肥胖与小儿危重哮喘ICU住院时长之间的关联

摘要(中文译文)

评估肥胖与危重哮喘患儿ICU住院时间（LOS）之间的关联，并评估社会经济因素是否会改变这一关系。一项多中心回顾性队列研究，使用虚拟PICU系统（VPS）数据库，纳入2010年至2020年间因哮喘入住ICU的2-19岁儿童。患者按体重指数（BMI）百分位进行分类。患有慢性疾病及缺失相关数据的儿童被排除。采用多变量Cox回归和logistic回归模型进行分析，并校正混杂因素。研究涵盖VPS数据库中的所有PICU。共纳入来自53个中心的16,412名儿童，其数据足以判定BMI、种族和保险类型。无干预措施。主要结局为存活者中ICU出院的风险比，以ICU LOS作为时间-事件变量。次要结局包括入住ICU第一小时内及第一小时后使用有创或无创机械通气（NIV）的情况。肥胖与存活者中较低的ICU出院风险比相关（风险比[HR] 0.87 [95% CI，0.83-0.91]），与较长的ICU LOS一致。肥胖与第一小时内机械通气（MV）的较高比值比相关（比值比[OR] 1.24 [95% CI，1.12-1.39]），第一小时后亦如此（OR 1.63 [95% CI，1.39-1.92]）。在校正年龄、性别、种族、保险类型、肺炎诊断、转运状态及整体疾病严重程度（儿童死亡风险III）后，这些关联仍然存在。在黑人儿童中，肥胖与较长的ICU LOS无关（HR 0.95 [95% CI，0.89-1.03]，p = 0.22）。除此之外，种族和保险类型未显著改变这些关联。肥胖与危重哮喘患儿较长的ICU住院时间和增加的呼吸支持独立相关。这些发现在不同种族和社会经济群体中基本一致。

Abstract

To evaluate the association between obesity and ICU length of stay (LOS) in children with critical asthma and assess whether socioeconomic factors modify this relationship. A multicenter retrospective cohort study using the Virtual PICU Systems (VPS) database of children 2-19 years old admitted to ICUs with asthma between 2010 and 2020. Patients were classified by body mass index (BMI) percentile. Children with chronic medical conditions and those missing relevant data were excluded. Multivariable Cox and logistic regression models were performed and adjusted for confounders. All PICUs in the VPS database. A total of 16,412 children from 53 centers with available data to assign BMI, race, and insurance type were included. None. The primary outcome was hazard of ICU discharge among survivors, with ICU LOS as the time-to-event variable. Secondary outcomes included the use of invasive or noninvasive mechanical ventilation (NIV) within the first hour of ICU admission and after the first hour. Obesity was associated with a lower hazard of ICU discharge among survivors (hazard ratio [HR] 0.87 [95% CI, 0.83-0.91]), consistent with longer ICU LOS. Obesity was associated with higher odds of MV in the first hour (odds ratio [OR] 1.24 [95% CI, 1.12-1.39]) and after the first hour (OR 1.63 [95% CI, 1.39-1.92]). These associations remained after adjustment for age, sex, race, insurance type, pneumonia diagnosis, transfer status, and overall severity of illness (Pediatric Risk of Mortality III). Among Black children, obesity was not associated with longer ICU LOS (HR 0.95 [95% CI, 0.89-1.03], p = 0.22). Otherwise, race and insurance type did not significantly modify these associations. Obesity is independently associated with longer ICU stays and increased respiratory support in children with critical asthma. These findings are predominantly consistent across racial and socioeconomic groups.

如何引用

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 的其他文献

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