Tian Jing, Jin Ke, Qian Haohao, Xu Hongyang
Department of Critical Care Medicine, Wuxi People's Hospital, Wuxi Medical Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
Diabetol Metab Syndr. 2024 Dec 3;16(1):292. doi: 10.1186/s13098-024-01538-y.
Previous studies have shown that the obesity paradox exists in cardiovascular disease (CVD), giving patients a survival advantage, but controversy remains as to whether it applies to patients with cardiogenic shock (CS), especially in the elderly. We therefore aimed to determine whether obesity affects 28-day prognosis in elderly patients with CS.
We used clinical data from the Medical Information Market in Critical Care IV (MIMIC-IV) database. Critical patients with CS were categorized into two groups based on age; age < 65 years and ≥ 65 years were classified as young adult patients and elderly patients, respectively. Patients were then categorized into two subgroups based on their body mass index (BMI), one with a BMI ≥ 30 kg/m and the other with a BMI < 30 kg/m. The primary outcome was a 28-day prognosis. Secondary outcomes were mechanical ventilation status, length of hospitalization, and length of ICU stay.
1827 patients from the MIMIC-IV ICU database were analyzed, of which 571 patients were < 65 years old and 1256 patients were ≥ 65 years old. According to multifactorial logistic analysis, BMI > 30 kg/m was not a 28-day risk factor for death in elderly patients critically ill with CS (Overweight OR 1.28, P = 0.221; Obesity OR 1.15, P = 0.709; Severe obesity OR 1.46, P = 0.521; using normal weight as a reference). In contrast, underweight was a risk factor (OR 2.42, P = 0.039). Kaplan-Meier curves showed that in the older age group, 28-day survival was significantly higher in patients with BMI ≥ 30 kg/m compared to those with BMI < 30 kg/m [261 (66.75%) vs. 522 (60.35%), P = 0.024].
Underweight affects the 28-day prognosis of critically ill elderly patients with CS. In contrast, overweight and or obesity do not appear to have a significant impact on the prognosis of these patients.
既往研究表明，心血管疾病（CVD）中存在肥胖悖论，即肥胖赋予患者生存优势，但肥胖悖论是否适用于心源性休克（CS）患者，尤其是老年患者，仍存在争议。因此，我们旨在确定肥胖是否会影响老年CS患者的28天预后。
我们使用了重症监护IV期医学信息市场（MIMIC-IV）数据库中的临床数据。患有CS的重症患者按年龄分为两组；年龄<65岁和≥65岁的患者分别被归类为年轻成年患者和老年患者。然后根据患者的体重指数（BMI）将其分为两个亚组，一个BMI≥30kg/m，另一个BMI<30kg/m。主要结局是28天预后。次要结局是机械通气状态、住院时间和重症监护病房（ICU）住院时间。
对MIMIC-IV重症监护病房数据库中的1827例患者进行了分析，其中571例患者年龄<65岁，1256例患者年龄≥65岁。根据多因素逻辑分析，BMI>30kg/m不是老年重症CS患者28天死亡的危险因素（超重：比值比[OR]1.28，P=0.221；肥胖：OR1.15，P=0.709；重度肥胖：OR1.46，P=0.521；以正常体重为参照）。相比之下，体重过轻是一个危险因素（OR2.42，P=0.039）。Kaplan-Meier曲线显示，在老年组中，BMI≥30kg/m的患者28天生存率显著高于BMI<30kg/m的患者[261例（66.75%）对522例（60.35%），P=0.024]。
体重过轻会影响老年重症CS患者的28天预后。相比之下，超重和/或肥胖似乎对这些患者的预后没有显著影响。
