Extreme Obesity and Outcomes in Critically Ill Patients
Extreme Obesity and Outcomes in Critically Ill Patients
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DOI：
10.1378/chest.10-3023
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发表时间：
2011-11-01
期刊：
影响因子：
9.6
通讯作者：
Heyland, Daren K.
中科院分区：
文献类型：
--
作者：
Martino, Jenny L.;Stapleton, Renee D.;Heyland, Daren K.
背景：最近的文献表明，肥胖危重患者的预后并不比正常体重的患者更差。然而，极端肥胖(BMI和Gt；=40 kg/m(2))的结果尚不清楚。我们试图确定极端肥胖和ICU结果之间的联系。方法：我们分析了2007年至2009年期间33个国家355个ICU的355个ICU的多中心国际营养实践观察性研究的数据。患者包括机械通气的成年人=18岁谁留在ICU的>；结果：8813例患者中，3490例体重正常(BMI 18.5~24.9 kg/m(2))，348例BMI 40~49.9 kg/m(2例)，118例BMI 50~59.9 kg/m(2例)，58例BMI和GT；=60公斤/米(2)。未经调整的分析表明，极度肥胖的危重患者的死亡率有所提高(死亡OR为0.77；95%CI为0.62-0.94)，但在调整混杂因素后，这种相关性并不显著。然而，对幸存者的校正分析发现，极度肥胖患者的DMV和ICU LOS较长，最肥胖患者(BMI和GT；=60 kg/m(2))的住院LOS也较长。结论：与正常体重相比，在危重疾病期间，极端肥胖与较差的生存优势无关。然而，在幸存者中，BMI和Gt；=40 kg/m(2)与较长的机械通气时间和在ICU中的时间有关。这些结果可能会对极度肥胖的危重患者的预后产生影响。2011年；140(5)：1198-1206
Background: Recent literature suggests that obese critically ill patients do not have worse outcomes than patients who are normal weight. However, outcomes in extreme obesity (BMI >= 40 kg/m(2)) are unclear. We sought to determine the association between extreme obesity and ICU outcomes.Methods: We analyzed data from a multicenter international observational study of ICU nutrition practices that occurred in 355 ICUs in 33 countries from 2007 to 2009. Included patients were mechanically ventilated adults >= 18 years old who remained in the ICU for >72 h. Using generalized estimating equations and Cox proportional hazard modeling with clustering by ICU and adjusting for potential confounders, we compared extremely obese to normal-weight patients in terms of duration of mechanical ventilation (DMV), ICU length of stay (LOS), hospital LOS, and 60-day mortality.Results: Of the 8,813 patients included in this analysis, 3,490 were normal weight (BMI 18.5-24.9 kg/m(2)), 348 had BMI 40 to 49.9 kg/m(2), 118 had BMI 50 to 59.9 kg/m(2), and 58 had BMI >= 60 kg/m(2). Unadjusted analyses suggested that extremely obese critically ill patients have improved mortality (OR for death, 0.77; 95% CI, 0.62-0.94), but this association was not significant after adjustment for confounders. However, an adjusted analysis of survivors found that extremely obese patients have a longer DMV and ICU LOS, with the most obese patients (BMI >= 60 kg/m(2)) also having longer hospital LOS.Conclusions: During critical illness, extreme obesity is not associated with a worse survival advantage compared with normal weight. However, among survivors, BMI >= 40 kg/m(2) is associated with longer time on mechanical ventilation and in the ICU. These results may have prognostic implications for extremely obese critically ill patients. CHEST 2011; 140(5):1198-1206