Department of Anesthesiology, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong Province, 522000, China.
Guangdong Medical University, No. 2 Wenming East Road, Xiashan District, Zhanjiang, Guangdong Province, 524023, China.
BMC Cardiovasc Disord. 2023 Mar 23;23(1):150. doi: 10.1186/s12872-023-03179-x.
There has been controversy about how obesity affects the clinical prognosis for patients with atrial fibrillation (AF), and the relationship between obesity and outcomes in critically ill patients with AF remains unclear. The purpose of this study was to explore the association between obesity and short- and medium-term mortality in critically ill patients with AF.
The Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was used to conduct a retrospective cohort analysis on 9282 critically ill patients with AF. Patients were categorized into four groups based on their body mass index (BMI) values: underweight, normal-weight, overweight, and obese. The outcomes of this study were 30-day, 90-day, and 1-year all-cause mortality. Cox proportional-hazards models and restricted cubic spline analyses were performed to investigate the association between BMI and mortality.
For 30-day mortality, after adjustment for all confounding factors, the hazard ratio (HR) with 95% confidence interval (CI) for the underweight, overweight, and obese categories were 1.58 (1.21, 2.07), 0.82 (0.72, 0.93), and 0.79 (0.68, 0.91), respectively, compared to the normal-weight category. Using multivariable-adjusted restricted cubic spline analysis, an "L-shaped" correlation was observed between BMI and 30-day mortality. For each 1 kg/m increase in BMI when BMI was less than 30 kg/m, the risk of 30-day mortality decreased by 6.4% (HR, 95% CI: 0.936 [0.918, 0.954]; P < 0.001); however, this relationship was not present when BMI was greater than or equal to 30 kg/m. Similar results were observed for 90-day and 1-year mortality.
There was a nonlinear relationship between BMI and all-cause mortality among critically ill patients with AF. All-cause mortality and the BMI were negatively correlated when the BMI was less than 30 kg/m.
肥胖对心房颤动（AF）患者的临床预后有何影响一直存在争议，而肥胖与危重病 AF 患者结局的关系尚不清楚。本研究旨在探讨肥胖与危重病 AF 患者短期和中期死亡率的关系。
利用医疗信息互操作资源库第四版（MIMIC-IV）数据库，对 9282 例危重病 AF 患者进行回顾性队列分析。根据体重指数（BMI）值将患者分为 4 组：体重不足、正常体重、超重和肥胖。本研究的结局为 30 天、90 天和 1 年全因死亡率。采用 Cox 比例风险模型和限制性立方样条分析来探讨 BMI 与死亡率之间的关系。
对于 30 天死亡率，在调整所有混杂因素后，体重不足、超重和肥胖组的危险比（HR）及其 95%置信区间（CI）分别为 1.58（1.21，2.07）、0.82（0.72，0.93）和 0.79（0.68，0.91），与正常体重组相比。使用多变量调整的限制性立方样条分析发现，BMI 与 30 天死亡率之间存在“L 形”关系。当 BMI 小于 30kg/m 时，BMI 每增加 1kg/m，30 天死亡率的风险降低 6.4%（HR，95%CI：0.936[0.918，0.954]；P<0.001）；然而，当 BMI 大于或等于 30kg/m 时，这种关系并不存在。90 天和 1 年死亡率也观察到了类似的结果。
危重病 AF 患者的 BMI 与全因死亡率之间存在非线性关系。当 BMI 小于 30kg/m 时，全因死亡率与 BMI 呈负相关。
