Chongqing Medical University, Chongqing, 400016, People's Republic of China.
The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
Eur J Med Res. 2024 Jul 29;29(1):392. doi: 10.1186/s40001-024-01962-w.
This study investigates the obesity paradox, where obesity is linked to lower mortality in certain patient groups, focusing on its impact on long-term mortality in chronic critically ill (CCI) patients.
We retrospectively analyzed CCI patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database's Intensive Care Unit, categorizing them into six groups based on Body Mass Index (BMI). Using stepwise multivariable Cox regression and restricted cubic spline models, we examined the association between BMI and 90 day mortality, accounting for confounding variables through subgroup analyses.
The study included 1996 CCI patients, revealing a 90 day mortality of 34.12%. Overweight and obese patients exhibited significantly lower mortality compared to normal-weight individuals. Adjusted analysis showed lower mortality risks in overweight and obese groups (HRs 0.60 to 0.72, p < 0.001). The cubic spline model indicated a negative correlation between BMI and 90 day mortality, with subgroup analyses highlighting interactions with age.
Our findings confirm the obesity paradox in CCI patients, especially among the elderly (65-85 years) and very elderly (≥ 85 years). The results suggest a beneficial association of higher BMI in older CCI patients, though caution is advised for those under 45.
本研究探讨了肥胖悖论，即在某些患者群体中，肥胖与较低的死亡率相关，重点关注肥胖对慢性危重病（CCI）患者长期死亡率的影响。
我们回顾性分析了来自医疗信息共享数据库-IV（MIMIC-IV）重症监护室的 CCI 患者，根据体重指数（BMI）将他们分为六组。使用逐步多变量 Cox 回归和限制三次样条模型，我们研究了 BMI 与 90 天死亡率之间的关联，通过亚组分析考虑混杂变量。
本研究纳入了 1996 名 CCI 患者，90 天死亡率为 34.12%。超重和肥胖患者的死亡率明显低于正常体重个体。调整分析显示，超重和肥胖组的死亡风险较低（HRs 0.60 至 0.72，p<0.001）。三次样条模型表明 BMI 与 90 天死亡率之间呈负相关，亚组分析强调了与年龄的交互作用。
我们的研究结果证实了 CCI 患者中的肥胖悖论，特别是在老年人（65-85 岁）和非常老年人（≥85 岁）中。结果表明，CCI 老年患者的 BMI 较高与其有益相关，但对于 45 岁以下的患者需谨慎。
