体质指数与心房颤动病人死亡率相关性的Meta分析

[目的]探讨不同水平体质指数(BMI)与心房颤动病人全因死亡率及心血管疾病死亡率的关系。[方法]系统检索PubMed、EMbase、Web of Science、The Cochrane Library、中国知网(CNKI)、万方、维普数据库,检索时间自建库至2019年8月31日。由两名研究者分别独立提取数据,核对无误后应用RevMan 5.3软件进行数据合并。合格文献限定于研究BMI和心房颤动死亡率相关性的队列研究,BMI至少分2组,研究结果呈现各组死亡的相对风险比(HR)及95%置信区间(95%CI)。[结果]最终纳入11篇文献,其中1篇为回顾性队列研究,1篇为随机对照试验的事后分析,其余均为前瞻性队列研究,共包含54 685例心房颤动病人。Meta分析结果显示:全因死亡率,与正常体质指数组比较,低体质指数组死亡率更高[HR=1.89,95%CI(1.28,2.80),P=0.001],超重组死亡率更低[HR=0.73,95%CI(0.68,0.79),P0.000 01],肥胖组死亡率也更低[HR=0.65,95%CI(0.60,0.72),P0.000 01]。心血管疾病死亡率,与正常体质指数组比较,低体质指数组死亡率更高[HR=2.49,95%CI(1.38,4.50),P=0.003],超重组死亡率更低[HR=0.70,95%CI(0.59,0.85),P=0.000 2],肥胖组死亡率也更低[HR=0.73,95%CI(0.59,0.91),P=0.005]。[结论]当前证据显示,超重和肥胖可降低心房颤动病人的死亡率,而低体重则增加了心房颤动病人的死亡率。     

肌少症对心力衰竭患者预后影响的系统评价

目的 系统评价肌少症对心力衰竭患者预后的影响。方法 计算机检索PubMed、Web of Science、Embase、The Cochrane Library、CBM、CINAHL、CNKI、万方和维普数据库,并使用“滚雪球”法检索肌少症对心力衰竭患者预后相关的队列研究,检索时限从建库至2022年6月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果 本研究最终纳入8篇队列研究,包括2 261例患者。Meta分析结果显示,与非肌少症相比,有肌少症的心力衰竭患者全因死亡风险更高[HR=1.32,95%CI(1.18,1.47),P<0.001],且肌少症也会增加心力衰竭患者心源性不良事件发生的风险[HR=1.01,95%CI(1.01,1.02),P<0.001]。亚组分析结果显示,肌少症对急性失代偿性心力衰竭患者的全因死亡没有影响[HR=1.26,95%CI(1.00,1.59),P=0.05],但会增加慢性心力衰竭患者全因死亡的风险[HR=1.61,95%CI(1.09,2.36),P=0.02]。结论 本...     

衰弱与非心血管手术心力衰竭患者结局的Meta分析

目的 系统评价衰弱对非心血管手术心力衰竭患者预后的影响。方法 计算机检索CNKI、VIP、CBM、WanFang Data、PubMed、EMbase、Web of Science和The Cochrane Library数据库,搜集关于衰弱对非心血管手术心力衰竭患者预后影响的队列研究,检索时限均从建库至2021年11月1日。由2名研究者独立筛选文献,提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件和Stata 14.0软件进行Meta分析。结果 共纳入20个研究,包括11 127例患者。Meta分析结果显示：衰弱增加非心血管手术心力衰竭患者全因死亡[HR=1.72,95%CI(1.61,1.84),P<0.000 01]、住院[HR=2.06,95%CI(1.26,3.37),P=0.004]和联合终点风险[HR=1.59,95%CI(1.37,1.84),P<0.000 01]。结论 当前证据表明,衰弱可增加非心血管手术心力衰竭患者全因死亡、住院、联合终点风险。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。     

