。
结论
在连续住院的 2019 冠状病毒病患者中，肥胖是插管或死亡的独立危险因素。
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