Hjalmarsson Alfred, Rawshani Araz, Råmunddal Truls, Rawshani Aidin, Hjalmarsson Clara, Myredal Anna, Höskuldsdottir Gudrun, Hessulf Fredrik, Hirlekar Geir, Angerås Oskar, Petursson Petur
Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
The Swedish Cardiopulmonary Resuscitation Registry, Västra Götaland County, Gothenburg, Sweden.
Resusc Plus. 2023 Aug 10;15:100446. doi: 10.1016/j.resplu.2023.100446. eCollection 2023 Sep.
Although an "obesity paradox", which states an increased chance of survival for patients with obesity after myocardial infarction has been proposed, it is less clear whether this phenomenon even exists in patients suffering out-of-hospital cardiac arrest (OHCA) and if diabetes, which is often associated with obesity, implies an additional risk.
To investigate if and how obesity, with or without diabetes, affects the survival of patients with OHCA.
This study included 55,483 patients with OHCA reported to the Swedish Registry of Cardiopulmonary Resuscitation between 2010 and 2020. Patients were classified in five groups: obesity only (Ob), type 1 diabetes only (T1D), type 2 diabetes only (T2D), obesity and any diabetes (ObD), or belonging to the group other (OTH). Patient characteristics and outcomes were studied using descriptive statistics, logistic, and Cox proportional regression.
Obesity only was found in 2.7% of the study cohort, while 3.2% had obesity and any type of diabetes. Ob patients were significantly younger than all other patients (p ≤ 0.001); the 30 day-survival was 9.6% in Ob, and 10.6%, 7.3%, 6.9%, and 12.7% in T1D, T2D, ObD, and OTH, respectively, with OR (95% CI) of 0.69 (0.57-0.82), 0.78 (0.56-1.05), 0.65 (0.59-0.71), and 0.55 (0.45-0.66) for Ob, T1D, T2D, and ObD, respectively (reference group OTH). No time-related trends in 30-days survival were found.
Obesity was present in 6% of the population and was associated with younger age and a 30% reduction in survival; a combination of obesity and diabetes further reduced the survival rate.
尽管有人提出了“肥胖悖论”，即心肌梗死后肥胖患者的生存几率增加，但对于院外心脏骤停（OHCA）患者是否存在这一现象，以及与肥胖常相关的糖尿病是否意味着额外风险，尚不清楚。
研究肥胖（无论是否合并糖尿病）对院外心脏骤停患者生存情况的影响及方式。
本研究纳入了2010年至2020年间向瑞典心肺复苏登记处报告的55483例院外心脏骤停患者。患者分为五组：单纯肥胖（Ob）、仅1型糖尿病（T1D）、仅2型糖尿病（T2D）、肥胖合并任何类型糖尿病（ObD）或属于其他组（OTH）。使用描述性统计、逻辑回归和Cox比例回归研究患者特征和结局。
研究队列中2.7%为单纯肥胖，3.2%为肥胖合并任何类型糖尿病。肥胖患者明显比所有其他患者年轻（p≤0.001）；肥胖组30天生存率为9.6%，1型糖尿病组、2型糖尿病组、肥胖合并糖尿病组和其他组分别为10.6%、7.3%、6.9%和12.7%，肥胖组、1型糖尿病组、2型糖尿病组和肥胖合并糖尿病组的OR（95%CI）分别为0.69（0.57 - 0.82）、0.78（0.56 - 1.05）、0.65（0.59 - 0.71）和0.55（0.45 - 0.66）（参照组为其他组）。未发现30天生存率的时间相关趋势。
6%的人群存在肥胖，肥胖与年轻及生存率降低30%相关；肥胖与糖尿病并存进一步降低了生存率。
