Department of Anesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.
Department of Anesthesiology and Intensive Care, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.
J Crit Care. 2022 Dec;72:154162. doi: 10.1016/j.jcrc.2022.154162. Epub 2022 Oct 8.
The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS.
The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed.
292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome.
The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.
验证肥胖对重症 SARS-CoV-2 ARDS 患者长期结局的影响。
这项回顾性研究纳入了 2020 年 3 月至 2022 年 3 月期间在大容量 ECMO 中心收治的患者。分析了体重指数（BMI）、合并症和治疗措施对短期和 90 天结局的影响。
共纳入 292 例患者，其中 119 例（40.8%）接受了静脉-静脉 ECMO 治疗，这些患者大多（73%）在当地医院进行 ECMO 置管。58.5%的患者肥胖（64.7%在 ECMO 治疗中），BMI＞40 的患者中 ECMO 最常见（49%）。肥胖患者的 ICU 死亡率（36.8%对非肥胖患者的 33.9%，p = 0.58）仅与非肥胖患者的 ECMO 相关（p = 0.04）。ECMO 和非 ECMO 患者的 90 天死亡率（肥胖患者的 48.5%对非肥胖患者的 45.5%，p = 0.603）均不受 BMI 的显著影响（p = 0.47，p = 0.771）。肥胖与不良结局相关的危险因素是年龄＜50 岁（RR 2.14）和慢性免疫抑制治疗史（RR 2.11，p = 0.009）。较高剂量的类固醇（RR 0.57，p = 0.05）与更好的结局相关。
肥胖的高发生率与短期和长期结局无不良相关性。肥胖患者行 ECMO 治疗，ARDS 晚期使用类固醇可能会提高生存率。
