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Association Between Obesity and Short-And Long-Term Mortality in Patients With Acute Respiratory Distress Syndrome Based on the Berlin Definition

医学 急性呼吸窘迫综合征 体重不足 体质指数 回顾性队列研究 逻辑回归 肥胖 超重 肥胖悖论 重症监护 内科学 混淆 比例危险模型 死亡率 儿科 重症监护医学
作者
Wei Zhang,Yadan Wang,Weijie Li,Jun Wang
出处
期刊:Frontiers in Endocrinology [Frontiers Media SA]
卷期号:11 被引量:15
标识
DOI:10.3389/fendo.2020.611435
摘要

Purpose Acute respiratory distress syndrome (ARDS) is one of the most common causes of death in intensive care units (ICU). Previous studies have reported the potential protective effect of obesity on ARDS patients. However, these findings are inconsistent, in which less was reported on long-term prognosis and diagnosed ARDS by Berlin definition. This study aimed to investigate the relationship between obesity and short-term and long-term mortality in patients with ARDS based on the Berlin Definition. Methods This is a retrospective cohort study from the Medical Information Mart for Intensive Care III (MIMIC-III) database, in which all the patients were diagnosed with ARDS according to the Berlin definition. The patients were divided into four groups according to the WHO body mass index (BMI) categories. The multivariable logistic regression and Cox regression analysis were used to investigate the relationship between BMI and short-term and long-term mortality. Result A total of 2,378 patients with ARDS were enrolled in our study. In-hospital mortality was 27.92%, and 1,036 (43.57%) patients had died after 1-year follow-up. After adjusting for confounders, the in-hospital and 1-year mortality risks of obese patients were significantly lower than those of normal weight (OR 0.72, 95%CI 0.55–0.94, P=0.0168; HR 0.80, 95%CI 0.68–0.94 P=0.0084; respectively), while those mortality risks of underweight patients were higher than normal weight patients (P=0.0102, P=0.0184; respectively). The smooth curve showed that BMI, which was used as a continuous variable, was negatively correlated with in-hospital and 1-year mortality. The results were consistent after being stratified by age, gender, race, type of admission, severity of organ dysfunction, and severity of ARDS. The Kaplan-Meier survival curves showed that obese patients had significant lower 1-year mortality than normal weight patients. Conclusion We found that obesity was associated with decreased risk of short-term and long-term mortality in patients with ARDS.
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