Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
J Crit Care. 2021 Dec;66:75-77. doi: 10.1016/j.jcrc.2021.08.005. Epub 2021 Aug 27.
The obesity paradox refers to the observation that obese patients admitted to intensive care units (ICU) have lower case fatality as compared to healthy weight patients. However, selection bias could explain the apparent paradox. Our objective was to assess whether obese people have a different overall burden of critical illness associated mortality. A retrospective population-based cohort study was conducted in North Brisbane ICUs during 2017-2019. Patients were classified as underweight, healthy weight, overweight, and obese according to BMIs <18.5, 18.5-24.9, 25-29.9, and ≥ 30 kg/m, respectively. ICU admission incidence rates were 245.6, 138.2, 178.9, and 421.9 per 100,000 population; 90-day all cause case fatalities were 24.0%, 17.0%, 18.1%, and 16.0%; and critical illness associated mortality rates were 58.8, 23.4, 32.4, and 67.7 per 100,000 population among underweight, healthy weight, overweight, and obese patients, respectively. As compared to patients of healthy weight, those who were underweight (relative risk; RR 2.51; 95% CI, 1.79-3.44), overweight (RR 1.38; 95% CI, 1.16-1.65), and obese (RR 2.89; 2.43-3.43) were each at significantly higher risk for critical illness associated mortality. While obese patients have lower case fatality they are at much higher risk for ICU admission and as result suffer the highest burden of critical illness associated mortality in our region.
肥胖悖论是指观察到与健康体重患者相比，入住重症监护病房（ICU）的肥胖患者的病死率较低。然而，选择偏差可能可以解释这种明显的悖论。我们的目的是评估肥胖患者是否存在与危重病相关死亡率相关的不同整体负担。这是一项在 2017 年至 2019 年期间在北布里斯班 ICU 进行的回顾性基于人群的队列研究。根据 BMI<18.5、18.5-24.9、25-29.9 和≥30kg/m2，将患者分别归类为体重不足、健康体重、超重和肥胖。ICU 入院发生率分别为每 10 万人 245.6、138.2、178.9 和 421.9；90 天全因病死率分别为 24.0%、17.0%、18.1%和 16.0%；危重病相关死亡率分别为每 10 万人 58.8、23.4、32.4 和 67.7，体重不足、健康体重、超重和肥胖患者分别为。与健康体重患者相比，体重不足（相对风险；RR 2.51；95%CI，1.79-3.44）、超重（RR 1.38；95%CI，1.16-1.65）和肥胖（RR 2.89；2.43-3.43）患者危重病相关死亡率的风险均显著增加。虽然肥胖患者的病死率较低，但他们入住 ICU 的风险要高得多，因此在我们的地区，他们承受着与危重病相关死亡率相关的最高负担。
