Impact of obesity on outcomes for patients hospitalised with pneumonia.
Impact of obesity on outcomes for patients hospitalised with pneumonia.
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DOI：
10.1183/09031936.00185211
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发表时间：
2013-04
期刊：
影响因子：
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通讯作者：
Hitchcock Noël P
中科院分区：
文献类型：
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作者：
King P;Mortensen EM;Bollinger M;Restrepo MI;Copeland LA;Pugh MJ;Nakashima B;Anzueto A;Hitchcock Noël P
肥胖在美国是一个日益严重的问题，对肥胖和肺炎之间关系的研究得出了相互矛盾的结果。利用2002-2006财政年度退伍军人事务部的行政数据，我们检查了一组出院诊断为肺炎的住院患者。体重指数分为体重过轻（< 18.5）、正常（参照组18.5-24.9）、超重（25-29.9）、肥胖（30-39.9）和病态肥胖（≥40）。我们的主要分析是采用多层回归模型，包括90天死亡率、重症监护病房（ICU）入院、机械通气需求和血管加压药的使用。该队列由18746名受试者组成。3%的人体重过轻，30%正常，35%超重，26%肥胖，4%病态肥胖。在回归模型中，校正潜在混杂因素后，病态肥胖与死亡率无关（优势比0.96,95%可信区间0.72-1.28），但肥胖与死亡率降低相关（0.86,95% 0.74-0.99）。肥胖和病态肥胖均与ICU住院、机械通气使用或血管加压药物使用无关。体重过轻的患者90天死亡率增加（1.40,1.14-1.73）。虽然肥胖是一种日益严重的健康流行病，但它似乎对临床结果影响不大，并可能降低因肺炎住院的退伍军人的死亡率。
Obesity is an increasing problem in the United States, and research into the association between obesity and pneumonia has yielded conflicting results. Using Department of Veterans Affairs administrative data between fiscal years 2002-2006, we examined a cohort of patients hospitalized with a discharge diagnosis of pneumonia. Body Mass Index was categorized as underweight (< 18.5), normal (18.5-24.9, reference group), overweight (25-29.9), obese (30-39.9), and morbidly obese (≥40). Our primary analyses were multi-level regression models with the outcomes of 90-day mortality, intensive care unit (ICU) admission, need for mechanical ventilation and vasopressor utilization. The cohort comprised of 18,746 subjects. Three percent were underweight, 30% were normal, 35% were overweight, 26% were obese, and 4% were morbidly obese. In the regression models, after adjusting for potential confounders, morbid obesity was not associated with mortality (odds ratio 0.96, 95% confidence interval 0.72-1.28), but obesity was associated with decreased mortality (0.86, 95% 0.74-0.99). Neither obesity nor morbid obesity were associated with ICU admission, use of mechanical ventilation or vasopressor utilization. Underweight patients had increased 90-day mortality (1.40, 1.14-1.73). Although obesity is a growing health epidemic, it appears to have little impact on clinical outcomes and may reduce mortality for veterans hospitalized with pneumonia.