体重指数与白血病关系病例对照研究的Meta分析

目的比较不同体重指数(BMI)在白血病发病风险中的相关性。方法在Pub Med、Web of Science、万方数据库、中国知网、中国生物医学文献等数据库中,检索从2000年1月至2015年7月发表的不同BMI与白血病发病关系的病例对照研究。根据纳入标准和排除标准进行资料的提取,并对纳入的病例对照研究进行质量评价,采用Rev Man5.3软件对其进行Meta分析。结果共有四个病例对照研究纳入本Meta分析,其文献质量的评分均为4分以上,其中,白血病患者共2 681例(病例组),非白血病及相关肿瘤的其他患者共7 389例(对照组)。Meta分析显示,低BMl组的合并效应量OR=0.84[95%CI(0.62~1.13),P=0.26],超重组的合并效应量OR=0.93[95%CI(0.72~1.20),P=0.59],肥胖组的合并效应量OR=1.38[95%CI(0.96~2.00),P=0.08]。结论 BMI与白血病的发病风险呈正相关,提示低BMI可能是白血病发病的保护性因素,而肥胖可能是白血病发病的危险因素。     

极低热量生酮饮食对超重/肥胖人群减重干预有效性和安全性的Meta分析

目的 系统评价极低热量生酮饮食（VLCKD）对超重/肥胖人群减重干预的有效性和安全性。方法 计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CNKI、WanFang Data、VIP和CBM数据库,搜集超重/肥胖患者使用VLCKD干预的随机对照试验（RCT）,检索时限均从建库至2021年8月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件进行Meta分析。结果 共纳入5个RCT,包括245例超重/肥胖症患者。Meta分析结果显示：当基线BMI≥30 kg/m2时,与对照组饮食相比,VLCKD能够降低超重/肥胖患者的身体质量指数（BMI）[MD=-2.92,95%CI（-4.33,-1.50）,P<0.05]、体质量[MD=-7.00,95%CI（-10.48,-3.53）,P<0.05]和腰围[MD=-7.40,95%CI（-12.68,-2.12）,P<0.05]。亚组分析结果显示,VLCKD与对照组相比,可降低超重/肥胖且患有糖尿病人群的血糖[MD=-9.60...     

冠状动脉钙化积分与冠状动脉疾病及全因性死亡相关性的Meta分析

目的系统评价冠状动脉钙化积分(CACS)与冠状动脉疾病(CAD)及全因死亡事件相关性。方法计算机检索Pubmed、The Cochrane Library、EMbase、CKNI、WanFang Data数据库,搜集CACS与CAD及全因性死亡(All-cause mortality)相关性的队列研究,检索时限从建库至2020年6月。由2名资料员提取文献并进行评价纳入研究的偏倚风险后,采用Stata 14.0软件进行Meta分析。结果纳入11个队列研究,包括59143例被研究者。Meta结果显示:与CACS<10相比,CACS≤100组[HR=2.46,95%CI(1.77,3.41),P=0.000,I^(2)=55.5%]、100     

老年营养风险指数预测维持性血液透析患者结局的Meta分析

目的老年营养风险指数(geriatric nutritional risk index,GNRI)作为常用的营养风险筛查工具,用于评估多种病理条件下的营养状况。本文系统评价GNRI与维持性血液透析患者预后的相关性。方法通过检索web of science、Pubmed、Embase、Cochrane Library和中国知网、万方医学数据库收集相关文章。结局指标为维持性血液透析患者全因死亡率、心血管死亡率及心血管事件。检索的截止日期是2020年11月。通过Review Manager 5.3提取和汇集HR值及其95%CI及其他的相关信息。结果共纳入20项研究,10 162名患者。Meta分析结果表明,未设定截断值时,GNRI预测维持性血液透析患者的全因死亡风险结局(HR=0.96,95%CI:0.94～0.98,P0.001)、心血管死亡率结局(HR=0.94,95%CI:0.91～0.980,P0.001)有统计学意义,而心血管事件结局(HR=0.96,95%CI:0.86～1.08,P=0.510)无统计学意义。设定截断值后二分类值GNRI与维持性血液透析患者的全因死亡率结局(HR=2.13,95%CI:1.84～2.46,P0.001)、心血管死亡率(HR=2.00,95%CI:1.04～3.88,P=0.040)有统计学意义。结论 GNRI与维持性血液透析患者的全因死亡率、心血管死亡率有关,GNRI可以作为维持性血液透析患者不良结局的预测指标。     

