PDF(Pubmed)
Abstract：
BACKGROUND: This study investigates the obesity paradox, where obesity is linked to lower mortality in certain patient groups, focusing on its impact on long-term mortality in chronic critically ill (CCI) patients.
METHODS: We retrospectively analyzed CCI patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database\'s Intensive Care Unit, categorizing them into six groups based on Body Mass Index (BMI). Using stepwise multivariable Cox regression and restricted cubic spline models, we examined the association between BMI and 90 day mortality, accounting for confounding variables through subgroup analyses.
RESULTS: The study included 1996 CCI patients, revealing a 90 day mortality of 34.12%. Overweight and obese patients exhibited significantly lower mortality compared to normal-weight individuals. Adjusted analysis showed lower mortality risks in overweight and obese groups (HRs 0.60 to 0.72, p < 0.001). The cubic spline model indicated a negative correlation between BMI and 90 day mortality, with subgroup analyses highlighting interactions with age.
CONCLUSIONS: Our findings confirm the obesity paradox in CCI patients, especially among the elderly (65-85 years) and very elderly (≥ 85 years). The results suggest a beneficial association of higher BMI in older CCI patients, though caution is advised for those under 45.
METHODS: We retrospectively analyzed CCI patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database\'s Intensive Care Unit, categorizing them into six groups based on Body Mass Index (BMI). Using stepwise multivariable Cox regression and restricted cubic spline models, we examined the association between BMI and 90 day mortality, accounting for confounding variables through subgroup analyses.
RESULTS: The study included 1996 CCI patients, revealing a 90 day mortality of 34.12%. Overweight and obese patients exhibited significantly lower mortality compared to normal-weight individuals. Adjusted analysis showed lower mortality risks in overweight and obese groups (HRs 0.60 to 0.72, p < 0.001). The cubic spline model indicated a negative correlation between BMI and 90 day mortality, with subgroup analyses highlighting interactions with age.
CONCLUSIONS: Our findings confirm the obesity paradox in CCI patients, especially among the elderly (65-85 years) and very elderly (≥ 85 years). The results suggest a beneficial association of higher BMI in older CCI patients, though caution is advised for those under 45.
摘要：
背景：这项研究调查了肥胖悖论，肥胖与某些患者群体的死亡率较低有关，重点关注其对慢性危重（CCI）患者长期死亡率的影响。
方法：我们回顾性分析了重症监护医学信息集市（MIMIC-IV）数据库中的CCI患者，根据身体质量指数（BMI）将其分为六组。使用逐步多变量Cox回归和受限三次样条模型，我们检查了BMI与90天死亡率之间的关系，通过子组分析考虑混杂变量。
结果：该研究包括1996名CCI患者，90天死亡率为34.12%。与体重正常的个体相比，超重和肥胖患者的死亡率显着降低。调整后的分析显示，超重和肥胖组的死亡风险较低（HR为0.60至0.72，p<0.001）。三次样条模型表明BMI与90天死亡率呈负相关,亚组分析强调与年龄的相互作用。
结论：我们的发现证实了CCI患者的肥胖悖论，尤其是老年人（65-85岁）和高龄（≥85岁）。结果表明，在老年CCI患者中，较高的BMI是有益的关联。尽管建议45岁以下的人谨慎行事。
方法：我们回顾性分析了重症监护医学信息集市（MIMIC-IV）数据库中的CCI患者，根据身体质量指数（BMI）将其分为六组。使用逐步多变量Cox回归和受限三次样条模型，我们检查了BMI与90天死亡率之间的关系，通过子组分析考虑混杂变量。
结果：该研究包括1996名CCI患者，90天死亡率为34.12%。与体重正常的个体相比，超重和肥胖患者的死亡率显着降低。调整后的分析显示，超重和肥胖组的死亡风险较低（HR为0.60至0.72，p<0.001）。三次样条模型表明BMI与90天死亡率呈负相关,亚组分析强调与年龄的相互作用。
结论：我们的发现证实了CCI患者的肥胖悖论，尤其是老年人（65-85岁）和高龄（≥85岁）。结果表明，在老年CCI患者中，较高的BMI是有益的关联。尽管建议45岁以下的人谨慎行事。
