Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis.
Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis.
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DOI：
10.1186/s13054-016-1360-z
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发表时间：
2016-06-15
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影响因子：
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通讯作者：
Eichacker PQ
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作者：
Pepper DJ;Sun J;Welsh J;Cui X;Suffredini AF;Eichacker PQ
在美国，至少有25%的入住重症监护室（ICU）的成年人体重指数（BMI）超重、肥胖或病态肥胖。BMI对因脓毒症需要ICU治疗的成人校正死亡率的影响尚不清楚。我们对因脓毒症、严重脓毒症和脓毒性休克而入住ICU的成人进行了一项系统回顾，分析了体重不足、超重、肥胖和病态肥胖BMI相对于正常BMI的校正全因死亡率。检索了截至2015年11月18日的PubMed、科克伦图书馆和EMBASE电子数据库，无语言限制。我们纳入了多变量回归分析的研究，这些研究使用标准BMI分类对因脓毒症、严重脓毒症和脓毒性休克而入住ICU的成人进行全因死亡率分析。文章是经多位评审者协商一致选出的。电子数据库检索得到10，312篇文章，其中6篇符合条件。数据由一名审查员提取，然后由三名独立审查员审查。对于所进行的荟萃分析，使用随机效应模型合并死亡率的校正比值比（aOR）。使用Newcastle-Ottawa队列研究质量评估量表评估偏倚风险。4项回顾性（n = 6609例患者）和2项前瞻性（n = 556例）研究符合入选标准。与正常BMI相比，在5项研究中，超重或肥胖BMI降低了死亡率的校正比值比（95%CI）[aOR] [0.83（0.75，0.91）p < 0.001和0.82（分别为0.67，0.99）p = 0.04]，具有低或中度异质性（分别为I2 = 15.7%，p = 0.31和I2 = 53.0%，p = 0.07）。在3项研究中，病态肥胖BMI和体重不足BMI均未改变aOR [分别为0.90（0.59，1.39），p = 0.64; I2 = 43.3%，p = 0.17;和1.24（0.79，1.95），p = 0.35; I2 = 15.6%，p = 0.31]。只有一项研究明确定义了如何以及何时计算身高和体重测量值。潜在感染部位和疾病严重程度可能有利于超重和肥胖BMI。这是第一个荟萃分析表明超重或肥胖的BMI降低了因脓毒症、严重脓毒症或脓毒性休克而入住ICU的成人的校正死亡率。需要针对这些局限性进行更严格的研究，以阐明BMI对脓毒症ICU结局的影响。PROSPERO国际系统性综述前瞻性登记册10.15124/CRD 42014010556。2014年7月11日注册。本文的在线版本（doi：10.1186/s13054-016-1360-z）包含补充材料，可供授权用户使用。
At least 25 % of adults admitted to intensive care units (ICU) in the United States have an overweight, obese or morbidly obese body mass index (BMI). The effect of BMI on adjusted mortality in adults requiring ICU treatment for sepsis is unclear. We performed a systematic review of adjusted all-cause mortality for underweight, overweight, obese and morbidly obese BMIs relative to normal BMI for adults admitted to the ICU with sepsis, severe sepsis, and septic shock. PubMed, the Cochrane Library, and EMBASE electronic databases were searched through November 18, 2015, without language restrictions. We included studies that reported multivariate regression analyses for all-cause mortality using standard BMI categories for adults admitted to the ICU for sepsis, severe sepsis, and septic shock. Articles were selected by consensus among multiple reviewers. Electronic database searches yielded 10,312 articles, of which six were eligible. Data were extracted by one reviewer and then reviewed by three independent reviewers. For the meta-analyses performed, the adjusted odds ratios (aOR) of mortality were combined using a random-effects model. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale for cohort studies. Four retrospective (n = 6609 patients) and two prospective (n = 556) studies met inclusion criteria. Compared to normal BMI, across five studies each, overweight or obese BMIs reduced the adjusted odds ratio (95 % CI) of mortality [aOR] [0.83 (0.75, 0.91) p < 0.001 and 0.82 (0.67, 0.99) p = 0.04, respectively] with low or moderate heterogeneity (I2 = 15.7 %, p = 0.31 and I2 = 53.0 %, p = 0.07, respectively). Across three studies each, morbidly obese BMI and underweight BMI did not alter aOR [0.90 (0.59, 1.39), p = 0.64; I2 = 43.3 %, p = 0.17; and 1.24 (0.79, 1.95), p = 0.35; I2 = 15.6 %, p = 0.31 respectively]. Only one study clearly defined how and when height and weight measurements were calculated. Site of underlying infection and illness severity may have favored overweight and obese BMIs. This is the first meta-analysis to show that overweight or obese BMIs reduce adjusted mortality in adults admitted to the ICU with sepsis, severe sepsis, or septic shock. More rigorous studies that address these limitations are needed to clarify the impact of BMI on sepsis ICU outcomes. PROSPERO International prospective register of systematic reviews 10.15124/CRD42014010556. Registered on July 11, 2014. The online version of this article (doi:10.1186/s13054-016-1360-z) contains supplementary material, which is available to authorized users.