较高的体重指数与成人新冠病毒肺炎住院患者的不良预后密切相关：一项全国住院患者样本研究。

Higher body mass index is strongly linked to poor outcomes in adult COVID-19 hospitalizations: A National Inpatient Sample Study.

作者信息

Elkhapery Ahmed, Abdelhay Ali, Boppana Hemanth Krishna, Abdalla Zeinab, Mohamed Mohamed, Al-Ali Omar, Hashem Anas, Mahmoud Amir, Mahmoud Eisa, Niu Chengu, Dalbah Rami, Chow Ming-Yan

机构信息

Rochester General Hospital Internal Medicine Residency Program Rochester New York USA.

Department of Medicine University of Sharjah Sharjah United Arab Emirates.

出版信息

Obes Sci Pract. 2023 Sep 11;10(1):e692. doi: 10.1002/osp4.692. eCollection 2024 Feb.

DOI:10.1002/osp4.692

PMID:38264003

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10804336/

Abstract

AIMS

The coronavirus disease 2019 (COVID-19) pandemic has resulted in more than 6 million deaths worldwide. Studies on the impact of obesity on patients hospitalized with COVID-19 pneumonia have been conflicting, with some studies describing worse outcomes in patients with obesity, while other studies reporting no difference in outcomes. Previous studies on obesity and critical illness have described improved outcomes in patients with obesity, termed the "obesity paradox." The study assessed the impact of obesity on the outcomes of COVID-19 hospitalizations, using a nationally representative database.

MATERIALS AND METHODS

ICD-10 code U071 was used to identify all hospitalizations with the principal diagnosis of COVID-19 infection in the National Inpatient Database 2020. ICD-10 codes were used to identify outcomes and comorbidities. Hospitalizations were grouped based on body mass index (BMI). Multivariable logistic regression was used to adjust for demographic characteristics and comorbidities.

RESULTS

A total of 56,033 hospitalizations were identified. 48% were male, 49% were white and 22% were black. Patients hospitalized with COVID-19 pneumonia in the setting of obesity and clinically severe obesity were often younger. Adjusted for differences in comorbidities, there was a significant increase in mortality, incidence of mechanical ventilation, shock, and sepsis with increased BMI. The mortality was highest among hospitalizations with BMI ≥60, with an adjusted odds ratio of 2.66 (95% Confidence interval 2.18-3.24) compared to hospitalizations with normal BMI. There were increased odds of mechanical ventilation across all BMI groups above normal, with the odds of mechanical ventilation increasing with increasing BMI.

CONCLUSION

The results show that obesity is independently associated with worse patient outcomes in COVID-19 hospitalizations and is associated with higher in-patient mortality and higher rates of mechanical ventilation. The underlying mechanism of this is unclear, and further studies are needed to investigate the cause of this.

摘要

目的

2019年冠状病毒病（COVID-19）大流行已导致全球超过600万人死亡。关于肥胖对COVID-19肺炎住院患者影响的研究结果相互矛盾，一些研究表明肥胖患者的预后较差，而其他研究则报告预后无差异。先前关于肥胖与危重病的研究描述了肥胖患者预后改善的情况，即“肥胖悖论”。本研究使用全国代表性数据库评估了肥胖对COVID-19住院患者预后的影响。

材料与方法

使用国际疾病分类第十版（ICD-10）编码U071在2020年全国住院患者数据库中识别所有以COVID-19感染为主要诊断的住院病例。使用ICD-10编码识别结局和合并症。根据体重指数（BMI）对住院病例进行分组。采用多变量逻辑回归对人口统计学特征和合并症进行调整。

结果

共识别出56033例住院病例。其中48%为男性，49%为白人，22%为黑人。肥胖和临床严重肥胖情况下因COVID-19肺炎住院的患者往往更年轻。调整合并症差异后，随着BMI增加，死亡率、机械通气发生率、休克和脓毒症发生率显著升高。BMI≥60的住院患者死亡率最高，与BMI正常的住院患者相比，调整后的优势比为2.66（95%置信区间2.18-3.24）。所有高于正常BMI组的机械通气几率均增加，且机械通气几率随BMI升高而增加。