Department of Anesthesiology and Intensive Care Medicine, CHRU-Nancy, Université de Lorraine, Nancy, France.
Medical Information Department, CHRU-Nancy, CNRS, Inria, LORIA, Université de Lorraine, Nancy, France.
Int J Obes (Lond). 2021 Sep;45(9):2028-2037. doi: 10.1038/s41366-021-00872-9. Epub 2021 Jun 10.
Patients with obesity are at increased risk of severe COVID-19, requiring mechanical ventilation due to acute respiratory failure. However, conflicting data are obtained for intensive care unit (ICU) mortality.
To analyze the relationship between obesity and in-hospital mortality of ICU patients with COVID-19.
SUBJECTS/METHODS: Patients admitted to the ICU for COVID-19 acute respiratory distress syndrome (ARDS) were included retrospectively. The following data were collected: comorbidities, body mass index (BMI), the severity of ARDS assessed with PaO/FiO (P/F) ratios, disease severity measured by the Simplified Acute Physiology Score II (SAPS II), management and outcomes.
For a total of 222 patients, there were 34 patients (15.3%) with normal BMI, 92 patients (41.4%) who were overweight, 80 patients (36%) with moderate obesity (BMI:30-39.9 kg/m), and 16 patients (7.2%) with severe obesity (BMI ≥ 40 kg/m). Overall in-hospital mortality was 20.3%. Patients with moderate obesity had a lower mortality rate (13.8%) than patients with normal weight, overweight or severe obesity (17.6%, 21.7%, and 50%, respectively; P = 0.011. Logistic regression showed that patients with a BMI ≤ 29 kg/m (odds ratio [OR] 3.64, 95% CI 1.38-9.60) and those with a BMI > 39 kg/m (OR 10.04, 95% CI 2.45-41.09) had a higher risk of mortality than those with a BMI from 29 to 39 kg/m. The number of comorbidities (≥2), SAPS II score, and P/F < 100 mmHg were also independent predictors for in-hospital mortality.
COVID-19 patients admitted to the ICU with moderate obesity had a lower risk of death than the other patients, suggesting a possible obesity paradox.
肥胖患者患严重 COVID-19 的风险增加，需要因急性呼吸衰竭而进行机械通气。然而，关于重症监护病房（ICU）死亡率的结果却存在冲突。
分析肥胖与 COVID-19 患者 ICU 住院死亡率之间的关系。
受试者/方法：回顾性纳入因 COVID-19 急性呼吸窘迫综合征（ARDS）而入住 ICU 的患者。收集以下数据：合并症、体重指数（BMI）、用 PaO/FiO（P/F）比值评估的 ARDS 严重程度、用简化急性生理学评分 II（SAPS II）测量的疾病严重程度、管理和结局。
共有 222 例患者，其中 34 例（15.3%）BMI 正常，92 例（41.4%）超重，80 例（36%）中度肥胖（BMI：30-39.9kg/m），16 例（7.2%）重度肥胖（BMI≥40kg/m）。总体院内死亡率为 20.3%。中度肥胖患者的死亡率（13.8%）低于 BMI 正常、超重或重度肥胖患者（17.6%、21.7%和 50%，P=0.011）。Logistic 回归显示，BMI≤29kg/m（比值比 [OR] 3.64，95%CI 1.38-9.60）和 BMI＞39kg/m（OR 10.04，95%CI 2.45-41.09）的患者死亡风险高于 BMI 为 29-39kg/m 的患者。合并症数量（≥2）、SAPS II 评分和 P/F＜100mmHg 也是院内死亡率的独立预测因素。
入住 ICU 的 COVID-19 肥胖患者的死亡风险低于其他患者，提示可能存在肥胖悖论。
