Anahita Jalilvand, Megan Ireland, Courtney Collins, Whitney Kellett, Scott Strassel, Robert Tamer, Wendy Wahl, Jon Wisler
{"title":"肥胖与败血症手术患者早期生存率提高但晚期死亡率增加有关：倾向匹配分析","authors":"Anahita Jalilvand, Megan Ireland, Courtney Collins, Whitney Kellett, Scott Strassel, Robert Tamer, Wendy Wahl, Jon Wisler","doi":"10.1097/TA.0000000000004316","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>While obesity is a risk factor for postoperative complications, its impact following sepsis is unclear. The primary objective of this study was to evaluate the association between obesity and mortality following admission to the surgical intensive care unit (SICU) with sepsis.</p><p><strong>Methods: </strong>We conducted a single center retrospective review of SICU patients grouped into obese (n = 766, body mass index ≥30 kg/m 2 ) and nonobese (n = 574; body mass index, 18-29.9 kg/m 2 ) cohorts. Applying 1:1 propensity matching for age, sex, comorbidities, sequential organ failure assessment, and transfer status, demographic data, comorbidities, and sepsis presentation were compared between groups. Primary outcomes included in-hospital and 90-day mortality, ICU length of stay, need for mechanical ventilation (IMV) and renal replacement therapy (RRT). p < 0.05 was considered significant.</p><p><strong>Results: </strong>Obesity associates with higher median ICU length of stay (8.2 vs. 5.6, p < 0.001), need for IMV (76% vs. 67%, p = 0.001), ventilator days (5 vs. 4, p < 0.004), and RRT (23% vs. 12%, p < 0.001). In-hospital (29% vs. 18%, p < 0.0001) and 90-day mortality (34% vs. 24%, p = 0.0006) was higher for obese compared with nonobese groups. Obesity independently predicted need for IMV (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1), RRT (OR, 2.2; 95% CI, 1.5-3.1), in-hospital (OR, 2.1; 95% CI, 1.5-2.8), and 90-day mortality (HR, 1.4; 95% CI, 1.1-1.8), after adjusting for sequential organ failure assessment, age, sex, and comorbidities. Comparative survival analyses demonstrate a paradoxical early survival benefit for obese patients followed by a rapid decline after 7 days (logrank p = 0.0009).</p><p><strong>Conclusion: </strong>Obesity is an independent risk factor for 90-day mortality for surgical patients with sepsis, but its impact appeared later in hospitalization. Understanding differences in systemic responses between these cohorts may be important for optimizing critical care management.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531704/pdf/","citationCount":"0","resultStr":"{\"title\":\"Obesity is associated with improved early survival but increased late mortality in surgical patients with Sepsis: A propensity matched analysis.\",\"authors\":\"Anahita Jalilvand, Megan Ireland, Courtney Collins, Whitney Kellett, Scott Strassel, Robert Tamer, Wendy Wahl, Jon Wisler\",\"doi\":\"10.1097/TA.0000000000004316\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>While obesity is a risk factor for postoperative complications, its impact following sepsis is unclear. The primary objective of this study was to evaluate the association between obesity and mortality following admission to the surgical intensive care unit (SICU) with sepsis.</p><p><strong>Methods: </strong>We conducted a single center retrospective review of SICU patients grouped into obese (n = 766, body mass index ≥30 kg/m 2 ) and nonobese (n = 574; body mass index, 18-29.9 kg/m 2 ) cohorts. Applying 1:1 propensity matching for age, sex, comorbidities, sequential organ failure assessment, and transfer status, demographic data, comorbidities, and sepsis presentation were compared between groups. Primary outcomes included in-hospital and 90-day mortality, ICU length of stay, need for mechanical ventilation (IMV) and renal replacement therapy (RRT). p < 0.05 was considered significant.