新冠肺炎中是否存在肥胖悖论？国际 HOPE-COVID-19 注册研究的观点。
Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry.
机构信息
University Medical Center Mannheim (UMM), University of Heidelberg, Mannheim, Germany.
Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación, Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
出版信息
Obes Res Clin Pract. 2021 May-Jun;15(3):275-280. doi: 10.1016/j.orcp.2021.02.008. Epub 2021 Mar 3.
BACKGROUND
Obesity has been described as a protective factor in cardiovascular and other diseases being expressed as 'obesity paradox'. However, the impact of obesity on clinical outcomes including mortality in COVID-19 has been poorly systematically investigated until now. We aimed to compare clinical outcomes among COVID-19 patients divided into three groups according to the body mass index (BMI).
METHODS
We retrospectively collected data up to May 31, 2020. 3635 patients were divided into three groups of BMI (<25 kg/m; n = 1110, 25-30 kg/m; n = 1464, and >30 kg/m; n = 1061). Demographic, in-hospital complications, and predictors for mortality, respiratory insufficiency, and sepsis were analyzed.
RESULTS
The rate of respiratory insufficiency was more recorded in BMI 25-30 kg/m as compared to BMI < 25 kg/m (22.8% vs. 41.8%; p < 0.001), and in BMI > 30 kg/m than BMI < 25 kg/m, respectively (22.8% vs. 35.4%; p < 0.001). Sepsis was more observed in BMI 25-30 kg/m and BMI > 30 kg/m as compared to BMI < 25 kg/m, respectively (25.1% vs. 42.5%; p = 0.02) and (25.1% vs. 32.5%; p = 0.006). The mortality rate was higher in BMI 25-30 kg/m and BMI > 30 kg/m as compared to BMI < 25 kg/m, respectively (27.2% vs. 39.2%; p = 0.31) (27.2% vs. 33.5%; p = 0.004). In the Cox multivariate analysis for mortality, BMI < 25 kg/m and BMI > 30 kg/m did not impact the mortality rate (HR 1.15, 95% CI: 0.889-1.508; p = 0.27) (HR 1.15, 95% CI: 0.893-1.479; p = 0.27). In multivariate logistic regression analyses for respiratory insufficiency and sepsis, BMI < 25 kg/m is determined as an independent predictor for reduction of respiratory insufficiency (OR 0.73, 95% CI: 0.538-1.004; p = 0.05).
CONCLUSIONS
HOPE COVID-19-Registry revealed no evidence of obesity paradox in patients with COVID-19. However, Obesity was associated with a higher rate of respiratory insufficiency and sepsis but was not determined as an independent predictor for a high mortality.
背景
肥胖已被描述为心血管疾病和其他疾病的保护因素，表现为“肥胖悖论”。然而，肥胖对 COVID-19 患者临床结局（包括死亡率）的影响直到现在才得到系统的研究。我们旨在根据体重指数（BMI）将 COVID-19 患者分为三组，比较临床结局。
方法
我们回顾性地收集了截至 2020 年 5 月 31 日的数据。3635 名患者被分为三组 BMI（<25kg/m；n=1110，25-30kg/m；n=1464，和>30kg/m；n=1061）。分析人口统计学、住院并发症以及死亡率、呼吸衰竭和脓毒症的预测因素。
结果
与 BMI<25kg/m 相比，BMI 为 25-30kg/m 时呼吸衰竭的发生率更高（22.8%比 41.8%；p<0.001），BMI>30kg/m 时呼吸衰竭的发生率也更高（22.8%比 35.4%；p<0.001）。与 BMI<25kg/m 相比，BMI 为 25-30kg/m 和 BMI>30kg/m 时，脓毒症的发生率更高（25.1%比 42.5%；p=0.02）和（25.1%比 32.5%；p=0.006）。与 BMI<25kg/m 相比，BMI 为 25-30kg/m 和 BMI>30kg/m 时的死亡率更高（27.2%比 39.2%；p=0.31）（27.2%比 33.5%；p=0.004）。在死亡率的 Cox 多变量分析中，BMI<25kg/m 和 BMI>30kg/m 并没有影响死亡率（HR 1.15，95%CI：0.889-1.508；p=0.27）（HR 1.15，95%CI：0.893-1.479；p=0.27）。在呼吸衰竭和脓毒症的多变量逻辑回归分析中，BMI<25kg/m 被确定为呼吸衰竭发生率降低的独立预测因素（OR 0.73，95%CI：0.538-1.004；p=0.05）。
结论
HOPE COVID-19-Registry 研究未发现 COVID-19 患者存在肥胖悖论的证据。然而，肥胖与更高的呼吸衰竭和脓毒症发生率相关，但不是高死亡率的独立预测因素。
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