体重指数对脊髓损伤后生存率的影响。

Effect of body mass index on survival after spinal cord injury.

作者信息

Fallah Nader, Noonan Vanessa K, Thorogood Nancy P, Kwon Brian K, Kopp Marcel A, Schwab Jan M

机构信息

Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada.

Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

出版信息

Front Neurol. 2024 Jan 26;14:1269030. doi: 10.3389/fneur.2023.1269030. eCollection 2023.

DOI:10.3389/fneur.2023.1269030

PMID:38344110

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10853461/

Abstract

INTRODUCTION

Increased mortality after acute and chronic spinal cord injury (SCI) remains a challenge and mandates a better understanding of the factors contributing to survival in these patients. This study investigated whether body mass index (BMI) measured after acute traumatic SCI is associated with a change in mortality.

METHODS

A prospective longitudinal cohort study was conducted with 742 patients who were admitted to the Acute Spine Unit of the Vancouver General Hospital between 2004 and 2016 with a traumatic SCI. An investigation of the association between BMI on admission and long-term mortality was conducted using classification and regression tree (CART) and generalized additive models (spline curves) from acute care up to 7.7 years after SCI (chronic phase). Multivariable models were adjusted for (i) demographic factors (e.g., age, sex, and Charlson Comorbidity Index) and (ii) injury characteristics (e.g., neurological level and severity and Injury Severity Score).

RESULTS

After the exclusion of incomplete datasets ( = 602), 643 patients were analyzed, of whom 102 (18.5%) died during a period up to 7.7 years after SCI. CART identified three distinct mortality risk groups: (i) BMI: > 30.5 kg/m, (ii) 17.5-30.5 kg/m, and (iii) < 17.5 kg/m. Mortality was lowest in the high BMI group (BMI > 30.5 kg/m), followed by the middle-weight group (17.5-30.5 kg/m), and was highest in the underweight group (BMI < 17.5 kg/m). High BMI had a mild protective effect against mortality after SCI (hazard ratio 0.28, 95% CI: 0.09-0.88, = 0.029), concordant with a modest "obesity paradox". Moreover, being underweight at admission was a significant risk factor for mortality up to 7.7 years after SCI (hazard ratio 5.5, 95% CI: 2.34-13.17, < 0.001).

DISCUSSION

Mortality risk (1 month to 7.7 years after SCI) was associated with differences in BMI at admission. Further research is needed to better understand the underlying mechanisms. Given an established association of BMI with metabolic determinants, these results may suggest unknown neuro-metabolic pathways that are crucial for patient survival.

摘要

引言

急性和慢性脊髓损伤（SCI）后死亡率增加仍然是一项挑战，需要更好地了解影响这些患者生存的因素。本研究调查了急性创伤性SCI后测量的体重指数（BMI）是否与死亡率变化相关。

方法

对2004年至2016年间入住温哥华总医院急性脊柱科的742例创伤性SCI患者进行了一项前瞻性纵向队列研究。使用分类回归树（CART）和广义相加模型（样条曲线），对SCI后长达7.7年（慢性期）的急性护理阶段入院时的BMI与长期死亡率之间的关联进行了调查。多变量模型针对（i）人口统计学因素（如年龄、性别和查尔森合并症指数）和（ii）损伤特征（如神经学水平和严重程度以及损伤严重程度评分）进行了调整。

结果

排除不完整数据集（n = 602）后，对643例患者进行了分析，其中102例（18.5%）在SCI后长达7.7年的期间内死亡。CART确定了三个不同的死亡风险组：（i）BMI：> 30.5kg/m²，（ii）17.5 - 30.5kg/m²，和（iii）< 17.5kg/m²。高BMI组（BMI > 30.5kg/m²）的死亡率最低，其次是中等体重组（17.5 - 30.5kg/m²），体重过轻组（BMI < 17.5kg/m²）的死亡率最高。高BMI对SCI后的死亡率有轻度保护作用（风险比0.28，95%CI：0.09 - 0.88，P = 0.029），与适度的“肥胖悖论”一致。此外，入院时体重过轻是SCI后长达7.7年死亡率的一个重要危险因素（风险比5.5，95%CI：2.34 - 13.17，P < 0.001）。