</p><p><strong>Results: </strong>Obesity associates with higher median ICU length of stay (8.2 vs. 5.6, p < 0.001), need for IMV (76% vs. 67%, p = 0.001), ventilator days (5 vs. 4, p < 0.004), and RRT (23% vs. 12%, p < 0.001). In-hospital (29% vs. 18%, p < 0.0001) and 90-day mortality (34% vs. 24%, p = 0.0006) was higher for obese compared with nonobese groups. Obesity independently predicted need for IMV (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1), RRT (OR, 2.2; 95% CI, 1.5-3.1), in-hospital (OR, 2.1; 95% CI, 1.5-2.8), and 90-day mortality (HR, 1.4; 95% CI, 1.1-1.8), after adjusting for sequential organ failure assessment, age, sex, and comorbidities. Comparative survival analyses demonstrate a paradoxical early survival benefit for obese patients followed by a rapid decline after 7 days (logrank p = 0.0009).</p><p><strong>Conclusion: </strong>Obesity is an independent risk factor for 90-day mortality for surgical patients with sepsis, but its impact appeared later in hospitalization. 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引用次数: 0
摘要
导言：肥胖是导致术后并发症的一个风险因素，但其对脓毒症的影响尚不明确。本研究的主要目的是评估肥胖与因脓毒症入住外科重症监护病房（SICU）后的死亡率之间的关系：我们对SICU患者进行了单中心回顾性研究，将其分为肥胖组（n = 766，体重指数≥30 kg/m2）和非肥胖组（n = 574，体重指数18-29.9 kg/m2）。通过对年龄、性别、合并症、SOFA和转院情况进行1:1倾向匹配，比较两组间的人口统计学数据、合并症和脓毒症表现。主要结果包括院内和90天死亡率、重症监护室住院时间（LOS）、机械通气（IMV）需求和肾脏替代治疗（RRT）需求。P<0.05为显著性结果：肥胖与较高的中位 ICU LOS（8.2 vs 5.6，P < 0.001）、IMV 需求（76% vs 67%，P = 0.001）、呼吸机天数（5 vs 4，P < 0.004）和 RRT（23% vs 12%，P < 0.001）有关。与非肥胖组相比，肥胖组的院内死亡率（29% vs 18%，p < 0.0001）和 90 天死亡率（34% vs 24%，p = 0.0006）更高。在对 SOFA、年龄、性别和合并症进行调整后，肥胖可独立预测 IMV（OR 1.6，95th CI：1.2-2.1）、RRT（OR 2.2，95th CI：1.5-3.1）、院内（OR 2.1，95th CI：1.5-2.8）和 90 天死亡率（HR：1.4，95th CI：1.1-1.8）。生存率比较分析表明，肥胖患者早期生存率较高，但7天后生存率迅速下降（logrank p = 0.0009）：结论：肥胖是脓毒症手术患者 90 天死亡率的独立风险因素，但其影响在住院后期才显现出来。了解这些组群之间全身反应的差异可能对优化重症监护管理非常重要：证据等级：III。
Obesity is associated with improved early survival but increased late mortality in surgical patients with Sepsis: A propensity matched analysis.
Background: While obesity is a risk factor for postoperative complications, its impact following sepsis is unclear. The primary objective of this study was to evaluate the association between obesity and mortality following admission to the surgical intensive care unit (SICU) with sepsis.
Methods: We conducted a single center retrospective review of SICU patients grouped into obese (n = 766, body mass index ≥30 kg/m 2 ) and nonobese (n = 574; body mass index, 18-29.9 kg/m 2 ) cohorts. Applying 1:1 propensity matching for age, sex, comorbidities, sequential organ failure assessment, and transfer status, demographic data, comorbidities, and sepsis presentation were compared between groups. Primary outcomes included in-hospital and 90-day mortality, ICU length of stay, need for mechanical ventilation (IMV) and renal replacement therapy (RRT). p < 0.05 was considered significant.
Results: Obesity associates with higher median ICU length of stay (8.2 vs. 5.6, p < 0.001), need for IMV (76% vs. 67%, p = 0.001), ventilator days (5 vs. 4, p < 0.004), and RRT (23% vs. 12%, p < 0.001). In-hospital (29% vs. 18%, p < 0.0001) and 90-day mortality (34% vs. 24%, p = 0.0006) was higher for obese compared with nonobese groups. Obesity independently predicted need for IMV (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1), RRT (OR, 2.2; 95% CI, 1.5-3.1), in-hospital (OR, 2.1; 95% CI, 1.5-2.8), and 90-day mortality (HR, 1.4; 95% CI, 1.1-1.8), after adjusting for sequential organ failure assessment, age, sex, and comorbidities. Comparative survival analyses demonstrate a paradoxical early survival benefit for obese patients followed by a rapid decline after 7 days (logrank p = 0.0009).
Conclusion: Obesity is an independent risk factor for 90-day mortality for surgical patients with sepsis, but its impact appeared later in hospitalization. Understanding differences in systemic responses between these cohorts may be important for optimizing critical care management.
Level of evidence: Prognostic and Epidemiological; Level III.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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