Chen Chung-Ting, Lin Meng-Chen, Lee Yi-Jing, Li Li-Hua, Chen Ying-Ju, Chuanyi Hou Peter, How Chorng-Kuang
Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 May 1;84(5):504-509. doi: 10.1097/JCMA.0000000000000513.
To determine the impact of body mass index (BMI) on clinical outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM).
We conducted a retrospective cohort study of 261 adult OHCA survivors who received complete TTM between January 2011 and December 2018 using data from the Research Patient Database Registry of Partners HealthCare system in Boston. Patients were categorized as underweight (BMI < 18.5 kg/m2), normal weight (BMI = 18.5-24.9 kg/m2), overweight (BMI = 25-29.9 kg/m2), and obese (BMI ≥ 30 kg/m2), according to the World Health Organization classification.
The average BMI was 28.9 ± 7.1 kg/m2. Patients with a higher BMI had higher rates of hypertension and diabetes mellitus, and were more likely to be witnessed on collapse. Patients with lower BMI levels had higher sequential organ failure assessment (SOFA) scores, blood urea nitrogen values, and mild thrombocytopenia rates (platelet count <150 K/μL) after the TTM treatment. The survival to discharge and favorable neurological outcome at discharge were reported in 117 (44.8%) and 76 (29.1%) patients, respectively. The survival at discharge, favorable neurologic outcomes at discharge, length of hospital admission, and the occurrence of acute kidney injury did not significantly differ between the BMI subgroups. In logistic regression model, BMI was not an independent predictor for survival at discharge (adjusted odds ratio 0.945, 95% CI 0.883-1.012, p = 0.108) nor for the favorable neurologic outcome at discharge (adjusted odds ratio 1.022, 95% CI 0.955-1.093, p = 0.528).
In OHCA patients treated with TTM, there was no significant difference across BMI subgroups for survival or favorable neurologic outcome at discharge.
确定体重指数（BMI）对接受目标温度管理（TTM）的院外心脏骤停（OHCA）幸存者临床结局的影响。
我们对2011年1月至2018年12月期间在波士顿合作伙伴医疗系统研究患者数据库登记处接受完整TTM治疗的261名成年OHCA幸存者进行了一项回顾性队列研究。根据世界卫生组织的分类，患者被分为体重过轻（BMI<18.5kg/m²）、正常体重（BMI=18.5-24.9kg/m²）、超重（BMI=25-29.9kg/m²）和肥胖（BMI≥30kg/m²）。
平均BMI为28.9±7.1kg/m²。BMI较高的患者高血压和糖尿病发生率较高，且更有可能在晕倒时被目击。BMI水平较低的患者在TTM治疗后序贯器官衰竭评估（SOFA）评分、血尿素氮值和轻度血小板减少率（血小板计数<150K/μL）较高。分别有117名（44.8%）和76名（29.1%）患者出院存活且出院时神经功能良好。出院存活率、出院时良好的神经功能结局、住院时间和急性肾损伤的发生率在BMI亚组之间没有显著差异。在逻辑回归模型中，BMI不是出院存活（调整后的优势比为0.945，95%CI为0.883-1.012，p=0.108）或出院时良好神经功能结局（调整后的优势比为1.022，95%CI为0.955-1.093，p=0.528）的独立预测因素。
在接受TTM治疗的OHCA患者中，BMI亚组之间在出院存活或良好神经功能结局方面没有显著差异。
