Lin Jian-Chang, Zheng Jian-Jun, Wu Guo-Hua, Chen Zhao-Hong, Chen Xiao-Dong, Jiang Qiong
Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China.
Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China; Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian, China.
Burns. 2022 May;48(3):547-554. doi: 10.1016/j.burns.2022.02.004. Epub 2022 Feb 7.
Many studies show a "obesity paradox", which seems to protect against death. Whether an obesity paradox space is present in severe burn patients remains a matter of great debate. Most research on the obesity paradox of burn injuries is classified by body mass index (BMI) rather than by age.
To investigate whether the obesity paradox exists in severe burn patients stratified by age.
Retrospective analysis was performed on 490 patients with severe burns who were ≥ 18 years of age and were admitted to Fujian Medical University Union Hospital from January 2005 to December 2020. Demographic and clinical characteristics were collected, including age, BMI, total body surface area (TBSA), presence of inhalation injury, abbreviated burn severity index (ABSI) score, diabetes comorbidities, hypertension comorbidities, and in-hospital mortality. The patients were divided into the younger group (18 ≤ age<65 years) and the older group (age ≥ 65 years). The important variables of the two groups were compared. The predictive value of BMI stratified by age on in-hospital mortality was evaluated by binary logistic regression analysis and the Cochran's and Mantel-Haenszel statistics.
A total of 490 patients were selected for this study, and were divided into the younger group (413) and the elderly group (77) according to their ages. In the younger group, logistic regression analyses indicated that high BMI remained significantly and independently associated with decreased in-hospital mortality (P = 0.021). That is, in-hospital mortality decreased by 17.8% when BMI increased by 1 kg/m. In the older group, BMI was not associated with in-hospital mortality (P = 0.808). In the younger group, the results of Pearson's chi-square test was less than 0.05, indicating a correlation between BMI and prognosis. In the older group, the conclusion was contrary with, no correlation between BMI and prognosis. If the confounding factors of age were not considered, this results in no correlation between BMI and prognosis. In the younger group, the survival/death ratio of patients with overweight and obesity was 2.078 times that of patients with normal weight.
In this study of patients with severe burns, overweight and obesity had protective effect on burn injury in the younger group (18 ≤ age<65 years), but not in the older group (age ≥ 65 years). Investigating the obesity paradox in burn patients needs to consider age differences. However, multicentre clinical trials are needed to verify the results.
许多研究显示出一种“肥胖悖论”，即肥胖似乎能预防死亡。严重烧伤患者中是否存在肥胖悖论仍存在很大争议。大多数关于烧伤肥胖悖论的研究是按体重指数（BMI）而非年龄进行分类的。
探讨按年龄分层的严重烧伤患者中是否存在肥胖悖论。
对2005年1月至2020年12月在福建医科大学附属协和医院住院的490例年龄≥18岁的严重烧伤患者进行回顾性分析。收集人口统计学和临床特征，包括年龄、BMI、烧伤总面积（TBSA）、吸入性损伤情况、简化烧伤严重程度指数（ABSI）评分、糖尿病合并症、高血压合并症及住院死亡率。将患者分为较年轻组（18≤年龄<65岁）和较年长组（年龄≥65岁）。比较两组的重要变量。通过二元逻辑回归分析以及 Cochr an检验和Mantel-Haenszel统计分析评估按年龄分层的BMI对住院死亡率的预测价值。
本研究共纳入490例患者，根据年龄分为较年轻组（413例）和老年组（77例）。在较年轻组中，逻辑回归分析表明高BMI仍与降低的住院死亡率显著且独立相关（P = 0.021）。也就是说，BMI每增加1kg/m²，住院死亡率下降17.8%。在较年长组中，BMI与住院死亡率无关（P = 0.808）。在较年轻组中，Pearson卡方检验结果小于0.05，表明BMI与预后相关。在较年长组中，结论相反，BMI与预后无相关性。若不考虑年龄的混杂因素，会得出BMI与预后无相关性的结果。在较年轻组中，超重和肥胖患者的生存/死亡比是正常体重患者的2.078倍。
在这项对严重烧伤患者的研究中，超重和肥胖对较年轻组（18≤年龄<65岁）的烧伤有保护作用，但对较年长组（年龄≥65岁）则没有。研究烧伤患者的肥胖悖论需要考虑年龄差异。然而，需要多中心临床试验来验证结果。
