Harvard Medical School, Boston, MA, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Obes Res Clin Pract. 2021 May-Jun;15(3):235-242. doi: 10.1016/j.orcp.2021.03.010. Epub 2021 Apr 6.
Previous literature has suggested that obesity impacts mortality risk differently in bacterial versus viral infections. This study sought to further elucidate this association in pneumonia versus influenza.
Retrospective cohort study.
Data were collected from the US Nationwide Readmission Database from 2013 to 2014.
Patients were categorized into three weight groups: normal weight (BMI 18.5-25.0 kg/m), obese (BMI 30-40.0 kg/m), and morbidly obese (BMI ≥ 40 kg/m). To minimize confounding, we excluded patients with a history of smoking, alcoholism, or chronic wasting conditions, as suggested by the Global BMI Mortality Collaboration. To further isolate obesity from baseline differences across cohorts, we performed a three-way propensity matching analysis. The association between body weight and in-hospital all-cause 30-day mortality was assessed using Cox proportional hazard regression analysis.
132,965 influenza and 34,177 pneumonia hospitalizations were identified. For patients with influenza, obesity (hazard ratio [HR]: 1.51; 95% CI: 1.01-2.26) and morbid obesity (HR: 1.64; 95% CI: 1.10-2.44) were associated with higher in-hospital 30-day mortality compared to normal weight. For pneumonia, obesity (HR, 0.41; 95% CI, 0.20-0.84) and morbid obesity (HR, 0.49; 95% CI, 0.25-0.96) were associated with reduced 30-day mortality compared to normal weight.
Obesity may increase 30-day mortality risk during influenza hospitalization but provide mortality benefit in pneumonia, a divergent effect not adequately explained by lower admission threshold.
既往文献提示肥胖对细菌性感染与病毒性感染的死亡率风险的影响不同。本研究旨在进一步阐明肺炎与流感中这种相关性。
回顾性队列研究。
数据来自 2013 年至 2014 年的美国全国再入院数据库。
患者分为三组体重：正常体重（BMI 18.5-25.0 kg/m）、肥胖（BMI 30-40.0 kg/m）和病态肥胖（BMI ≥ 40 kg/m）。为了最大程度地减少混杂因素，我们根据全球 BMI 死亡率协作组织的建议，排除有吸烟、酗酒或慢性消耗性疾病史的患者。为了进一步将肥胖与队列间的基线差异隔离，我们进行了三方倾向匹配分析。使用 Cox 比例风险回归分析评估体重与住院 30 天全因死亡率之间的关联。
确定了 132965 例流感和 34177 例肺炎住院患者。对于流感患者，肥胖（危险比 [HR]：1.51；95%置信区间：1.01-2.26）和病态肥胖（HR：1.64；95%置信区间：1.10-2.44）与住院 30 天内死亡率较高相关。对于肺炎，肥胖（HR，0.41；95%置信区间，0.20-0.84）和病态肥胖（HR，0.49；95%置信区间，0.25-0.96）与正常体重相比，与降低 30 天死亡率相关。
肥胖可能会增加流感住院期间 30 天死亡率风险，但在肺炎中提供死亡率获益，这是一种无法通过较低的入院阈值充分解释的不同效应。
