患有 COVID-19 和非 COVID-19 呼吸系统疾病的重症监护患者的肥胖与死亡率：英国的一项跨背景比较研究

IF 7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

BMC Medicine Pub Date : 2024-09-13 DOI:10.1186/s12916-024-03598-3

Joshua A. Bell, David Carslake, Amanda Hughes, Kate Tilling, James W. Dodd, James C. Doidge, David A. Harrison, Kathryn M. Rowan, George Davey Smith

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引用次数: 0

摘要

在 COVID-19 和非 COVID-19 呼吸系统疾病中，肥胖与死亡率的关系截然相反。我们通过研究偏差不同的时间和地域背景下相关性的一致性，评估了肥胖与 COVID-19 和非 COVID-19 重症监护患者死亡率之间可能存在的因果关系。我们使用了英格兰、威尔士和北爱尔兰 297 个重症监护病房 (ICU) 的数据（重症监护国家审计与研究中心病例混合计划）。我们研究了COVID-19（N = 34,701; 2020年2月-2021年8月）和非COVID-19呼吸系统疾病（N = 25,205; 2018年2月-2019年8月）患者的总体体重指数（BMI）与30天死亡率的关系，并按ICU入院日期和地区进行了分类。与非COVID-19患者相比，COVID-19患者更年轻、更少为白人、更多为极度肥胖。COVID-19患者的合并症较少，但死亡率较高。社会人口学因素和合并症因素及其与体重指数和死亡率的关系因入住重症监护室的日期而异，而不是因入住重症监护室的地区而异。在 COVID-19 患者中，体重指数越高，死亡率越高（每标准差的危险比 (HR) = 1.05；95% CI = 1.03-1.07）。只有极度肥胖和 2020 年 2-4 月期间才会出现这种情况（HR = 1.52，95% CI = 1.30-1.77 与推荐体重相比）；之后这种情况会减弱。在非 COVID-19 患者中，较高的体重指数与较低的死亡率相关（每 SD HR = 0.83；95% CI = 0.81-0.86），在所有超重/肥胖组别以及不同日期和地区都是如此，尽管程度随时间而变化。在 COVID-19 患者中，肥胖与较高的死亡率相关，但在非 COVID-19 呼吸道患者中，肥胖与较低的死亡率相关。在这两个患者组中，这些关联似乎很容易受到混杂因素/选择偏差的影响，从而对因果效应的存在或稳定性提出质疑。

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Adiposity and mortality among intensive care patients with COVID-19 and non-COVID-19 respiratory conditions: a cross-context comparison study in the UK

Adiposity shows opposing associations with mortality within COVID-19 versus non-COVID-19 respiratory conditions. We assessed the likely causality of adiposity for mortality among intensive care patients with COVID-19 versus non-COVID-19 by examining the consistency of associations across temporal and geographical contexts where biases vary. We used data from 297 intensive care units (ICUs) in England, Wales, and Northern Ireland (Intensive Care National Audit and Research Centre Case Mix Programme). We examined associations of body mass index (BMI) with 30-day mortality, overall and by date and region of ICU admission, among patients admitted with COVID-19 (N = 34,701; February 2020–August 2021) and non-COVID-19 respiratory conditions (N = 25,205; February 2018–August 2019). Compared with non-COVID-19 patients, COVID-19 patients were younger, less often of a white ethnic group, and more often with extreme obesity. COVID-19 patients had fewer comorbidities but higher mortality. Socio-demographic and comorbidity factors and their associations with BMI and mortality varied more by date than region of ICU admission. Among COVID-19 patients, higher BMI was associated with excess mortality (hazard ratio (HR) per standard deviation (SD) = 1.05; 95% CI = 1.03–1.07). This was evident only for extreme obesity and only during February–April 2020 (HR = 1.52, 95% CI = 1.30–1.77 vs. recommended weight); this weakened thereafter. Among non-COVID-19 patients, higher BMI was associated with lower mortality (HR per SD = 0.83; 95% CI = 0.81–0.86), seen across all overweight/obesity groups and across dates and regions, albeit with a magnitude that varied over time. Obesity is associated with higher mortality among COVID-19 patients, but lower mortality among non-COVID-19 respiratory patients. These associations appear vulnerable to confounding/selection bias in both patient groups, questioning the existence or stability of causal effects.

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来源期刊

BMC Medicine 医学-医学：内科

CiteScore

13.10

自引率

1.10%

发文量

435

审稿时长

4-8 weeks

期刊介绍： BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.