基于柏林定义的肥胖与急性呼吸窘迫综合征患者短期和长期死亡率的相关性研究。
Association Between Obesity and Short-And Long-Term Mortality in Patients With Acute Respiratory Distress Syndrome Based on the Berlin Definition.
机构信息
Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China.
Medical Department, Ruibiao (Wuhan) Biotechnology Co. Ltd, Wuhan, China.
出版信息
Front Endocrinol (Lausanne). 2021 Feb 12;11:611435. doi: 10.3389/fendo.2020.611435. eCollection 2020.
PURPOSE
Acute respiratory distress syndrome (ARDS) is one of the most common causes of death in intensive care units (ICU). Previous studies have reported the potential protective effect of obesity on ARDS patients. However, these findings are inconsistent, in which less was reported on long-term prognosis and diagnosed ARDS by Berlin definition. This study aimed to investigate the relationship between obesity and short-term and long-term mortality in patients with ARDS based on the Berlin Definition.
METHODS
This is a retrospective cohort study from the Medical Information Mart for Intensive Care III (MIMIC-III) database, in which all the patients were diagnosed with ARDS according to the Berlin definition. The patients were divided into four groups according to the WHO body mass index (BMI) categories. The multivariable logistic regression and Cox regression analysis were used to investigate the relationship between BMI and short-term and long-term mortality.
RESULT
A total of 2,378 patients with ARDS were enrolled in our study. In-hospital mortality was 27.92%, and 1,036 (43.57%) patients had died after 1-year follow-up. After adjusting for confounders, the in-hospital and 1-year mortality risks of obese patients were significantly lower than those of normal weight (OR 0.72, 95%CI 0.55-0.94, P=0.0168; HR 0.80, 95%CI 0.68-0.94 P=0.0084; respectively), while those mortality risks of underweight patients were higher than normal weight patients (P=0.0102, P=0.0184; respectively). The smooth curve showed that BMI, which was used as a continuous variable, was negatively correlated with in-hospital and 1-year mortality. The results were consistent after being stratified by age, gender, race, type of admission, severity of organ dysfunction, and severity of ARDS. The Kaplan-Meier survival curves showed that obese patients had significant lower 1-year mortality than normal weight patients.
CONCLUSION
We found that obesity was associated with decreased risk of short-term and long-term mortality in patients with ARDS.
目的
急性呼吸窘迫综合征（ARDS）是重症监护病房（ICU）中最常见的死亡原因之一。既往研究报道肥胖对 ARDS 患者具有潜在的保护作用。然而，这些发现并不一致，其中较少报道根据柏林定义诊断的 ARDS 的长期预后。本研究旨在根据柏林定义，探讨肥胖与 ARDS 患者短期和长期死亡率之间的关系。
方法
这是一项来自医疗信息集市重症监护 III 版（MIMIC-III）数据库的回顾性队列研究，其中所有患者均根据柏林定义诊断为 ARDS。患者根据世界卫生组织（WHO）体重指数（BMI）类别分为四组。采用多变量逻辑回归和 Cox 回归分析探讨 BMI 与短期和长期死亡率之间的关系。
结果
共纳入 2378 例 ARDS 患者。院内死亡率为 27.92%，1036 例（43.57%）患者在 1 年随访后死亡。在校正混杂因素后，肥胖患者的院内和 1 年死亡率明显低于正常体重患者（OR 0.72，95%CI 0.55-0.94，P=0.0168；HR 0.80，95%CI 0.68-0.94，P=0.0084），而消瘦患者的死亡率则高于正常体重患者（P=0.0102，P=0.0184）。平滑曲线表明，BMI 作为连续变量与院内和 1 年死亡率呈负相关。根据年龄、性别、种族、入院类型、器官功能障碍严重程度和 ARDS 严重程度进行分层后，结果一致。Kaplan-Meier 生存曲线显示肥胖患者 1 年死亡率明显低于正常体重患者。
结论
我们发现肥胖与 ARDS 患者短期和长期死亡率降低相关。
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