身体质量指数和死亡率之间的关系在需要静脉外体支持的患者中不是线性的
Elwin Tham1, Stuart Campbell1, Heather Hayanga1
1Department of Cardiovascular and Thoracic Surgery, West Virginia University Morgantown, WVa.
The Journal of thoracic and cardiovascular surgery
|December 2, 2023
概括
致病性肥胖症可能不是毒性体外膜氧化 (VVECMO) 的禁忌. 这项研究发现身体质量指数 (BMI) 和死亡率之间存在非线性关系,这表明目前VVECMO候选人BMI值需要重新评估.
科学领域:
- 关键护理医学 关键护理医学
- 心肺支 提供心肺支
- 肥胖问题研究研究
背景情况:
- 致病性肥胖 (BMI>40) 往往是毒性体外膜氧化 (VVECMO) 的相对禁忌,原因是死亡率增加.
- 现有的证据有限,重点是技术挑战,而不是最终的结果.
- 较高的体重指数 (BMI) 和VVECMO结果之间的关系需要进一步研究.
研究的目的:
- 评估身体质量指数 (BMI) 对严重急性呼吸系统综合征冠状病毒2 (SARS-CoV-2) 感染需要VVECMO的患者死亡率的影响.
- 检查不同BMI范围与VVECMO结果之间的关联.
- 重新评估BMI的有效性作为VVECMO的禁忌.支持.
主要方法:
- 从国家COVID队列协作数据库 (2019年9月至2022年8月) 追溯对象分析1,033,229名BMI≤60的患者,诊断出SARS-CoV-2感染.
- 分析的重点是774名需要VVECMO支持的成年患者.
- 用单变量和多变量混合效应的逻辑回归模型来评估死亡率,控制年龄,并发症评分和其他因素. 小组分析将BMI 40-60与BMI百分位数进行比较.
主要成果:
- 在VVECMO患者中,总死亡率为47.8%.
- 高龄和较高的查尔森并发症指数 (CCI) 与增加的死亡率显著相关 (分别P < .0001和P = .009).
- 观察到BMI与死亡率之间的非线性关系:BMI 25-32之间死亡率增加,但BMI 32-37之间死亡率下降. 与较低的BMI百分位相比,BMI40-60的ECMO死亡率没有显著差异.
结论:
- 晚年和较高的CCI是VVECMO患者死亡的确诊风险因素.
- 该研究发现BMI和死亡率之间存在非线性关联,BMI为32-37的患者的死亡率较低,而BMI为25-32.
- 这些发现挑战了VVECMO目前基于BMI的禁忌,表明需要对患者进行个性化评估.
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