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腾讯登录患败血症的肥胖患者或更易于存活
| 导读 | 近日，刊登在国际杂志Critical Care Medicine上的一篇研究论文中，来自美国密歇根大学医学院的研究人员通过研究表明，肥胖病人在入院治疗败血症后或许更易于存活，败血症是一种院内危机病人生命的感染性疾病。 |
近日，刊登在国际杂志Critical Care Medicine上的一篇研究论文中，来自美国密歇根大学医学院的研究人员通过研究表明，肥胖病人在入院治疗败血症后或许更易于存活，败血症是一种院内危机病人生命的感染性疾病。
文章中研究人员揭示了肥胖如何影响患者机体对感染的反应，研究者对1404名参与者进行调查研究，发现重症病人更易于因患致死性感染而存活，因为一旦其感染致死性疾病就需要在医院的重症监护室进行治疗，这往往会使得患者得到及时救治而延缓其寿命。肥胖往往会对个体的健康不良，研究者Hallie C. Prescott博士说道，医生们认为肥胖病人的机体素质很差，这会影响患者机体的健康及治疗情况；而这项研究中，研究者发现，患败血症的肥胖病人实际上死亡率较低，而且其具有和正常体重病人的一样的预后结果。
文章中研究人员重点调查了个体的体重指数和患严重院内败血症感染的功能缺陷之间的关联。败血症的发生在过去15年里增长了两倍，已经引起了科学家们的极大关注，因败血症得以生存的病人在入院治疗期间需要进行很长的治疗才可以康复，而因败血症入院得以存活的肥胖缓则则需要更多的健康护理来帮助恢复其身体健康。
研究者指出，体重过重或许会引发机体对危重病表现出不同的反应，而更好地理解这其中的差异或许可以帮助有效改善败血症患者或其它危重病患者的生存质量和机体健康。（转化医学网360zhyx.com）
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转化医学网推荐的原文摘要：
Obesity and 1-year outcomes in older Americans with severe sepsis.
Crit Care Med doi: 10.1097/CCM.0000000000000336
Prescott HC1, Chang VW, O'Brien JM Jr, Langa KM, Iwashyna TJ.
OBJECTIVES:Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index.
DESIGN:Observational cohort study.
SETTING:U.S. hospitals.
PATIENTS:We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64).
CONCLUSIONS:Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.
Comment in：Comorbidity or covert advantage? The obesity conundrum*. [Crit Care Med. 2014]
Crit Care Med doi: 10.1097/CCM.0000000000000336
Prescott HC1, Chang VW, O'Brien JM Jr, Langa KM, Iwashyna TJ.
OBJECTIVES:Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index.
DESIGN:Observational cohort study.
SETTING:U.S. hospitals.
PATIENTS:We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64).
CONCLUSIONS:Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.
Comment in：Comorbidity or covert advantage? The obesity conundrum*. [Crit Care Med. 2014]
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