目标温度管理治疗院外心脏骤停幸存者的体重指数与神经结局的关系。
The relationship between body mass index and neurologic outcomes in survivors of out-of-hospital cardiac arrest treated with targeted temperature management.
机构信息
Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Emergency Medicine, Eunpyeong St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
出版信息
PLoS One. 2022 Mar 29;17(3):e0265656. doi: 10.1371/journal.pone.0265656. eCollection 2022.
BACKGROUND
The association of body mass index with outcome in patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) is unclear. The purpose of this study was to examine the effect of body mass index (BMI) on neurological outcomes and mortality in resuscitated patients treated with TTM after OHCA.
METHODS
This multicenter, prospective, observational study was performed with data from 22 hospitals included in the Korean Hypothermia Network KORHN-PRO registry. Comatose adult patients treated with TTM after OHCA between October 2015 and December 2018 were enrolled. The BMI of each patient was calculated and classified according to the criteria of the World Health Organization (WHO). Each group was analyzed in terms of demographic characteristics and associations with six-month neurologic outcomes and mortality after cardiac arrest (CA).
RESULTS
Of 1,373 patients treated with TTM identified in the registry, 1,315 were included in this study. One hundred two patients were underweight (BMI <18.5 kg/m2), 798 were normal weight (BMI 18.5-24.9 kg/m2), 332 were overweight (BMI 25-29.9 kg/m2), and 73 were obese (BMI ≥ 30 kg/m2). The higher BMI group had younger patients and a greater incidence of diabetes and hypertension. Six-month neurologic outcomes and mortality were not different among the BMI groups (p = 0.111, p = 0.234). Univariate and multivariate analyses showed that BMI classification was not associated with six-month neurologic outcomes or mortality. In the subgroup analysis, the underweight group treated with TTM at 33°C was associated with poor neurologic outcomes six months after CA (OR 2.090, 95% CI 1.010-4.325, p = 0.047), whereas the TTM at 36°C group was not (OR 0.88, 95% CI 0.249-3.112, p = 0.843).
CONCLUSIONS
BMI was not associated with six-month neurologic outcomes or mortality in patients surviving OHCA. However, in the subgroup analysis, underweight patients were associated with poor neurologic outcomes when treated with TTM at 33°C.
背景
肥胖指数（BMI）与院外心脏骤停（OHCA）后接受目标温度管理（TTM）治疗的患者结局之间的关联尚不清楚。本研究的目的是检查 BMI 对 OHCA 后接受 TTM 治疗的复苏患者的神经结局和死亡率的影响。
方法
这是一项多中心、前瞻性、观察性研究，数据来自 2015 年 10 月至 2018 年 12 月期间纳入韩国低温网络 KORHN-PRO 登记处的 22 家医院。纳入了接受 OHCA 后接受 TTM 治疗的昏迷成年患者。根据世界卫生组织（WHO）的标准计算每位患者的 BMI 并进行分类。分析了每个组的人口统计学特征以及与心脏骤停（CA）后 6 个月的神经结局和死亡率之间的关系。
结果
在登记处中确定的 1373 例接受 TTM 治疗的患者中，有 1315 例被纳入本研究。102 例患者体重不足（BMI＜18.5kg/m2），798 例为正常体重（BMI 18.5-24.9kg/m2），332 例超重（BMI 25-29.9kg/m2），73 例肥胖（BMI≥30kg/m2）。较高 BMI 组的患者年龄较小，糖尿病和高血压的发生率更高。BMI 组之间 6 个月的神经结局和死亡率无差异（p=0.111，p=0.234）。单因素和多因素分析表明，BMI 分类与 6 个月的神经结局或死亡率无关。在亚组分析中，在 33°C 下接受 TTM 治疗的体重不足组与 CA 后 6 个月的不良神经结局相关（OR 2.090，95%CI 1.010-4.325，p=0.047），而 36°C 组的 TTM 治疗则无相关性（OR 0.88，95%CI 0.249-3.112，p=0.843）。
结论
BMI 与 OHCA 后存活患者的 6 个月神经结局或死亡率无关。但是，在亚组分析中，在 33°C 下接受 TTM 治疗的体重不足患者与不良神经结局相关。
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