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Xu D, Lu Y, Wang Y, Li F. The obesity paradox and 90 day mortality in chronic critically ill patients: a cohort study using a large clinical database. Eur J Med Res 2024; 29:392. [PMID: 39075583 PMCID: PMC11285416 DOI: 10.1186/s40001-024-01962-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/04/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND This study investigates the obesity paradox, where obesity is linked to lower mortality in certain patient groups, focusing on its impact on long-term mortality in chronic critically ill (CCI) patients. METHODS We retrospectively analyzed CCI patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database's Intensive Care Unit, categorizing them into six groups based on Body Mass Index (BMI). Using stepwise multivariable Cox regression and restricted cubic spline models, we examined the association between BMI and 90 day mortality, accounting for confounding variables through subgroup analyses. RESULTS The study included 1996 CCI patients, revealing a 90 day mortality of 34.12%. Overweight and obese patients exhibited significantly lower mortality compared to normal-weight individuals. Adjusted analysis showed lower mortality risks in overweight and obese groups (HRs 0.60 to 0.72, p < 0.001). The cubic spline model indicated a negative correlation between BMI and 90 day mortality, with subgroup analyses highlighting interactions with age. CONCLUSION Our findings confirm the obesity paradox in CCI patients, especially among the elderly (65-85 years) and very elderly (≥ 85 years). The results suggest a beneficial association of higher BMI in older CCI patients, though caution is advised for those under 45.
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Affiliation(s)
- Danyu Xu
- Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yan Lu
- Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yan Wang
- Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Feng Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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Alas-Pineda C, Aguilar-Andino D, Vallecillo Munguia FA, Padilla David GM, Umaña AN, Romero Reyes L, Cárcamo A, Osorio AL, Zuniga-Moya J, Montalvan-Sanchez E, Atchley TJ, Laskay NMB, Estevez-Ordonez D, Garner O, Norwood DA. The effect of limited healthcare access on poor outcomes among hospitalized COVID-19 patients in Honduras: A single center cohort study. Heliyon 2024; 10:e24015. [PMID: 38234894 PMCID: PMC10792576 DOI: 10.1016/j.heliyon.2024.e24015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
Background The COVID-19 pandemic has had a severe impact on the Latin American subcontinent, particularly in areas with limited hospital resources and a restricted Intensive Care Unit (ICU) capacity. This study aimed to provide a comprehensive description of the clinical characteristics, outcomes, and factors associated with survival of COVID-19 hospitalized patients in Honduras. Research question What were the characteristics and outcomes of COVID-19 patients in a large referral center in Honduras? Study design and methods This study employed a retrospective cohort design conducted in a single center in San Pedro Sula, Honduras, between October 2020 to March 2021. All hospitalized cases of confirmed COVID-19 during this timeframe were included in the analysis. Univariable and multivariable survival analysis were performed using Kaplan-Meier curves and Cox proportional hazards model aiming to identify factors associated with decreased 30 day in-hospital survival, using a priori-selected factors. Results A total of 929 confirmed cases were identified in this cohort, with males accounting for 55.4 % of cases. The case fatality rate among the hospitalized patients was found to be 50.1 % corresponding to 466 deaths. Patients with comorbidities such as hypertension, diabetes, obesity, chronic kidney disease, chronic obstructive pulmonary disease and cardiovascular disease had a higher likelihood of mortality. Additionally, non-survivors had a significantly longer time from illness onset to hospital admission compared to survivors (8.2 days vs 4.7 days). Among the cohort, 306 patients (32.9 %) met criteria for ICU admission. However, due to limited capacity, only 60 patients (19·6 %) were admitted to the ICU. Importantly, patients that were unable to receive level-appropriate care had lower likelihood of survival compared to those who received level-appropriate care (hazard ratio: 1.84). Interpretation This study represents, the largest investigation of in-hospital COVID-19 cases in Honduras and Central America. The findings highlight a substantial case fatality rate among hospitalized patients. In this study, patients who couldn't receive level-appropriate care (ICU admission) had a significantly lower likelihood of survival when compared to those who did. These results underscore the significant impact of healthcare access during the pandemic, particularly in low- and middle-income countries.
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Affiliation(s)
- César Alas-Pineda
- Facultad de Medicina y Cirugía, Universidad Católica de Honduras – Campus San Pedro y San Pablo, San Pedro Sula, Cortés, Honduras
- Departamento de Epidemiología, Hospital Nacional Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
| | - David Aguilar-Andino
- Escuela Universitaria de Ciencias de la Salud, Universidad Nacional Autónoma de Honduras en el Valle de Sula, San Pedro Sula, Honduras
- Departamento de Epidemiología, Hospital Nacional Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
| | | | | | - Andrea N. Umaña
- Facultad de Medicina y Cirugía, Universidad Católica de Honduras – Campus San Pedro y San Pablo, San Pedro Sula, Cortés, Honduras
| | - Luis Romero Reyes
- Hospital Nacional Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Alejandro Cárcamo
- Hospital Nacional Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Ana Liliam Osorio
- Hospital Nacional Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Julio Zuniga-Moya
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Travis J. Atchley
- Department of Neurosurgery, School of Medicine, University of Birmingham at Alabama, AL, USA
| | | | | | - Orlando Garner
- Clinical Assistant Professor, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, TX, USA
| | - Dalton Argean Norwood
- Escuela Universitaria de Ciencias de la Salud, Universidad Nacional Autónoma de Honduras en el Valle de Sula, San Pedro Sula, Honduras
- Division of Preventive Medicine, School of Medicine, University of Birmingham at Alabama, AL, USA
- Minority Health & Health Equity Research Center, University of Birmingham at Alabama, AL, USA
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