Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki City, Japan.
Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Kita-ku, Japan.
Respir Care. 2021 Sep;66(9):1433-1439. doi: 10.4187/respcare.08660. Epub 2021 Mar 9.
Body mass index (BMI) can be an important indicator for health outcomes among critically ill patients. However, the association between BMI and ventilator dependence at ICU discharge among these patients remains unknown. We aimed to evaluate the association between BMI at ICU admission and ventilator dependence at the time of ICU discharge. As secondary outcomes, we used ICU mortality, hospital mortality, and implementation of tracheostomy during ICU stay.
This is a retrospective cohort study. The data were derived from The Japanese Intensive Care Patient Database, a nationwide ICU database in Japan. We included all patients in the registry who were ≥ 16 y old, received mechanical ventilation, and were admitted to an ICU between April 2018 and March 2019. On the basis of their BMI at ICU admission, subjects were classified as underweight (< 18.5 kg/m); normal weight (≥ 18.5 kg/m to < 23 kg/m); overweight (≥ 23 kg/m to < 27.5 kg/m); or obese (≥ 27.5 kg/m).
Among 11,801 analyzed subjects, 388 (3.3%) subjects were ventilator-dependent at ICU discharge. Compared with normal-weight subjects, the risk for ventilator dependence at ICU discharge increased among underweight subjects even after adjusting for potential confounders and inter-ICU variance in 2-level multivariable logistic regression analysis (odds ratio 1.46 [95% CI 1.18-1.79]). Although obesity was also associated with a higher risk of ventilator dependence, the association was less clear (odds ratio 1.10 [95% CI 0.99-1.22]). The risk of ICU mortality, hospital mortality, and implementation of tracheostomy also increased in underweight subjects.
Critically ill underweight subjects had a higher risk of ventilator dependence at ICU discharge compared to normal-weight subjects, even after adjusting for potential confounders and inter-ICU variance. The association between BMI and ventilator dependence should be examined using information on subjects' nutritional status and frailty in further studies.
体重指数（BMI）可以作为危重症患者健康结局的重要指标。然而，这些患者 ICU 出院时 BMI 与呼吸机依赖之间的关系尚不清楚。我们旨在评估 ICU 入院时 BMI 与 ICU 出院时呼吸机依赖之间的关系。次要结局为 ICU 死亡率、医院死亡率和 ICU 期间行气管切开术。
这是一项回顾性队列研究。数据来自日本全国性 ICU 数据库——日本重症监护患者数据库。我们纳入了 2018 年 4 月至 2019 年 3 月登记的所有年龄≥16 岁、接受机械通气并入住 ICU 的患者。根据 ICU 入院时的 BMI，将受试者分为消瘦组（＜18.5 kg/m）；正常体重组（≥18.5 kg/m 至＜23 kg/m）；超重组（≥23 kg/m 至＜27.5 kg/m）；肥胖组（≥27.5 kg/m）。
在分析的 11801 名受试者中，388 名（3.3%）受试者在 ICU 出院时需要呼吸机支持。与正常体重组相比，即使在校正了 2 水平多变量逻辑回归分析中的潜在混杂因素和 ICU 间差异后，消瘦组 ICU 出院时发生呼吸机依赖的风险也更高（比值比 1.46[95%置信区间 1.18-1.79]）。尽管肥胖也与更高的呼吸机依赖风险相关，但这种关联不太明确（比值比 1.10[95%置信区间 0.99-1.22]）。ICU 死亡率、医院死亡率和气管切开术的实施风险在消瘦组也有所增加。
与正常体重组相比，危重症消瘦患者 ICU 出院时发生呼吸机依赖的风险更高，即使在校正了潜在混杂因素和 ICU 间差异后也是如此。在进一步的研究中，应使用有关受试者营养状况和衰弱的信息来检查 BMI 与呼吸机依赖之间的关系。
