Sreenivasan Jayakumar, Khan Muhammad Shahzeb, Sharedalal Parija, Hooda Urvashi, Fudim Marat, Demmer Ryan T, Yuzefpolskaya Melana, Ahmad Hasan, Khan Sadiya S, Lanier Gregg M, Colombo Paolo C, Rich Jonathan D
Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY (J.S., P.S., U.H., H.A., G.M.L.).
Department of Medicine, Cook County Health, Chicago, IL (M.S.K.).
Circ Heart Fail. 2021 Mar;14(3):e007937. doi: 10.1161/CIRCHEARTFAILURE.120.007937. Epub 2021 Mar 12.
The association of obesity on outcomes in patients with cardiogenic shock requiring acute mechanical circulatory support has not been thoroughly investigated.
We evaluated the National Readmission Database for adults with either acute myocardial infarction or heart failure complicated by cardiogenic shock requiring acute mechanical circulatory support between January 2016 and November 2017. Exposure was assessed using , codes for the degree of obesity with the reference being body mass index (BMI) of 20.0 to 29.9 group. Multiple logistic regression and Cox regression analysis were used to analyze in-hospital mortality and 30-day readmission, respectively.
The survey-weighted sample included a total of 35 555 hospitalizations with a mean age of 65.4±0.2 years and 29.8% females. Obesity was associated with higher in-hospital mortality (no obesity, 26.4% [BMI, 20.0-29.9] versus class I obesity, 25.0% [BMI, 30.0-34.9] versus class II obesity, 28.7% [BMI, 35.0-39.9] versus class III obesity, 34.9% [BMI, ≥40]; <0.001). On stratified analysis, compared with a nonobese phenotype, younger adults (age <60) with class II and class III obesity (odds ratio, 1.9 [95% CI, 1.1-3.5], =0.02; odds ratio, 2.1 [95% CI, 1.2-3.7], =0.01) and older adults (age ≥60) with class III obesity (odds ratio, 1.7 [95% CI, 1.2-2.4], =0.005) had higher mortality. There was no association between the degree of obesity and 30-day readmission.
Among adults with acute myocardial infarction or acute heart failure resulting in cardiogenic shock requiring acute mechanical circulatory support, younger adults with class II and class III obesity and older patients with class III obesity have a higher risk of in-hospital mortality compared with nonobese patients.
肥胖与需要急性机械循环支持的心源性休克患者预后之间的关联尚未得到充分研究。
我们评估了2016年1月至2017年11月期间因急性心肌梗死或心力衰竭并发心源性休克而需要急性机械循环支持的成年患者的国家再入院数据库。使用肥胖程度编码评估暴露情况，以体重指数（BMI）为20.0至29.9组作为参照。分别采用多因素logistic回归和Cox回归分析来分析住院死亡率和30天再入院情况。
经调查加权后的样本共包括35555次住院，平均年龄为65.4±0.2岁，女性占29.8%。肥胖与较高的住院死亡率相关（无肥胖，26.4%[BMI，20.0 - 29.9]；I级肥胖，25.0%[BMI，30.0 - 34.9]；II级肥胖，28.7%[BMI，35.0 - 39.9]；III级肥胖，34.9%[BMI，≥40]；P<0.001）。分层分析显示，与非肥胖表型相比，II级和III级肥胖的年轻成年人（年龄<60岁）（比值比，1.9[95%CI，1.1 - 3.5]，P = 0.02；比值比，2.1[95%CI，1.2 - 3.7]，P = 0.01）以及III级肥胖的老年成年人（年龄≥60岁）（比值比，1.7[95%CI，1.2 - 2.4]，P = 0.005）死亡率更高。肥胖程度与30天再入院之间无关联。
在因急性心肌梗死或急性心力衰竭导致心源性休克而需要急性机械循环支持的成年人中，与非肥胖患者相比，II级和III级肥胖的年轻成年人以及III级肥胖的老年患者住院死亡风险更高。
