Hou Chunhong, Qi Yu, Zhang Tuo, Liu Ya, Wu Jingli, Li Wenting, Li Jiaqi, Li Xia
Heze Hospital Affiliated to Shandong First Medical University, Heze Municipal Hospital, Heze, China.
Cheeloo College of Medicine, Shandong University, Jinan, China.
Int J Obes (Lond). 2025 May 12. doi: 10.1038/s41366-025-01805-6.
The obesity paradox, where higher body mass index (BMI) is associated with improved survival, is observed in sepsis and cancer individually. However, its effect in patients with both conditions is unclear. The objective of this study is to evaluate the obesity paradox in intensive care unit (ICU) patients with sepsis and cancer and examine whether BMI's impact on mortality varies across patient phenotypes.
Data from the Medical Information Mart for Intensive Care IV database were analyzed. Patients were categorized by BMI into underweight (<18.5 kg/m, n = 173), normal weight (18.5-24.9 kg/m, n = 1283), overweight (25-29.9 kg/m, n = 1498), and obesity (≥30 kg/m, n = 960). The primary outcome was 28-day mortality, with secondary outcomes including 6-month mortality, 1-year mortality, length of ICU stay, continuous renal replacement therapy usage, and invasive ventilation usage. Multivariable logistic regression and restricted cubic splines were used to explore the BMI-mortality relationship, and unsupervised clustering was performed to identify patient phenotypes.
Among 3914 patients, obesity was associated with lower mortality. Clustering revealed four distinct phenotypes, with the protective effect of obesity being more evident in patients with lower Sequential Organ Failure Assessment (SOFA) scores (Cluster1, Cluster2 and Cluster3).
The obesity paradox is evident in both short-term outcome (28-day mortality) and long-term outcomes (6-month and 1-year mortality) among patients with sepsis and cancer, particularly in those presenting with lower disease severity. These findings highlight the need for personalized treatment approaches in this complex patient population.
肥胖悖论是指较高的体重指数（BMI）与生存率提高相关，这一现象在脓毒症和癌症患者中均有观察到。然而，其在同时患有这两种疾病的患者中的影响尚不清楚。本研究的目的是评估重症监护病房（ICU）中患有脓毒症和癌症的患者的肥胖悖论，并探讨BMI对死亡率的影响是否因患者表型而异。
分析了重症监护医学信息集市IV数据库中的数据。患者按BMI分为体重过轻（<18.5 kg/m²，n = 173）、正常体重（18.5 - 24.9 kg/m²，n = 1283）、超重（25 - 29.9 kg/m²，n = 1498）和肥胖（≥30 kg/m²，n = 960）。主要结局是28天死亡率，次要结局包括6个月死亡率、1年死亡率、ICU住院时间、持续肾脏替代治疗的使用情况和有创通气的使用情况。采用多变量逻辑回归和受限立方样条来探讨BMI与死亡率的关系，并进行无监督聚类以识别患者表型。
在3914例患者中，肥胖与较低的死亡率相关。聚类分析揭示了四种不同的表型，肥胖的保护作用在序贯器官衰竭评估（SOFA）评分较低的患者（第1组、第2组和第3组）中更为明显。
肥胖悖论在患有脓毒症和癌症的患者的短期结局（28天死亡率）和长期结局（6个月和1年死亡率）中均很明显，尤其是在疾病严重程度较低的患者中。这些发现凸显了在这一复杂患者群体中采用个性化治疗方法的必要性。
