城市内医疗服务提供机构中肥胖的新冠患者的临床转归和炎症标志物水平。
Clinical outcomes and inflammatory marker levels in patients with Covid-19 and obesity at an inner-city safety net hospital.
机构信息
Department of Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts, United States of America.
Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts, United States of America.
出版信息
PLoS One. 2020 Dec 16;15(12):e0243888. doi: 10.1371/journal.pone.0243888. eCollection 2020.
OBJECTIVES
Patients with Covid-19 and obesity have worse clinical outcomes which may be driven by increased inflammation. This study aimed to characterize the association between clinical outcomes in patients with obesity and inflammatory markers.
METHODS
We analyzed data for patients aged ≥18 years admitted with a positive SARS-CoV-2 PCR test. We used multivariate logistic regression to determine the association between BMI and intensive care unit (ICU) transfer and all-cause mortality. Inflammatory markers (C-reactive protein [CRP], lactate dehydrogenase [LDH], ferritin, and D-dimer) were compared between patients with and without obesity (body mass index [BMI] ≥30 kg/m2).
RESULTS
Of 791 patients with Covid-19, 361 (45.6%) had obesity. In multivariate analyses, BMI ≥35 was associated with a higher odds of ICU transfer (adjusted odds ratio [aOR] 2.388 (95% confidence interval [CI]: 1.074-5.310) and hospital mortality (aOR = 4.3, 95% CI: 1.69-10.82). Compared to those with BMI<30, patients with obesity had lower ferritin (444 vs 637 ng/mL; p<0.001) and lower D-dimer (293 vs 350 mcg/mL; p = 0.009), non-significant differences in CRP (72.8 vs 84.1 mg/L, p = 0.099), and higher LDH (375 vs 340, p = 0.009) on the first hospital day.
CONCLUSIONS
Patients with obesity were more likely to have poor outcomes even without increased inflammation.
目的
患有新冠肺炎和肥胖症的患者临床结局更差，这可能是由炎症增加引起的。本研究旨在描述肥胖患者的临床结局与炎症标志物之间的关联。
方法
我们分析了年龄≥18 岁并经 SARS-CoV-2 PCR 检测呈阳性的患者数据。我们使用多变量逻辑回归来确定 BMI 与重症监护病房（ICU）转科和全因死亡率之间的关系。比较了肥胖症患者（BMI≥30kg/m2）与非肥胖症患者之间的炎症标志物（C 反应蛋白[CRP]、乳酸脱氢酶[LDH]、铁蛋白和 D-二聚体）。
结果
在 791 例新冠肺炎患者中，有 361 例（45.6%）患有肥胖症。在多变量分析中，BMI≥35 与 ICU 转科的几率更高相关（调整后的优势比[aOR]为 2.388（95%置信区间[CI]：1.074-5.310）和医院死亡率（aOR=4.3，95%CI：1.69-10.82）。与 BMI<30 的患者相比，肥胖症患者的铁蛋白（444 vs 637ng/mL；p<0.001）和 D-二聚体（293 vs 350mcg/mL；p=0.009）更低，C 反应蛋白（72.8 vs 84.1mg/L，p=0.099）无显著差异，乳酸脱氢酶（375 vs 340，p=0.009）更高，入院第一天。
结论
即使没有炎症增加，肥胖症患者的预后也更差。
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