体重指数与恶性淋巴瘤关系病例对照研究的Meta分析

目的采用Meta分析的方法探讨体重指数(BMI)与恶性淋巴瘤的关系。方法计算机检索Web of Science、PubMed、EMbase、CNKI、WanFang Data、VIP和CBM等国内外数据库,检索时间均从建库至2011年4月,查找BMI与恶性淋巴瘤发病关系的病例对照研究。由两位研究者按照纳入与排除标准进行资料提取和质量评价后,采用RevMan 5.0软件对各研究进行数据合并与分析。结果共纳入7个病例对照研究,合计8 416例恶性淋巴瘤患者和14 760例非恶性淋巴瘤的其他患者。7个纳入研究的质量评分均在4分以上,说明质量较可靠。Meta分析结果显示:低BMI人群的OR合并值为0.8[695%C(I0.79,0.95),P=0.003],超重人群的OR合并值为1.0[495%CI(0.98,1.11),P=0.16],肥胖人群的OR合并值为1.22[95%CI(1.04,1.43),P=0.01];对病理类型进行分层分析后发现,在弥漫性大B细胞淋巴瘤中肥胖者OR合并值为1.33[95%CI(1.18,1.50),P<0.000 01],而是否肥胖在滤泡性淋巴瘤和小淋巴细胞淋巴瘤/淋巴细胞白血病发生情况的亚组分析中,其差异无统计学意义。结论本Meta分析结果显示低BMI是恶性淋巴瘤的保护性因素,而肥胖是恶性淋巴瘤尤其是弥漫性大B细胞淋巴瘤发病的危险因素。     

LABA/ICS与LAMA对比治疗慢性阻塞性肺疾病稳定期的有效性和安全性META分析

目的:以Meta分析方法,对长效β_2受体激动剂/糖皮质激素联用(LABA/ICS)和长效抗胆碱药(LA-MA)治疗慢性阻塞性肺疾病(COPD)的有效性及安全性进行系统评价。方法:计算机检索Pub Med、EMbase、The Cochrane Library(CENTRAL)、Web of Science、Clinicaltrials.gov数据库,搜集关于LABA/ICS和LAMA治疗COPD相关的随机对照试验(RCTs),检索日期为建库起至2017年6月,使用Rev Man 5.3软件进行Meta分析。结果:Meta分析共纳入9个RCTs,研究对象2610人。结果得出:LABA/ICS与LAMA相比较,FEV1基线改变值[MD=15.48,95%CI(-20.77,51.74),P=0.40],1年以上随访期急性加重事件[MD=0.00,95%CI(-0.18,0.18),P=0.99],3-5月随访期急性加重事件[OR=0.76,95%CI(0.42,1.40),P=0.38],生活质量评价[SMD=-0.07,95%CI(-0.17,0.02),P=0.14]及全部不良事件[OR=1.14,95%CI(0.97,1.35),P=0.12]无明显差异;严重不良事件[OR=1.28,95%CI(1.02,1.61),P=0.03]及肺炎发病率[OR=2.14,95%CI(1.30,3.52),P=0.003]方面,LAMA小于LABA/ICS;全因死亡率[OR=0.52,95%CI(0.31,0.86),P=0.01],LABA/ICS小于LAMA。结论:LABA/ICS与LAMA对于改善FEV1、减少急性加重、提高生活质量方面有类似的效果。LABA/ICS增加肺炎风险,但全因死亡率较LAMA低,提示肺炎可能不会提高死亡率。受纳入研究质量和数量限制,上述结论应谨慎解读,需纳入更多高质量RCTs进一步验证。     

