Woo Hyun Cho1, Jin Young Oh2, Hye Ju Yeo3, Junhee Han4, Junghyun Kim5, Sang-Bum Hong6, Chi Ryang Chung7, So Hee Park8, Seung Yong Park9, Yun Su Sim10, Young-Jae Cho11, Sunghoon Park12, Byung Ju Kang13. 1. Department of Pulmonology and Critical Care Medicine, Pusan National University Yangsan Hospital, Republic of Korea. 2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Republic of Korea. 3. Department of Pulmonology and Critical Care Medicine, Pusan National University Yangsan Hospital, Republic of Korea. Electronic address: dugpwn@naver.com. 4. Department of Statistics, Hallym University, Republic of Korea. 5. Division of Pulmonary, Allergy, and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Republic of Korea. 6. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea. 7. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea. 8. Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Republic of Korea. 9. Department of Internal Medicine, Chonbuk National University Medical School, Republic of Korea. 10. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Kangnam Sacred Heart Hospital, Republic of Korea. 11. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea. 12. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Republic of Korea. 13. Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea.
Abstract
PURPOSE: To investigate whether the obesity survival paradox, where obesity is associated with improved survival, exists for pneumonia supported with extracorporeal membrane oxygenation (ECMO). MATERIALS AND METHODS: Between January 2014 and December 2015, 223 patients with acute respiratory failure who underwent ECMO in 11 hospitals in South Korea were enrolled retrospectively, and data relating to pneumonia cases were analyzed. Patients were divided into groups according to their pre-treatment body mass index (BMI): obese (BMI ≥ 25 kg/m2) and non-obese (BMI < 25 kg/m2). The BMI cut-off was adopted from the World Health Organization for Asian populations. RESULTS: In total, 84 patients had pneumonia: obese group, 26; non-obese group, 58 (mean BMI, 27.8 vs. 21.4, p < 0.001). Pre-ECMO parameters and rescue therapy did not differ between the groups. The rate of successful weaning from ECMO was not different between the groups (76.9% vs. 72.4%, p = 0.753), but survival-to-discharge (73.1% vs. 36.2%, p = 0.002) and 6-month survival (69.2% vs. 36.2%, p = 0.005) rates were higher in the obese group. After adjusting for age and the pre-treatment PaO2/FiO2 ratio, low BMI was significantly associated with 6-month mortality (odds ratio 3.28, 95% confidence interval: 1.06-11.03, p = 0.044). CONCLUSIONS: An obesity survival paradox exists in pneumonia supported with ECMO.
PURPOSE: To investigate whether the obesity survival paradox, where obesity is associated with improved survival, exists for pneumonia supported with extracorporeal membrane oxygenation (ECMO). MATERIALS AND METHODS: Between January 2014 and December 2015, 223 patients with acute respiratory failure who underwent ECMO in 11 hospitals in South Korea were enrolled retrospectively, and data relating to pneumonia cases were analyzed. Patients were divided into groups according to their pre-treatment body mass index (BMI): obese (BMI ≥ 25 kg/m2) and non-obese (BMI < 25 kg/m2). The BMI cut-off was adopted from the World Health Organization for Asian populations. RESULTS: In total, 84 patients had pneumonia: obese group, 26; non-obese group, 58 (mean BMI, 27.8 vs. 21.4, p < 0.001). Pre-ECMO parameters and rescue therapy did not differ between the groups. The rate of successful weaning from ECMO was not different between the groups (76.9% vs. 72.4%, p = 0.753), but survival-to-discharge (73.1% vs. 36.2%, p = 0.002) and 6-month survival (69.2% vs. 36.2%, p = 0.005) rates were higher in the obese group. After adjusting for age and the pre-treatment PaO2/FiO2 ratio, low BMI was significantly associated with 6-month mortality (odds ratio 3.28, 95% confidence interval: 1.06-11.03, p = 0.044). CONCLUSIONS: An obesity survival paradox exists in pneumonia supported with ECMO.
Authors: Jarosław Janc; Lidia Łysenko; Olga Lewandowska; Olimpia Chrzan; Michał Suchański; Marek Gemel; Patrycja Leśnik Journal: Int J Environ Res Public Health Date: 2022-02-27 Impact factor: 3.390