期刊
CRITICAL CARE
卷 17, 期 3, 页码 -出版社
BMC
DOI: 10.1186/cc12794
关键词
-
资金
- Canadian Institutes of Health Research: Canada - British Columbia: St. Paul's Hospital
- Vancouver General Hospital
- Royal Jubilee Hospital
- Kelowna General Hospital
- Richmond General Hospital
- Royal Columbian Hospital
- St. Boniface Hospital
- Winnipeg Health Science Centre
- Ottawa Hospital, General Campus, University Health NetworkToronto General & Toronto Western Hospitals
- St. Joseph's Hospital
- Mount Sinai Hospital
- Ottawa Hospital
- Civic Campus
- St. Michael's Hospital
- Sunnybrook and Women's College Health Science Centre
- Hamilton Health Sciences Centre
- London Health Sciences Centre
- Sudbury Regional Hospital
- Charles LeMoyne Hospital
- Hotel-Dieu Grace Hospital
- Alfred Hospital
- Royal Melbourne Hospital
- Monash Medical Centre
- Royal Perth Hospital
- Flinders Medical Centre
- Phoenix
- Mayo Clinic Hospital
Introduction: Obesity is an increasingly common comorbidity in critically ill patients. Whether obesity alters sepsis outcome, susceptibility, treatment, and response is not completely understood. Methods: We conducted a retrospective analysis comparing three group of septic shock patients based on the intervals of actual body mass index (BMI) in patients enrolled in the VASST (Vasopressin and Septic Shock Trial) cohort. Primary outcome measurement was 28-day mortality. We tested for differences in patterns of infection by comparing the primary site of infection and organism. We also compared the treatments (fluids and vasopressors) and inflammatory response, measuring adipose tissue-related cytokine concentrations (interleukin [IL]-6, monocyte chemotactic protein [MCP]-1, tumor necrosis factor [TNF]-alpha, and resistin) in plasma in a subset of 382 patients. Of the 778 patients in VASST, 730 patients who had body weight and height measurements were analyzed. Patients with BMI < 25 kg/m(2) (n = 276) were grouped as a reference and compared to 'overweight' (25< BMI < 30 kg/m(2), n = 209) and 'obese' (BMI = 30 kg/m(2), n = 245) patients. Results: Obese patients had the lowest 28-day mortality followed by overweight patients while patients with BMI < 25 kg/m(2) had the highest mortality (p = 0.02). Compared to the patients with BMI < 25 kg/m(2), obese and overweight patients also had a different pattern of infection with less lung (obese 35%, overweight 45%, BMI<25 kg/m(2) 50%, p = 0.003) and fungal infection (obese 8.2%, overweight 11%, and BMI<25 kg/m(2) 15.6%, p = 0.03). Per kilogram, obese and overweight patients received less fluid during the first four days (p<0.05) and received less norepinephrine (obese 0.14, overweight 0.21, BMI < 25 kg/m(2) 0.26 mu g/kg/min, p<0.0001) and vasopressin (obese 0.28, overweight 0.36, BMI < 25 kg/m(2) 0.43 mu U/kg/min, p<0.0001) on day 1 compared to patients with BMI < 25 kg/m(2). Obese and overweight patients also had a lower plasma IL-6 concentration at baseline (obese 106 [IQR 34-686], overweight 190 [IQR 44-2339], BMI < 25 kg/m(2) 235 [IQR 44-1793] pg/mL, p = 0.046). Conclusions: Overall obesity was associated with improved survival in septic shock and differences in pattern of infection, fluids, and vasopressors. Importantly, the magnitude of inflammatory IL-6 response is muted in the obese.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据