红细胞分布宽度与维持性血液透析患者预后关系的Meta分析

目的 通过Meta分析系统评价红细胞分布宽度(RDW)对维持性血液透析(MHD)患者的预后评估价值,进一步为临床判断提供理论支持。方法 检索中国知网、万方数据服务平台、中国生物医学数据库、PubMed、EMbase和The Cochrane Library数据库,全面搜索有关RDW与MHD患者预后关系的前瞻性与回顾性队列研究,检索时限为建库至2022年6月,由两名研究人员按照纳入与排除标准独立进行文献筛选、资料提取,并利用纽卡斯尔-渥太华量表进行质量评价,使用R 4.1.2软件分析数据。结果 共纳入13篇队列研究文献,合计113 535例MHD患者。RDW与MHD患者预后的关系：当RDW为连续性变量时,RDW每增加1%,全因死亡的风险增加32%(HR=1.32,95%CI:1.23～1.41),心血管疾病死亡风险增加42%(HR=1.42,95%CI:1.25～1.62);RDW为分类变量时,高RDW组全因死亡风险是低RDW组的1.36倍(HR=1.36,95%CI:1.13～1.64),高RDW组心血管疾病死亡风险是低RDW组的1.75倍(HR=1.75,95%CI:1.19～2.5...     

Overweight is associated with improved survival and outcomes in patients with atrial fibrillation

Background

The aim of this study was to investigate the association of body mass index (BMI) with mortality and cardiovascular events in Chinese patients with atrial fibrillation (AF).

Methods and results

This study consecutively enrolled AF patients presenting to an emergency department at 20 hospitals in China from November 2008 to October 2011. A total of 2,016 AF patients was enrolled, and patients were categorized as underweight (BMI <18.5), normal (BMI 18.5 to <24), overweight (BMI 24 to <28), and obese (BMI ≥28 all kg/m²). Multivariate Cox proportional hazards regression was used on all the patients. End points of the analyses were all-cause mortality, cardiovascular mortality, and combined end events. Among overall patients, mean BMI was 23.5 ± 3.6 kg/m²; 279 (13.8 %) patients died during 12-month follow-up, and so did 23.2 % underweight, 16.3, 9.5 and 9.2 % normal weight, overweight, and obese patients, respectively (P < 0.001). Cardiovascular mortality was 8.3% in all patients, and in underweight, normal weight, overweight and obese categories were 16.5, 9.0, 5.4 and 6.9 %, respectively (P < 0.001). On multivariate analysis, as continuous variable, BMI was not a risk factor for all-cause mortality in AF patients (hazard ratio [HR] 0.94; 95 % confidence interval [CI] 0.91–0.97; P = 0.001). As categorical variable, underweight (HR 1.57, 95 % CI 1.02–2.42, P = 0.041) and normal weight (HR 1.53, 95 % CI 1.13–2.06, P = 0.005) categories were associated with higher all-cause mortality as compared with overweight category. Underweight (HR 2.01, 95 % CI 1.76–3.43, P = 0.011) and normal weight patients (HR 1.53, 95 % CI 1.03–2.28, P = 0.037) also had higher cardiovascular mortality as compared with the overweight category.

Conclusions

Obesity and overweight were not risk factors for 12-month mortality in Chinese AF patients. Overweight AF patients have better survival and outcomes than normal weight (BMI 18.5–24 kg/m²) and underweight patients.     

Being overweight or obese is associated with decreased mortality in critically ill patients: A retrospective analysis of a large regional Italian multicenter cohort

Purpose

To describe the epidemiology of obesity in a large cohort of intensive care unit (ICU) patients and study its impact on outcomes.

Methods

All 3902 patients admitted to one of 24 ICUs in the Piedmont region of Italy from April 3 to September 29, 2006, were included in this retrospective analysis of data from a prospective, multicenter study.

Results

Mean body mass index (BMI) was 26.0 ± 5.4 kg/m²: 32.8% of patients had a normal BMI, 2.6% were underweight, 45.1% overweight, 16.5% obese, and 2.9% morbidly obese. ICU mortality was significantly (P < .05) lower in overweight (18.8%) and obese (17.5%) patients than in those of normal BMI (22%). In multivariate logistic regression analysis, being overweight (OR = 0.73; 95%CI: 0.58-0.91, P = .007) or obese (OR = 0.62; 95%CI: 50.45-0.85, P = .003) was associated with a reduced risk of ICU death. Being morbidly obese was independently associated with an increased risk of death in elective surgery patients whereas being underweight was independently associated with an increased risk of death in patients admitted for short-term monitoring and after elective surgery.

