Relation Between Obesity and Survival in Patients Hospitalized for Pulmonary Arterial Hypertension (from a Nationwide Inpatient Sample Database 2003 to 2011)
Relation Between Obesity and Survival in Patients Hospitalized for Pulmonary Arterial Hypertension (from a Nationwide Inpatient Sample Database 2003 to 2011)
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DOI：
10.1016/j.amjcard.2017.04.051
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发表时间：
2017-08-01
影响因子：
2.8
通讯作者：
Lavie, Carl J.
中科院分区：
文献类型：
--
作者：
Agarwal, Manyoo;Agrawal, Sahil;Lavie, Carl J.
有大量的研究报道，肥胖患者的各种心血管疾病的死亡率低于非肥胖患者，这种现象被称为“肥胖悖论”。“关于肥胖对肺动脉高压（PAH）患者预后的影响，数据有限。我们使用了2003年至2011年的国家住院患者样本数据库，以确定所有年龄>岁且主要诊断为PAH的住院患者。根据国际疾病分类第九次修订、临床修改、代码和诊断相关组，使用全国住院患者样本数据库中提供的Elixhauser共病指标确定诊断为肥胖的患者。采用多变量logistic回归分析比较肥胖和非肥胖PAH患者的住院死亡率。在18，450例初步诊断为PAH的患者中，14.7%为肥胖。与非肥胖白色患者相比，PAH肥胖患者更年轻，更常见于女性，更常见于黑人。在对人口统计学、医院特征和基线共病进行风险调整后，与非肥胖PAH患者相比，肥胖PAH患者的观察到的院内死亡率较低（3.5% vs 8.1%;调整后的比值比0.66，95%置信区间0.51 - 0.85，p=0.001）。总之，从9年的全国PAH患者队列中，我们观察到肥胖患者的风险调整院内死亡率显著低于非肥胖患者。(C)2017爱思唯尔公司All rights reserved.
There have been numerous studies reporting lower mortality rates in obese patients with various cardiovascular disorders than in nonobese patients, a phenomenon known as the "obesity paradox." Limited data exist regarding the effect of obesity on prognosis in patients with pulmonary arterial hypertension (PAH). We used the National Inpatient Sample database for years 2003 to 2011 to identify all patient hospitalizations aged years with a primary diagnosis of PAH. Patients with a diagnosis of obesity were identified using Elixhauser co-morbidity measure provided in Nationwide Inpatient Sample database, based on International Classification of Diseases, Ninth Revision, Clinical Modification, codes and the diagnosis-related groups. Multivariable logistic regression was used to compare in-hospital mortality between obese and nonobese patients with PAH. Of the 18,450 patients with a primary diagnosis of PAH, 14.7% were obese. Obese patients with PAH were younger, more often women, and more often black compared with nonobese white patients. After risk adjustment for demographics, hospital characteristics, and baseline co-morbidities, obese patients with PAH had lower observed in-hospital mortality compared with nonobese patients with PAH (3.5% vs 8.1%; adjusted odds ratio 0.66, 95% confidence interval 0.51 to 0.85, p=0.001). In conclusion, from a 9-year nationwide cohort of patients with PAH, we observed significantly lower risk-adjusted in-hospital mortality in obese patients compared with nonobese patients. (C) 2017 Elsevier Inc. All rights reserved.