肥胖与成年心力衰竭重症监护患者的 1 年全因生存率:来自 MIMIC-IV 的数据。

IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Fei Xu, Cheng Zhang
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引用次数: 0

摘要

背景:心力衰竭是一种威胁全球公共安全的疾病:心力衰竭是一种威胁全球公共安全的疾病。近年来,肥胖悖论在心血管疾病等领域得到了深入研究。随着年龄的增长、代谢的变化和脂肪功能的调节,也为疾病与分子代谢之间的对话提供了许多桥梁。本研究旨在探讨肥胖与年龄因素相结合对心力衰竭成人重症监护患者预后的影响:数据来自第四代重症监护医疗信息市场(MIMIC-IV version2.1),使用 Navicat(12.0.11)平台上的结构化查询语言。研究人员根据体重指数(BMI)分为两组,一组为体重指数≥ 30 kg/m²,另一组为体重指数结果:在这项队列研究中,有 3390 人属于 BMIOutcome:在重症监护室的心力衰竭患者中,肥胖对年龄≥ 60 岁的患者有生存益处。在 60 岁以下的患者中未观察到肥胖悖论。肥胖悖论适用于年龄≥ 60 岁的心衰患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Obesity and 1-year all-cause survival of adult intensive care patients with heart failure: data from the MIMIC-IV.

Background: Heart failure is a disease that threatens global public safety. In recent years, the obesity paradox has been studied in cardiovascular disease and other fields. With the progress of aging, metabolic changes and regulation of fat function, it also provides many bridges for the dialogue between disease and molecular metabolism. The purpose of this study is to investigate the effect of obesity on the outcome of adult intensive care patients with heart failure combined with age factors.

Method: Data were derived from the fourth-generation Medical Information Marketplace for Intensive Care (MIMIC-IV version2.1) using structured query language on the Navicat (12.0.11) platform. People were divided into two groups based on the body mass index (BMI), one group with BMI ≥ 30 kg/m² and another group with BMI < 30 kg/m². Afterwards, the patients were divided into two subgroups based on their ages. One group included patients aged<60, and the other included patients aged ≥ 60. The extracted information includes demographic characteristics, laboratory findings, comorbidities, scores. Main results included in-hospital mortality, ICU mortality, and 1-year mortality. Secondary outcomes included hospital interval and ICU interval, use of renal replacement therapy, and rates of noninvasive and invasive ventilation support.

Result: In this cohort study, 3390 people were in the BMI<30 group, 2301 people were in the BMI ≥ 30 group, 960 people were in the age<60 group, and 4731 people were in the age ≥ 60 group, including 3557 patients after propensity score matching in high age group. Among patients aged ≥ 60, BMI ≥ 30 group vs. BMI<30 group showed significantly lower in-hospital mortality (13% vs. 16%) and one-year mortality (41% vs. 55%), respectively. Neither primary nor secondary outcomes were significantly described in the competition among patients aged under 60. Restricted cubic spline reveals a J-shaped nonlinear association between BMI and clinical endpoints within the entire cohort. Kaplan-Meier curves revealed a survival advantage in BMI ≥ 30 group (p < 0.001). Following age stratification, a beneficial effect of BMI categories on one-year mortality risk was observed in heart failure patients aged ≥ 60 (Univariable HR, 0.71, 95% CI, 0.65-0.78, p < 0.001; Multivariable HR, 0.74, 95% CI, 0.67-0.81, p < 0.001), but not in those under 60 years old.

Outcome: In ICU patients with heart failure, obesity offers a survival benefit to those aged ≥ 60. No obesity paradox was observed in patients younger than 60 years old. The obesity paradox applies to patients aged ≥ 60 with heart failure.

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来源期刊
Diabetology & Metabolic Syndrome
Diabetology & Metabolic Syndrome ENDOCRINOLOGY & METABOLISM-
CiteScore
6.20
自引率
0.00%
发文量
170
审稿时长
7.5 months
期刊介绍: Diabetology & Metabolic Syndrome publishes articles on all aspects of the pathophysiology of diabetes and metabolic syndrome. By publishing original material exploring any area of laboratory, animal or clinical research into diabetes and metabolic syndrome, the journal offers a high-visibility forum for new insights and discussions into the issues of importance to the relevant community.
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