Conclusions

In this cohort, overweight and obese patients had a reduced risk of ICU death. Being underweight or morbidly obese was associated with an increased risk of death in some subgroups of patients.     

Impact of obesity on outcomes in patients with acute respiratory syndrome

ObjectivesWe assessed the relationship between obesity and all-cause mortality in patients with acute respiratory distress syndrome (ARDS).MethodsIn this retrospective cohort study, patient data were extracted from the eICU Collaborative Research Database and the Medical Information Mart for Intensive Care Database III. Body mass index (BMI) was grouped according to World Health Organization classifications: underweight, normal weight, overweight, obese. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality related to obesity.ResultsParticipants included 185 women and 233 men, mean age 70.7 ± 44.1 years and mean BMI 28.7 ± 8.1 kg/m². Compared with normal weight patients, obese patients tended to be younger (60.1 ± 13.7 years) and included more women (51.3% vs. 49.0%). In the unadjusted model, HRs (95% CIs) of 30-day mortality for underweight, overweight, and obesity were 1.57 (0.76, 3.27), 0.64 (0.39, 1.08), and 4.83 (2.25, 10.35), respectively, compared with those for normal weight. After adjustment, HRs (95% CIs) of 30-day mortality for underweight, overweight, and obesity were 1.82 (0.85, 3.90), 0.59 (0.29, 1.20), and 3.85 (1.73, 8.57), respectively, compared with the reference group; 90-day and 1-year all-cause mortalities showed similar trends.ConclusionsObesity was associated with increased all-cause mortality in patients with ARDS.     

Obesity is a risk factor for peritonitis in the Australian and New Zealand peritoneal dialysis patient populations.

OBJECTIVE: The aim of the present investigation was to examine the association between body mass index (BMI) and peritonitis rates among incident peritoneal dialysis (PD) patients in a large cohort with long-term follow-up. DESIGN: Retrospective observational cohort study of the Australian and New Zealand PD patient population. SETTING: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. PARTICIPANTS: The study included all incident adult patients (n = 10 709) who received PD in Australia and New Zealand in the 12-year period between 1 April 1991 and 31 March 2003. Patients were classified as obese (BMI > or = 30 kg/m2), overweight (BMI 25.0 - 29.9 kg/m2), normal weight (20 - 24.9 kg/m2), or underweight (< 20 kg/m2). MAIN MEASUREMENTS: Time to first peritonitis and episodes of peritonitis per patient-year were recorded over the 12-year period. RESULTS: Higher BMI was associated with a shorter time to first peritonitis episode, independent of other risk factors [hazard ratio 1.08 for each 5-kg/m2 increase in BMI, 95% confidence interval (CI) 1.04 - 1.12, p < 0.001]. When peritonitis outcomes were analyzed as episodes of peritonitis per patient-year, these rates were significantly higher among patients with higher BMI: underweight 0.69 episodes/year (95% CI 0.66 - 0.73), normal weight 0.79 (95% CI 0.77 - 0.81), overweight 0.88 (95% CI 0.85 - 0.90), obese 1.06 (95% CI 1.02 - 1.09). Coronary artery disease and chronic lung disease were associated with both shorter time to first peritonitis and higher peritonitis rates, independently of these other factors. There was also a "vintage effect," with lower peritonitis rates seen among people who commenced dialysis in more recent years. CONCLUSIONS: Higher BMI at the commencement of renal replacement therapy is a significant risk factor for peritonitis. The mechanisms for this remain undefined.     

