代谢健康和不健康肥胖对老年患者脓毒症合并感染性休克结局的影响

IF 2.1 3区 医学 Q2 CRITICAL CARE MEDICINE
Giorgi Chilingarashvili, Diksha Sanjana Pasnoor, Shreya Bajjuri, Ritika Parekh, Nirmala Manjappachar, Jyotsna Gummadi, Athmananda Nanjundappa, Rupak Desai
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引用次数: 0

摘要

目的:肥胖是老年人脓毒症并发症的危险因素。我们评估了代谢健康型肥胖(MHO)和代谢不健康型肥胖(MUHO)对感染性休克结局的影响。方法:我们使用全国住院患者样本(2016-2020)进行回顾性分析,确定了1737,075例65岁及以上的感染性休克住院患者,根据ICD-10诊断代码定义。无高血压、糖尿病或高脂血症的肥胖患者归为MHO;危险因素≥1者为MUHO。采用χ 2和Mann-Whitney U检验比较基线人口统计学和医院特征。多变量logistic回归校正了年龄、性别、种族、合并症指数和医院因素,估计了呼吸衰竭、机械通气、住院死亡率和心脏骤停的优势比(ORs)。次要终点包括住院时间(LOS)和住院费用。结果:268 050例肥胖患者中,23 915例(1.4%)为MHO, 244 135例(14.1%)为MUHO。这两种表型在女性中更为普遍,而在亚洲患者中最不常见。2020年,MHO患病率在美洲原住民中最高,而在西班牙裔中最常见。从2016年到2019年,两种表型的患病率保持稳定,在2020年败血症激增期间观察到适度增加。呼吸衰竭在MHO组最常见(约70%),其次是MUHO(约65%)和非肥胖患者(约60%)。在调整混杂因素后,与非肥胖患者相比,MHO组和MUHO组呼吸衰竭和机械通气的几率更高。2020年,所有年龄组的住院死亡率均有所上升;然而,MUHO患者的调整死亡率风险较低。心脏骤停率保持不变,而住院时间和住院费用在MHO患者中最高。结论:MHO和MUHO均有较高的呼吸衰竭和通气风险;MUHO的低死亡率值得进一步研究。临床意义肥胖表型分型可改善败血症风险分层,为代谢特异性管理提供信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Metabolically Healthy and Unhealthy Obesity on Outcomes of Sepsis Complicated by Septic Shock in Elderly Patients.

Purpose: Obesity is a risk factor for sepsis complications in older adults. We assessed the impact of metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO) on outcomes in septic shock.

Methods: We conducted a retrospective analysis using the National Inpatient Sample (2016-2020) to identify a cohort of 1,737,075 patients aged 65 years and older who were hospitalized with septic shock, as defined by ICD-10 diagnosis codes. Obese patients without hypertension, diabetes, or hyperlipidemia were classified as MHO; those with ≥1 risk factor as MUHO. Baseline demographics and hospital characteristics were compared using χ² and Mann-Whitney U tests. Multivariable logistic regression adjusted for age, sex, race, comorbidity index, and hospital factors estimated odds ratios (ORs) for respiratory failure, mechanical ventilation, in-hospital mortality, and cardiac arrest. Secondary endpoints included length of stay (LOS) and hospitalization cost.

Results: Among 268 050 obese patients, 23 915 (1.4%) were classified as MHO and 244 135 (14.1%) as MUHO. Both phenotypes were more prevalent in females and least common among Asian patients. MHO prevalence was highest among Native Americans, while MUHO was most common among Hispanics in 2020. From 2016 to 2019, the prevalence of both phenotypes remained stable, with modest increases observed during the 2020 sepsis surge. Respiratory failure occurred most frequently in the MHO group (∼70%), followed by MUHO (∼65%) and non-obese patients (∼60%). After adjusting for confounders, both MHO and MUHO groups had higher odds of respiratory failure and mechanical ventilation compared to non-obese patients. In-hospital mortality increased across all groups in 2020; however, MUHO patients had lower adjusted mortality risk. Cardiac arrest rates remained unchanged, while length of stay and hospitalization costs were highest among MHO patients.

Conclusions: MHO and MUHO both confer higher respiratory failure and ventilation risk; lower mortality in MUHO warrants further study.Clinical ImplicationsPhenotypic obesity classification may improve sepsis risk stratification and inform metabolic-specific management.

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来源期刊
Journal of Intensive Care Medicine
Journal of Intensive Care Medicine CRITICAL CARE MEDICINE-
CiteScore
7.60
自引率
3.20%
发文量
107
期刊介绍: Journal of Intensive Care Medicine (JIC) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and pediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.
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