Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China.
Biomed Res Int. 2020 Oct 15;2020:5781913. doi: 10.1155/2020/5781913. eCollection 2020.
Obesity is now recognized as one of the major public health threats, especially for patients with a critical illness. However, studies regarding whether and how body mass index (BMI) affects clinical outcomes in patients with sepsis are still scarce and controversial. The aim of our study was to determine the effect of BMI on critically ill patients with sepsis.
We performed this study using data from the Medical Information Center for Intensive Care III database. A multivariate Cox regression model was used to assess the independent association of BMI with the primary outcome.
A total of 7,967 patients were enrolled in this study. Firstly, we found that the 28-day mortality was reduced by 22% (HR = 0.78, 95% CI 0.69-0.88) and 13% (HR = 0.87, 95% CI 0.78-0.98) for obese and overweight compared to normal weight, respectively. Subsequently, a U-shaped association of BMI with 28-day mortality was observed in sepsis patients, with the lowest 28-day mortality at the BMI range of 30-40 kg/m. Finally, significant interactions were observed only for sex ( = 0.0071). Male patients with a BMI of 25-30 kg/m (HR = 0.74, 95% CI 0.63-0.86) and 30-40 kg/m (HR = 0.63, 95% CI 0.53-0.76) had a significantly lower risk of 28-day mortality.
A U-shaped association of BMI with 28-day mortality in critically ill sepsis patients was found, with the lowest 28-day mortality at a BMI range of 30-40 kg/m. Notably, male patients were protected by a higher BMI more effectively than female patients as males had a significantly lower mortality risk.
肥胖现已被视为主要公共健康威胁之一，尤其是对危重症患者而言。然而，关于体重指数（BMI）是否以及如何影响脓毒症患者的临床结局的研究仍然很少且存在争议。本研究旨在确定 BMI 对脓毒症危重症患者的影响。
我们使用来自医疗信息中心重症监护 III 数据库的数据进行了这项研究。采用多变量 Cox 回归模型评估 BMI 与主要结局的独立相关性。
共纳入 7967 例患者。首先，我们发现肥胖和超重患者的 28 天死亡率分别降低了 22%（HR=0.78，95%CI 0.69-0.88）和 13%（HR=0.87，95%CI 0.78-0.98）。随后，脓毒症患者的 BMI 与 28 天死亡率呈 U 型关联，BMI 在 30-40kg/m 范围内的 28 天死亡率最低。最后，仅观察到性别存在显著交互作用（=0.0071）。BMI 为 25-30kg/m（HR=0.74，95%CI 0.63-0.86）和 30-40kg/m（HR=0.63，95%CI 0.53-0.76）的男性患者 28 天死亡率显著降低。
危重症脓毒症患者的 BMI 与 28 天死亡率呈 U 型关联，BMI 在 30-40kg/m 范围内的 28 天死亡率最低。值得注意的是，与女性患者相比，男性患者的 BMI 越高，保护作用越明显，死亡率风险显著降低。