The role of body mass index in the development of thromboembolic events among cancer patients with PICCs: a systematic review

ObjectivePeripherally inserted central catheters (PICC) guarantee a stable and safe vascular access to administer irritants or vesicants therapies. However, they may occasionally be affected by relevant thrombotic complications especially in patients with hypercoagulability such as oncological patients. Among the identification of independent risk factors, the role of body mass index (BMI) ≥25 kg/m² is now emerging in literature with conflicting results. The aim of this systematic review is to analyze the available scientific literature in order to determine whether BMI could represent a risk factor in the development of thromboembolic event among cancer patients with PICCs.Data sources and review methodsA scientific literature review was performed in Pubmed, Embase and Cinahl from Jan 1, 2010 to September 10, 2020 in which we identified 100 records. Of these, 88 were excluded and 14 were reviewed in full text. Among the reviewed records, 6 articles satisfied the inclusion criteria for analysis. These criteria included the English language, oncological patients with PICCs, the evaluation of catheter-related thrombosis as well as the stratification of patients according to BMI. Studies off topic and lacking data on PICC related complications among overweight and underweight patients were excluded. The includedstudies, judged with Newcastle-Ottawa Scale, was fair-lower quality. The primary endpoint was the relative risk (RR) of PICC-related thrombosis of overweight/obese vs normal weight/underweight (i.e., BMI ≥25 vs <25 kg/m²) in cancer patients.ResultsA total of 2431 patients were included in the analysis. Overall, 15.1% of patients developed PICC-related thrombosis within a median time of 23.2 days (range 11.0-42.5) after PICC implantation. Concerning BMI, 52.6% of the entire population was overweight/obese. We assessed the proportion of patients with PICC-related thrombotic events in the two groups, with 28% (95% CI, 12%-45%) of events registered in the overweight/obese patients cohort, and 13% (95% CI, 6%-19%) in the normal weight/underweight cohort. The pooled relative risk (RR) was 2.06 (95% CI, 1.21-3.49, p<0.001) in overweight/obese vs normal weight/underweight patients.ConclusionThis review showed a two-fold risk of thrombosis in overweight/obese compared to normal weight/underweight oncological patients with PICCs. Underweight condition could also play a role in thrombosis development, especially in nasopharyngeal and digestive system cancer. Future prospective studies are needed to achieve reliable results and produce useful conclusion.     

Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

♦ Objectives: We studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up.♦ Methods: We followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m²) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m²; overweight, 23 - 24.9 kg/m²; normal, 18.5 - 22.9 kg/m² (reference category); and underweight, <18.5 kg/m². The outcomes of interest were compared between the groups.♦ Results: Of the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality (p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate (p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients.Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient-months (95% CI: 20.9 to 31.0 patient-months), 50 patient-months (95% CI: 33.6 to 66.4 patient-months), 57.7 patient-months (95% CI: 33.2 to 82.2 patient-months), and 49 patient-months (95% CI: 18.4 to 79.6 patient-months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients.♦ Conclusions: In our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.     

Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury

OBJECTIVE: To determine the association between body mass index (BMI) and hospital mortality for critically ill adults. DESIGN: Retrospective cohort study. SETTING: One-hundred six intensive care units (ICUs) in 84 hospitals. PATIENTS: Mechanically ventilated adults (n=1,488) with acute lung injury (ALI) included in the Project IMPACT database between December 1995 and September 2001. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Over half of the cohort had a BMI above the normal range. Unadjusted analyses showed that BMI was higher among subjects who survived to hospital discharge vs. those who did not (p<.0001). ICU and hospital mortality rates were lower in higher BMI categories. After risk-adjustment, BMI was independently associated with hospital mortality (p<.0001) when modeled as a continuous variable. The adjusted odds were highest at the lowest BMIs and then declined to a minimum between 35 and 40 kg/m2. Odds increased after the nadir but remained below those seen at low BMIs. With use of a categorical designation, BMI was also independently associated with hospital mortality (p=.0055). The adjusted odds were highest for the underweight BMI group (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.05-3.60) relative to the normal BMI group. As in the analysis using the continuous BMI variable, the odds of hospital mortality were decreased for the groups with higher BMIs (overweight adjusted OR, 0.72; 95% CI, 0.51-1.02; obese adjusted OR, 0.67; 95% CI, 0.46-0.97; severely obese adjusted OR, 0.78; 95% CI, 0.44-1.38). Differences in the use of heparin prophylaxis mediated some of the protective effect of severe obesity. CONCLUSIONS: BMI was associated with risk-adjusted hospital mortality among mechanically ventilated adults with ALI. Lower BMIs were associated with higher odds of death, whereas overweight and obese BMIs were associated with lower odds.     

