One size does not fit all in severe infection: obesity alters outcome, susceptibility, treatment, and inflammatory response.
One size does not fit all in severe infection: obesity alters outcome, susceptibility, treatment, and inflammatory response.
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一种方法并不适合治疗严重感染：肥胖会改变结果、易感性、治疗和炎症反应。
DOI：
10.1186/cc12794
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发表时间：
2013-06-20
期刊：
影响因子：
--
通讯作者：
Walley KR
中科院分区：
文献类型：
--
作者：
Wacharasint P;Boyd JH;Russell JA;Walley KR
肥胖是重症患者越来越常见的合并症。肥胖是否改变脓毒症的结局、易感性、治疗和反应尚不完全清楚。我们进行了一项回顾性分析，比较了三组感染性休克患者的实际体重指数（BMI）的时间间隔的基础上，在VASST（加压素和感染性休克试验）队列的患者。主要结局指标为28天死亡率。我们通过比较感染的原发部位和生物体来检验感染模式的差异。我们还比较了治疗（液体和血管加压药）和炎症反应，测量了382例患者的血浆中脂肪组织相关细胞因子浓度（白细胞介素[IL]-6，单核细胞趋化蛋白[MCP]-1，肿瘤坏死因子[TNF]-α和β-内酰胺酶）。在VASST的778例患者中，分析了730例进行了体重和身高测量的患者。将BMI <25 kg/m2的患者（n = 276）分组为参考，并与“超重”（25< BMI <30 kg/m2，n = 209）和“肥胖”（BMI >30 kg/m2，n = 245）患者进行比较。肥胖患者的28天死亡率最低，其次是超重患者，而BMI <25 kg/m2的患者死亡率最高（p = 0.02）。与BMI <25 kg/m2的患者相比，肥胖和超重患者也具有不同的肺部感染模式（肥胖35%，超重45%，BMI<25 kg/m2 50%，p = 0.003）和真菌感染模式（肥胖8.2%，超重11%，BMI<25 kg/m2 15.6%，p = 0.03）。每公斤体重，肥胖和超重患者在前四天接受的液体较少（p<0.05），并接受较少的去甲肾上腺素（肥胖0.14，超重0.21，BMI <25 kg/m2 0.26 µg/kg/min，p<0.0001）和加压素（肥胖0.28，超重0.36，BMI <25 kg/m2 0.43 µU/kg/min，p<0.0001）。肥胖和超重患者在基线时的血浆IL-6浓度也较低（肥胖106 [IQR 34-686]，超重190 [IQR 44-2339]，BMI <25 kg/m2 235 [IQR 44-1793] pg/mL，p = 0.046）。总体肥胖与感染性休克生存率的提高以及感染模式、液体和血管加压药的差异相关。重要的是，炎症性IL-6反应的幅度在肥胖者中是静音的。
Obesity is an increasingly common comorbidity in critically ill patients. Whether obesity alters sepsis outcome, susceptibility, treatment, and response is not completely understood. We conducted a retrospective analysis comparing three group of septic shock patients based on the intervals of actual body mass index (BMI) in patients enrolled in the VASST (Vasopressin and Septic Shock Trial) cohort. Primary outcome measurement was 28-day mortality. We tested for differences in patterns of infection by comparing the primary site of infection and organism. We also compared the treatments (fluids and vasopressors) and inflammatory response, measuring adipose tissue-related cytokine concentrations (interleukin [IL]-6, monocyte chemotactic protein [MCP]-1, tumor necrosis factor [TNF]-α, and resistin) in plasma in a subset of 382 patients. Of the 778 patients in VASST, 730 patients who had body weight and height measurements were analyzed. Patients with BMI <25 kg/m2 (n = 276) were grouped as a reference and compared to 'overweight' (25< BMI <30 kg/m2, n = 209) and 'obese' (BMI >30 kg/m2, n = 245) patients. Obese patients had the lowest 28-day mortality followed by overweight patients while patients with BMI <25 kg/m2 had the highest mortality (p = 0.02). Compared to the patients with BMI <25 kg/m2, obese and overweight patients also had a different pattern of infection with less lung (obese 35%, overweight 45%, BMI<25 kg/m2 50%, p = 0.003) and fungal infection (obese 8.2%, overweight 11%, and BMI<25 kg/m2 15.6%, p = 0.03). Per kilogram, obese and overweight patients received less fluid during the first four days (p<0.05) and received less norepinephrine (obese 0.14, overweight 0.21, BMI <25 kg/m2 0.26 µg/kg/min, p<0.0001) and vasopressin (obese 0.28, overweight 0.36, BMI <25 kg/m2 0.43 µU/kg/min, p<0.0001) on day 1 compared to patients with BMI <25 kg/m2. Obese and overweight patients also had a lower plasma IL-6 concentration at baseline (obese 106 [IQR 34-686], overweight 190 [IQR 44-2339], BMI <25 kg/m2 235 [IQR 44-1793] pg/mL, p = 0.046). Overall obesity was associated with improved survival in septic shock and differences in pattern of infection, fluids, and vasopressors. Importantly, the magnitude of inflammatory IL-6 response is muted in the obese.
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