BMI and pneumonia outcomes in critically ill covid-19 patients: An international multicenter study
BMI and pneumonia outcomes in critically ill covid-19 patients: An international multicenter study
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DOI：
10.1002/oby.23223
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发表时间：
2021-09-01
期刊：
影响因子：
6.9
通讯作者：
Pattou, Francois
中科院分区：
文献类型：
--
作者：
Chetboun, Mikael;Raverdy, Violeta;Pattou, Francois
目的以往研究揭示了新冠肺炎肺炎的严重程度与肥胖之间的关系。这项多中心回顾性队列研究的目的是明确新冠肺炎危重患者体重指数与相关代谢危险因素(糖尿病、高血压、高脂血症和当前吸烟状况)之间的关系。方法纳入2020年2月19日至2020年5月19日期间在21个中心(欧洲、以色列和美国)的新冠肺炎重症监护病房接受治疗的患者。主要和次要结果分别是需要有创机械通气(IMV)和28天死亡率。结果1,461例患者入选，年龄中位数(四分位数范围)为(40.9-72.0)；73.2%的患者为男性；体重指数中位数为28.1 kg/m(2)(25.4-32.3)；共有1,080名患者(73.9%)需要IMV；28天死亡率估计为36.1%(95%可信区间：33.0-39.5)。调整后的混合Logistic回归模型显示体重指数与IMV呈显著线性关系：优势比=1.27(95%CI：1.12~1.45)/5 kg/m(2)。调整后的COX比例风险回归模型显示BMI和死亡率之间存在显著关联，只有在III级肥胖患者中BMI和死亡率才增加(>；=40；风险比=1.68[95%CI：1.06-2.64])。结论在新冠肺炎危重患者中，观察到体重指数与是否需要IMV之间存在线性关联，而与其他代谢危险因素无关，而体重指数与死亡风险之间存在非线性关联。
Objective Previous studies have unveiled a relationship between the severity of coronavirus disease 2019 (COVID-19) pneumonia and obesity. The aims of this multicenter retrospective cohort study were to disentangle the association of BMI and associated metabolic risk factors (diabetes, hypertension, hyperlipidemia, and current smoking status) in critically ill patients with COVID-19. Methods Patients admitted to intensive care units for COVID-19 in 21 centers (in Europe, Israel, and the United States) were enrolled in this study between February 19, 2020, and May 19, 2020. Primary and secondary outcomes were the need for invasive mechanical ventilation (IMV) and 28-day mortality, respectively. Results A total of 1,461 patients were enrolled; the median (interquartile range) age was 64 years (40.9-72.0); 73.2% of patients were male; the median BMI was 28.1 kg/m(2) (25.4-32.3); a total of 1,080 patients (73.9%) required IMV; and the 28-day mortality estimate was 36.1% (95% CI: 33.0-39.5). An adjusted mixed logistic regression model showed a significant linear relationship between BMI and IMV: odds ratio = 1.27 (95% CI: 1.12-1.45) per 5 kg/m(2). An adjusted Cox proportional hazards regression model showed a significant association between BMI and mortality, which was increased only in obesity class III (>= 40; hazard ratio = 1.68 [95% CI: 1.06-2.64]). Conclusions In critically ill COVID-19 patients, a linear association between BMI and the need for IMV, independent of other metabolic risk factors, and a nonlinear association between BMI and mortality risk were observed.