Relationship of Body Mass Index With Total Mortality,Cardiovascular Mortality,and Myocardial Infarction After Coronary Revascularization: Evidence From a Meta-analysis

ObjectiveTo investigate the relationship of body mass index (BMI) with total mortality, cardiovascular (CV) mortality, and myocardial infarction (MI) after coronary revascularization procedures (coronary artery bypass grafting [CABG] and percutaneous coronary intervention [PCI]).Patients and MethodsSystematic search of studies was conducted using PubMed, CINAHL, Cochran CENTRAL, Scopus, and the Web of Science databases. We identified studies reporting the rate of MI, CV mortality, and total mortality among coronary artery disease patients' postcoronary revascularization procedures in various BMI categories: less than 20 (underweight), 20-24.9 (normal reference), 25-29.9 (overweight), 30-34.9 (obese), and 35 or more (severely obese). Event rates were compared using a random effects model assuming interstudy heterogeneity.ResultsA total of 36 studies (12 CABG; 26 PCI) were selected for final analyses. The risk of total mortality (relative risk [RR], 2.59; 95% CI, 2.09-3.21), CV mortality (RR, 2.67; 95% CI, 1.63-4.39), and MI (RR, 1.79; 95% CI, 1.28-2.50) was highest among patients with low BMI at the end of a mean follow-up period of 1.7 years. The risk of CV mortality was lowest among overweight patients (RR, 0.81; 95% CI, 0.68-0.95). Increasing degree of adiposity as assessed by BMI had a neutral effect on the risk of MI for overweight (RR, 0.92; 95% CI, 0.84-1.01), obese (RR, 0.99; 95% CI, 0.85-1.15), and severely obese (RR, 0.93; 95% CI, 0.78-1.11) patients.ConclusionAfter coronary artery disease revascularization procedures (PCI and CABG), the risk of total mortality, CV mortality, and MI was highest among underweight patients as defined by low BMI and CV mortality was lowest among overweight patients.     

Gamma glutamyltransferase and long-term survival: is it just the liver?

BACKGROUND: Increased gamma glutamyltransferase (GGT) is associated with cardiovascular disease. To date, however, few studies with sufficient sample size and follow-up have investigated the association of GGT with all-cause mortality. METHODS: The relation of GGT to the risk of death was examined in a cohort of 283 438 first attendants (inpatients or outpatients) of the Vienna General Hospital with request for GGT analysis as part of a routine screening panel and was monitored for up to 13 years. To evaluate GGT as a predictor, Cox proportional hazards models were calculated, which were adjusted for age and sex. RESULTS: In both men and women, GGT above the reference category (GGT > or = 9 U/L in women, > or = 14 U/L in men) was significantly (P <0.001) associated with all-cause, cancer, hepatobiliary, and vascular mortalities. Hazard ratios (HRs) for men and women were similar in all categories. Among patients who presented with GGT above the reference category, those younger than 30 years had higher all-cause mortality rates than did older individuals (HR 1.5-3.3 vs HR 1-1.3 >80 years, respectively). CONCLUSIONS: GGT is associated with mortality in both men and women, especially in patients younger than 30 years, and even high-normal GGT is a risk factor for all-cause mortality.     

低骨密度与卒中发生风险及全因死亡风险队列研究的Meta分析

目的 系统评价低骨密度(骨量减少和骨质疏松)与卒中发病风险及死亡风险的关系.方法 计算机检索中国知网数据库、万方数据库、维普中文期刊服务平台、PubMed、Embase、Cochrane Library数据库自建库至2020年2 月关于低骨密度和卒中发生风险及死亡风险的队列研究文献,由两名审查员根据纳入及排除标准独立筛...