Yuan Zinuo, Cheng Yiping, Han Junming, Wang Dawei, Dong Hang, Shi Yingzhou, Poulsen Kyle L, Fan Xiude, Zhao Jiajun
Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China.
Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
EClinicalMedicine. 2022 Jul 22;51:101577. doi: 10.1016/j.eclinm.2022.101577. eCollection 2022 Sep.
Increased body mass index (BMI) and metabolic abnormalities are controversial prognostic factors of lung cancer. However, the relationship between metabolic overweight/obesity phenotypes and hospital readmission in patients with lung cancer is rarely reported.
We established a retrospective cohort using the United States (US) Nationwide Readmissions Database (NRD). We included adult patients diagnosed with lung cancer from January 1, 2018 to November 30, 2018 and excluded patients combined with other cancers, pregnancy, died during hospitalization, low body weight, and those with missing data. The cohort was observed for hospital readmission until December 31, 2018. We defined and distinguished four metabolic overweight/obesity phenotypes: metabolically healthy with normal weight (MHNW), metabolically unhealthy with normal weight (MUNW), metabolically healthy with overweight or obesity (MHO), and metabolically unhealthy with overweight or obesity (MUO). The relationship between metabolic overweight/obesity phenotypes and 30-day readmission risk was assessed by multivariable Cox regression analysis.
Of the 115,393 patients included from the NRD 2018 (MHNW [58214, 50.4%], MUNW [44980, 39.0%], MHO [5044, 4.4%], and MUO [7155, 6.2%]), patients with the phenotype MUNW (6531, 14.5%), MHO (771, 15.3%), and MUO (1155, 16.1%) had a higher readmission rate compared to those with MHNW (7901, 13.6%). Compared with patients with the MHNW phenotype, those with the MUNW (hazard ratio [HR], 1.10; 95% CI, 1.06-1.14), MHO (HR, 1.15; 95% CI, 1.07-1.24), and MUO (HR, 1.28; 95% CI, 1.20-1.36) phenotypes had a higher risk of readmission, especially in men, those without surgical intervention, or those aged >60 years. In women, similar results with respect to readmission were observed in people aged >60 years (MUNW [HR, 1.07; 95% CI, 1.01-1.13], MHO [HR, 1.19; 95% CI, 1.06-1.35], and MUO [HR, 1.28; 95% CI, 1.16-1.41]). We also found increased costs for 30-day readmission in patients with MHO (OR, 1.18; 95% CI, 1.07-1.29) and MUO (OR, 1.11; 95% CI, 1.02-1.20).
Increased BMI and metabolic abnormalities are independently associated with higher readmission risks in patients with lung cancer, whereas increased BMI also increases the readmission costs. Follow-up and intervention method targeting increased BMI and metabolic abnormalities should be considered for patients with lung cancer.
The National Key Research and Development Program of China (2017YFC1309800).
体重指数（BMI）升高和代谢异常是肺癌存在争议的预后因素。然而，代谢性超重/肥胖表型与肺癌患者再次入院之间的关系鲜有报道。
我们利用美国全国再入院数据库（NRD）建立了一个回顾性队列。我们纳入了2018年1月1日至2018年11月30日期间诊断为肺癌的成年患者，并排除了合并其他癌症、怀孕、住院期间死亡、体重过低以及数据缺失的患者。对该队列进行观察直至2018年12月31日的再次入院情况。我们定义并区分了四种代谢性超重/肥胖表型：代谢健康且体重正常（MHNW）、代谢不健康且体重正常（MUNW）、代谢健康且超重或肥胖（MHO）以及代谢不健康且超重或肥胖（MUO）。通过多变量Cox回归分析评估代谢性超重/肥胖表型与30天再入院风险之间的关系。
在2018年NRD纳入的115393例患者中（MHNW [58214例，50.4%]，MUNW [44980例，39.0%]，MHO [5044例，4.4%]，MUO [7155例，6.2%]），与MHNW患者（7901例，13.6%）相比，MUNW（6531例，14.5%）、MHO（771例，15.3%）和MUO（1155例，16.1%）表型的患者再入院率更高。与MHNW表型的患者相比，MUNW（风险比[HR]，1.10；95%置信区间[CI]，1.06 - 1.14）、MHO（HR，1.15；95% CI，1.07 - 1.24）和MUO（HR，1.28；95% CI，1.20 - 1.36）表型的患者再入院风险更高，尤其是男性、未接受手术干预的患者或年龄>60岁的患者。在女性中，年龄>60岁的人群中观察到了与再入院相关的类似结果（MUNW [HR，1.07；95% CI，1.01 - 1.13]，MHO [HR，1.19；95% CI，1.06 - 1.35]，MUO [HR，1.28；95% CI，1.16 - 1.41]）。我们还发现MHO（比值比[OR]，1.18；95% CI，1.07 - 1.29）和MUO（OR，1.11；95% CI，1.02 - 1.20）表型的患者30天再入院费用增加。
BMI升高和代谢异常与肺癌患者更高的再入院风险独立相关，而BMI升高也会增加再入院费用。对于肺癌患者，应考虑针对BMI升高和代谢异常的随访及干预方法。
国家重点研发计划（2017YFC1309800）。
