ICU住院期间体质量变化与死亡率的相关性研究  

Correlation between change in body mass and mortality during hospitalization in intensive care unit:a retrospective cohort study

作　　者：张静静[1] 金旭婷 任佳佳 李若寒 李佳媚[1] 高雅[1] 王小闯[1] 王岗[1] ZHANG Jingjing;JIN Xuting;REN Jiajia;LI Ruohan;LI Jiamei;GAO Ya;WANG Xiaochuang;WANG Gang(Department of Critical Care Medicine,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an,Shanxi Province,710004,China)

机构地区：[1]西安交通大学第二附属医院重症医学科,西安710004

出　　处：《陆军军医大学学报》2023年第4期343-348,共6页Journal of Army Medical University

基　　金：国家自然科学基金面上项目(81770057);西安交通大学第二附属医院院人才培养专项科研基金[RC(XM)202011]。

摘　　要：目的探讨成年患者在重症监护室(intensive care unit,ICU)住院期间体质量变化对死亡率的影响。方法采用多中心回顾性队列研究,利用eICU-CRD数据库,纳入首次入院单次入住ICU且ICU住院时长>24 h的成年患者。采用单因素和多因素Logistic回归分析,并控制相关混杂因素,研究ICU住院期间体质量变化与死亡率之间的关系。在不同年龄组、急性生理和慢性健康评估Ⅳ评分(Acute Physiology and Chronic Health EvaluationⅣscore,APACHEⅣ)评分、ICU住院时长和入院时BMI基线水平中进行亚组分析。结果本研究共纳入ICU患者34311例,其中男性占比55.1%,白种人占比82.4%,≥65岁以上人群占比51.3%;与体质量降低组患者比较,体质量升高的患者出现肾衰竭(1938例,11.1%)、肝衰竭(106例,0.6%)和败血症(2442例,14.0%)的比例更高,并且体质量增加组的患者在ICU住院时长、医院住院时长和APACHEⅣ评分也较高。多因素Logistic回归模型结果显示体质量增加组患者的住院死亡率是体质量降低组的1.25倍(95%CI:1.16~1.36,P<0.001),ICU死亡率是体质量降低组的1.36倍(95%CI:1.22~1.50,P<0.001),而且在疾病严重程度较高、ICU住院时间较长的患者中更明显,并且研究结果不受年龄及BMI基线水平的影响。结论在成年患者中,体质量变化是其发生ICU死亡和医院死亡的独立危险因素。Objective To explore the effect of change in body mass on mortality during hospitalization in intensive care unit(ICU).Methods A multicenter and retrospective cohort study was conducted on patients who were firstly hospitalized in ICU and whose length of ICU stay were over 24 h,with data extracted from the eICU Collaborative Research Database.Univariate and multivariate logistic regression models were used to explore the relationship between body mass change and mortality in ICU patients.Interaction analysis was performed between body mass change and related covariates.Based on the results of interaction analysis and clinical practice,the association between body mass change and mortality was analyzed in subgroups stratified by age,Acute Physiology and Chronic Health Evaluation(APACHE)Ⅳscore,length of ICU stay and baseline BMI at ICU admission.Results A total of 34311 ICU patients were included,among which 55.1%were male,the white race accounted for 82.4%and 51.3%were≥65 years old.Compared with those with decreased body mass,patients with increased body mass had higher rates of renal failure(1938 cases,11.1%),liver failure(106 cases,0.6%),sepsis(2442 cases,14.0%),longer ICU stay,longer hospital stay and higher APACHEⅣscores.The multivariate logistic regression model showed the in-hospital and ICU mortality in patients with body mass gain were 1.25 times(95%CI:1.16~1.36,P<0.001)and 1.36 times(95%CI:1.22~1.50,P<0.001)higher than those with body mass decreased respectively.This difference is more significant in patients with higher APACHEⅣscore and the longer ICU stay.The different age subgroup or different baseline BMI levels exerted no effect on the results mentioned.Conclusion The change in body mass is the independent risk factor of the in-hospital and ICU motality.

关 键 词：体质量变化 ICU死亡率 医院死亡率 重症监护室 

分 类 号：R181.32[医药卫生—流行病学] R197.3[医药卫生—公共卫生与预防医学] R47