危重症 2019 冠状病毒病肺炎合并肥胖患者的中肾上腺髓质原(proadrenomedullin)、C 端内皮素-1(proendothelin-1)值与疾病进程并无差异。
Mid-regional proadrenomedullin, C-terminal proendothelin-1 values, and disease course are not different in critically ill SARS-CoV-2 pneumonia patients with obesity.
机构信息
Department of Intensive Care Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands.
Department of Clinical Chemistry, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands.
出版信息
Int J Obes (Lond). 2022 Oct;46(10):1801-1807. doi: 10.1038/s41366-022-01184-2. Epub 2022 Jul 15.
BACKGROUND/OBJECTIVES: Patients affected by obesity and Coronavirus disease 2019, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appear to have a higher risk for intensive care (ICU) admission. A state of low-grade chronic inflammation in obesity has been suggested as one of the underlying mechanisms. We investigated whether obesity is associated with differences in new inflammatory biomarkers mid-regional proadrenomedullin (MR-proADM), C-terminal proendothelin-1 (CT-proET-1), and clinical outcomes in critically ill patients with SARS-CoV-2 pneumonia.
SUBJECTS/METHODS: A total of 105 critically ill patients with SARS-CoV-2 pneumonia were divided in patients with obesity (body mass index (BMI) ≥ 30 kg/m, n = 42) and patients without obesity (BMI < 30 kg/m, n = 63) and studied in a retrospective observational cohort study. MR-proADM, CT-proET-1 concentrations, and conventional markers of white blood count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) were collected during the first 7 days.
RESULTS
BMI was 33.5 (32-36.1) and 26.2 (24.7-27.8) kg/m in the group with and without obesity. There were no significant differences in concentrations MR-proADM, CT-proET-1, WBC, CRP, and PCT at baseline and the next 6 days between patients with and without obesity. Only MR-proADM changed significantly over time (p = 0.039). Also, BMI did not correlate with inflammatory biomarkers (MR-proADM rho = 0.150, p = 0.125, CT-proET-1 rho = 0.179, p = 0.067, WBC rho = -0.044, p = 0.654, CRP rho = 0.057, p = 0.564, PCT rho = 0.022, p = 0.842). Finally, no significant differences in time on a ventilator, ICU length of stay, and 28-day mortality between patients with or without obesity were observed.
CONCLUSIONS
In critically ill patients with confirmed SARS-CoV-2 pneumonia, obesity was not associated with differences in MR-proADM, and CT-proET-1, or impaired outcome.
TRIAL REGISTRATION
Netherlands Trial Register, NL8460.
背景/目的：患有肥胖症和由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）的患者似乎有更高的入住重症监护病房（ICU）的风险。肥胖症中的低度慢性炎症状态被认为是潜在机制之一。我们研究了肥胖症是否与重症 SARS-CoV-2 肺炎患者的新炎症生物标志物中部分中段促肾上腺髓质素（MR-proADM）、C 端内皮素-1（CT-proET-1）以及临床结局的差异有关。
受试者/方法：总共纳入了 105 例重症 SARS-CoV-2 肺炎患者，将其分为肥胖组（BMI≥30kg/m²，n=42）和非肥胖组（BMI<30kg/m²，n=63），并进行回顾性观察队列研究。在最初的 7 天内采集了 MR-proADM、CT-proET-1 浓度以及白细胞计数（WBC）、C 反应蛋白（CRP）和降钙素原（PCT）等常规标志物。
结果
肥胖组的 BMI 为 33.5（32-36.1）kg/m²，非肥胖组的 BMI 为 26.2（24.7-27.8）kg/m²。肥胖组和非肥胖组患者在基线和接下来的 6 天内，MR-proADM、CT-proET-1、WBC、CRP 和 PCT 浓度均无显著差异。只有 MR-proADM 随时间显著变化（p=0.039）。此外，BMI 与炎症生物标志物无相关性（MR-proADM rho=0.150，p=0.125，CT-proET-1 rho=0.179，p=0.067，WBC rho=-0.044，p=0.654，CRP rho=0.057，p=0.564，PCT rho=0.022，p=0.842）。最后，肥胖组和非肥胖组患者在呼吸机使用时间、ICU 住院时间和 28 天死亡率方面无显著差异。
结论
在确诊的 SARS-CoV-2 肺炎重症患者中，肥胖症与 MR-proADM 和 CT-proET-1 水平的差异或不良预后无关。
试验注册
荷兰试验注册处，NL8460。
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