Dose-response relationship between weight status and clinical outcomes in pediatric influenza-related respiratory infections
Dose-response relationship between weight status and clinical outcomes in pediatric influenza-related respiratory infections
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DOI：
10.1002/ppul.23927
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发表时间：
2018-02-01
影响因子：
3.1
通讯作者：
Yasunaga, Hideo
中科院分区：
文献类型：
--
作者：
Okubo, Yusuke;Michihata, Nobuaki;Yasunaga, Hideo
背景体重不足/肥胖与流感感染表现之间的关系尚不清楚，特别是在儿童中。本研究调查流感相关呼吸道感染住院儿童的体重状况与临床结局之间的剂量-反应关系。方法利用日本国家住院患者数据库，获取18岁以下确诊为支气管炎/肺炎和流感的住院患者的出院记录。根据世界卫生组织的标准，这些患者被分为体重不足、正常体重、超重或肥胖组，使用长度体重、身高体重和年龄体重指数进行分类。结果共识别出27771例患者，其中体重不足2 637例，正常体重19701例，超重2 675例，肥胖2 758例。体重不足组的30天再入院时间(调整后的优势比为1.68；95%可信区间为1.28-2.18)和住院时间(调整后的差异为0.23天；95%可信区间为0.12-0.23天)显著高于体重正常组。在四个体重状况组中，没有观察到对重症监护或住院费用的需求有显著差异。体重状况与30天再入院之间有统计学意义的相关性的阈值是-0.95岁(第17个百分位数)的体重/身高、体重/身高或BMI的z分数。结论这些发现表明，体重不足状况是儿童因流感相关呼吸道感染而再次住院的危险因素。
BackgroundAssociations between underweight/obesity and manifestations of influenza infection remain unclear, especially in children. This study investigated the dose-response relationships between weight status and clinical outcomes among children hospitalized with influenza-related respiratory infections.MethodsWe obtained hospital discharge records of inpatients aged under 18 years with diagnoses of bronchitis/pneumonia and influenza, using a Japanese national inpatient database. The patients were classified as underweight, normal-weight, overweight, or obese groups using weight-for-length, weight-for-height, and body-mass-index for age following World Health Organization criteria. We compared need for intensive care, 30-day readmission, mean total hospitalization costs, and length of hospital stay across the four groups using multivariable regression models and restricted cubic spline functions.ResultsOverall, 27771 patients were identified, including 2637 underweight, 19701 normal-weight, 2675 overweight, and 2758 obese patients. The underweight group showed a significantly higher 30-day readmission (adjusted odds ratio, 1.68; 95% confidence interval, 1.28-2.18) and a longer length of stay (adjusted difference, 0.23 days; 95% confidence interval, 0.12-0.23 days) than the normal-weight group did. No significant differences in the need for intensive care or hospitalization costs were observed across the four weight status groups. The threshold for a statistically significant association between weight status and 30-day readmission was a z-score for weight-for-length, weight-for-height, or BMI for age of -0.95 (17th percentile).ConclusionThese findings demonstrated that underweight status is a risk factor for repeated hospital admissions because of influenza-related respiratory infections in children.