肥胖悖论与脓毒症的功能结局：一项多中心前瞻性研究。

Obesity Paradox and Functional Outcomes in Sepsis: A Multicenter Prospective Study.

机构信息

Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.

Department of Internal Medicine, School of Medicine, Pusan National University, BusanRepublic of Korea.

出版信息

Crit Care Med. 2023 Jun 1;51(6):742-752. doi: 10.1097/CCM.0000000000005801. Epub 2023 Feb 9.

DOI:10.1097/CCM.0000000000005801

PMID:36762918

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10187629/

Abstract

OBJECTIVES

In Asian populations, the correlation between sepsis outcomes and body mass is unclear. A multicenter, prospective, observational study conducted between September 2019 and December 2020 evaluated obesity's effects on sepsis outcomes in a national cohort.

SETTING

Nineteen tertiary referral hospitals or university-affiliated hospitals in South Korea.

PATIENTS

Adult patients with sepsis ( n = 6,424) were classified into obese ( n = 1,335) and nonobese groups ( n = 5,089).

MEASUREMENTS AND RESULTS

Obese and nonobese patients were propensity score-matched in a ratio of 1:1. Inhospital mortality was the primary outcome. After propensity score matching, the nonobese group had higher hospital mortality than the obese group (25.3% vs 36.7%; p < 0.001). The obese group had a higher home discharge rate (70.3% vs 65.2%; p < 0.001) and lower median Clinical Frailty Scale (CFS) (4 vs 5; p = 0.007) at discharge than the nonobese group, whereas the proportion of frail patients at discharge (CFS ≥ 5) was significantly higher in the nonobese group (48.7% vs 54.7%; p = 0.011). Patients were divided into four groups according to the World Health Organization body mass index (BMI) classification and performed additional analyses. The adjusted odds ratio of hospital mortality and frailty at discharge for underweight, overweight, and obese patients relative to normal BMI was 1.25 ( p = 0.004), 0.58 ( p < 0.001), and 0.70 ( p = 0.047) and 1.53 ( p < 0.001), 0.80 ( p = 0.095), and 0.60 ( p = 0.022), respectively.

CONCLUSIONS

Obesity is associated with higher hospital survival and functional outcomes at discharge in Asian patients with sepsis.

摘要

目的

在亚洲人群中，脓毒症结局与体重的相关性尚不清楚。一项于 2019 年 9 月至 2020 年 12 月进行的多中心、前瞻性、观察性研究评估了肥胖对全国队列中脓毒症结局的影响。

背景

韩国 19 家三级转诊医院或大学附属医院。

患者

脓毒症成年患者（n=6424）分为肥胖组（n=1335）和非肥胖组（n=5089）。

测量和结果

采用倾向评分匹配法将肥胖组和非肥胖组以 1:1 的比例进行匹配。住院死亡率为主要结局。倾向评分匹配后，非肥胖组住院死亡率高于肥胖组（25.3% vs 36.7%；p<0.001）。肥胖组出院时的家庭出院率更高（70.3% vs 65.2%；p<0.001），出院时的临床虚弱量表（CFS）中位数更低（4 分 vs 5 分；p=0.007），而非肥胖组出院时虚弱患者的比例（CFS≥5）明显更高（48.7% vs 54.7%；p=0.011）。根据世界卫生组织体重指数（BMI）分类将患者分为四组，并进行了额外分析。与正常 BMI 相比，消瘦、超重和肥胖患者的住院死亡率和出院时虚弱的调整比值比（OR）分别为 1.25（p=0.004）、0.58（p<0.001）和 0.70（p=0.047）和 1.53（p<0.001）、0.80（p=0.095）和 0.60（p=0.022）。