The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox

. 2022 Dec ; 72 () : 154162. [epub] 20221008

Jazyk angličtina Země Spojené státy americké Médium print-electronic

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/pmid36219946
Odkazy

PubMed 36219946
PubMed Central PMC9547545
DOI 10.1016/j.jcrc.2022.154162
PII: S0883-9441(22)00191-5
Knihovny.cz E-zdroje

PURPOSE: The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS. MATERIALS AND METHODS: The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed. RESULTS: 292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome. CONCLUSIONS: The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.

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Schetz M., De Jong A., Deane A.M., Druml W., Hemelaar P., Pelosi P., et al. Obesity in the critically ill: a narrative review. Intensive Care Med. 2019;45(6):757–769. PubMed

Centre ICNAR ICNARC registry. 2021. https://wwwicnarcorg/Our-Audit/Audits/Cmp/Reports

Chiumello D., Pozzi T., Storti E., Caccioppola A., Pontiroli A.E., Coppola S. Body mass index and acute respiratory distress severity in patients with and without SARS-CoV-2 infection. Br J Anaesth. 2020;125(4) e376-e7. PubMed PMC

Legrand M. Complications in patients with COVID-19. JAMA Cardiol. 2021;6(3):359. PubMed

Madjid M., Solomon S.D., Vardeny O. Complications in patients with COVID-19-reply. JAMA Cardiol. 2021;6(3):360. PubMed

Madjid M., Safavi-Naeini P., Solomon S.D., Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. 2020;5(7):831–840. PubMed

Rottoli M., Bernante P., Belvedere A., Balsamo F., Garelli S., Giannella M., et al. How important is obesity as a risk factor for respiratory failure, intensive care admission and death in hospitalised COVID-19 patients? Results from a single Italian Centre. Eur J Endocrinol. 2020;183(4):389–397. PubMed PMC

Kim T.S., Roslin M., Wang J.J., Kane J., Hirsch J.S., Kim E.J. BMI as a risk factor for clinical outcomes in patients hospitalized with COVID-19 in New York. Obesity (Silver Spring, Md) 2021;29(2):279–284. PubMed PMC

Gao M., Piernas C., Astbury N.M., Hippisley-Cox J., O’Rahilly S., Aveyard P., et al. Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study. Lancet Diabetes & Endocrinol. 2021;9(6):350–359. PubMed PMC

Anderson M.R., Shashaty M.G.S. Impact of obesity in critical illness. Chest. 2021;160(6):2135–2145. PubMed PMC

De Jong A., Wrigge H., Hedenstierna G., Gattinoni L., Chiumello D., Frat J.P., et al. How to ventilate obese patients in the ICU. Intensive Care Med. 2020;46(12):2423–2435. PubMed PMC

Parikh R., Garcia M.A., Rajendran I., Johnson S., Mesfin N., Weinberg J., et al. ICU outcomes in Covid-19 patients with obesity. Ther Adv Respir Dis. 2020;14 1753466620971146. PubMed PMC

Jose R.J., Manuel A. Does coronavirus disease 2019 disprove the obesity paradox in acute respiratory distress syndrome? Obesity (Silver Spring, Md) 2020;28(6):1007. PubMed PMC

Buetti N., Souweine B., Mermel L., Mimoz O., Ruckly S., Loiodice A., et al. Obesity and risk of catheter-related infections in the ICU. A post hoc analysis of four large randomized controlled trials. Intensive Care Med. 2021;47(4):435–443. PubMed

Lemyze M., Courageux N., Maladobry T., Arumadura C., Pauquet P., Orfi A., et al. Implications of obesity for the management of severe coronavirus disease 2019 pneumonia. Crit Care Med. 2020;48(9) e761-e7. PubMed PMC

Dana R., Bannay A., Bourst P., Ziegler C., Losser M.R., Gibot S., et al. Obesity and mortality in critically ill COVID-19 patients with respiratory failure. Int J Obes (Lond) 2005;45(9):2028–2037. 2021. PubMed PMC

Gupta S., Hayek S.S., Wang W., Chan L., Mathews K.S., Melamed M.L., et al. Factors associated with death in critically ill patients with coronavirus disease 2019 in the US. JAMA Intern Med. 2020;180(11):1436–1447. PubMed PMC

Hutagalung R., Marques J., Kobylka K., Zeidan M., Kabisch B., Brunkhorst F., et al. The obesity paradox in surgical intensive care unit patients. Intensive Care Med. 2011;37(11):1793–1799. PubMed

Badulak J., Antonini M.V., Stead C.M., Shekerdemian L., Raman L., Paden M.L., et al. Extracorporeal membrane oxygenation for COVID-19: updated 2021 guidelines from the extracorporeal life support organization. ASAIO J. 2021;67(5):485–495. PubMed PMC

Organisation ELS ELSO guidelines. 2020. https://wwwelsoorg/ecmo-resources/elso-ecmo-guidelinesaspx

Lebreton G., Schmidt M., Ponnaiah M., Folliguet T., Para M., Guihaire J., et al. Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in greater Paris, France: a multicentre cohort study. The lancet. Respir Med. 2021;9(8):851–862. doi: 10.1016/S2213-2600(21)00096-5. PubMed DOI PMC

Merritt-Genore H., Lyden E., Ryan T., Kwapnoski Z. The effect of patient obesity on extracorporeal membrane oxygenator outcomes and ventilator dependency. J Card Surg. 2020;35(6):1283–1286. PubMed

Galvagno S.M., Jr., Pelekhaty S., Cornachione C.R., Deatrick K.B., Mazzeffi M.A., Scalea T.M., et al. Does weight matter? Outcomes in adult patients on venovenous extracorporeal membrane oxygenation when stratified by obesity class. Anesth Analg. 2020;131(3):754–761. PubMed

Kon Z.N., Dahi S., Evans C.F., Byrnes K.A., Bittle G.J., Wehman B., et al. Class III obesity is not a contraindication to venovenous extracorporeal membrane oxygenation support. Ann Thorac Surg. 2015;100(5):1855–1860. PubMed

Zaidi S.A.A., Saleem K. Obesity as a risk factor for failure to wean from ECMO: a systematic review and meta-analysis. Can Respir J. 2021;2021:9967357. PubMed PMC

Cho W.H., Oh J.Y., Yeo H.J., Han J., Kim J., Hong S.B., et al. Obesity survival paradox in pneumonia supported with extracorporeal membrane oxygenation: analysis of the national registry. J Crit Care. 2018;48:453–457. PubMed

Daviet F., Guilloux P., Hraiech S., Tonon D., Velly L., Bourenne J., et al. Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort. Ann Intensive Care. 2021;11(1):157. PubMed PMC

Tonna J.E., Abrams D., Brodie D., Greenwood J.C., Rubio Mateo-Sidron J.A., