体重指数对合并严重脓毒症的COVID-19住院患者心肺结局的影响
Impact Of body Mass Index on Cardiopulmonary Outcomes of COVID-19 Hospitalizations Complicated by Severe Sepsis.
作者信息
Neppala Sivaram, Chigurupati Himaja Dutt, Mopuru Nikhilender Nag, Alle Naga Ruthvika, James Alpha, Bhalodia Ami, Shaik Sajida, Bandaru Revanth Reddy, Nanjundappa Athmananda, Sunkara Praveena, Gummadi Jyotsna, Desai Rupak
机构信息
University of Texas at San Antonio, San Antonio, TX, USA.
Department of Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA.
出版信息
Obes Pillars. 2024 Feb 14;10:100101. doi: 10.1016/j.obpill.2024.100101. eCollection 2024 Jun.
BACKGROUND
Body Mass Index (BMI) has a significant impact on Coronavirus disease (COVID-19) patient outcomes; however, major adverse cardiac and cerebrovascular outcomes in patients with severe sepsis have been poorly understood. Our study aims to explore and provide insight into its association.
METHODS
This is an observational study looking at the impact of BMI on COVID-19-severe sepsis hospitalizations. The primary outcomes are adjusted odds of all-cause in-hospital mortality, respiratory failure, and major adverse cardiac and cerebrovascular events (MACCE), which include acute myocardial infarction, cardiac arrest, and acute ischemic stroke. The secondary outcome was healthcare resource utilization. Coexisting comorbidities and patient features were adjusted with multivariable regression analyses.
RESULTS
Of 51,740 patients with severe COVID-19-sepsis admissions, 11.4% were overweight, 24.8% had Class I obesity (BMI 30-34.9), 19.8% had Class II obesity (BMI 35-39.9), and 43.9% had the categorization of Class III obesity (BMI >40) cohorts with age>18 years. The odds of MACCE in patients with class II obesity and class III obesity (OR 1.09 and 1.54; 95CI 0.93-1.29 and 1.33-1.79) were significantly higher than in overweight (p < 0.001). Class I, Class II, and Class III patients with obesity revealed lower odds of respiratory failure compared to overweight (OR 0.89, 0.82, and 0.82; 95CI 0.75-1.05, 0.69-0.97, and 0.70-0.97), but failed to achieve statistical significance (p = 0.079). On multivariable regression analysis, all-cause in-hospital mortality revealed significantly higher odds in patients with Class III obesity, Class II, and Class I (OR 1.56, 1.17, and 1.06; 95CI 1.34-1.81, 0.99-1.38, and 0.91-1.24) vs. overweight patients (p < 0.001).
CONCLUSIONS
Patients with Class II and Class III obesity had significantly higher odds of MACCE and in-hospital mortality in COVID-19-severe sepsis admissions.
背景
体重指数（BMI）对冠状病毒病（COVID-19）患者的预后有重大影响；然而，严重脓毒症患者的主要不良心脑血管结局尚未得到充分了解。我们的研究旨在探讨并深入了解其关联。
方法
这是一项观察性研究，旨在探讨BMI对COVID-19严重脓毒症住院患者的影响。主要结局是全因院内死亡率、呼吸衰竭以及主要不良心脑血管事件（MACCE）的调整后比值比，MACCE包括急性心肌梗死、心脏骤停和急性缺血性卒中。次要结局是医疗资源利用情况。通过多变量回归分析对共存的合并症和患者特征进行调整。
结果
在51740例因COVID-19严重脓毒症入院的患者中，11.4%为超重，24.8%为I类肥胖（BMI 30 - 34.9），19.8%为II类肥胖（BMI 35 - 39.9），43.9%为III类肥胖（BMI>40）且年龄>18岁的队列。II类肥胖和III类肥胖患者发生MACCE的比值比（OR分别为1.09和1.54；95%置信区间为0.93 - 1.29和1.33 - 1.79）显著高于超重患者（p<0.001）。I类、II类和III类肥胖患者呼吸衰竭的比值比低于超重患者（OR分别为0.89、0.82和0.82；95%置信区间为0.75 - 1.05、0.69 - 0.97和0.70 - 0.97），但未达到统计学显著性（p = 0.079）。在多变量回归分析中，III类肥胖、II类和I类肥胖患者的全因院内死亡率的比值比显著高于超重患者（OR分别为1.56、1.17和1.06；95%置信区间为1.34 - 1.81、0.99 - 1.38和0.91 - 1.24）（p<0.001）。
结论
在COVID-19严重脓毒症入院患者中，II类和III类肥胖患者发生MACCE和院内死亡的几率显著更高。
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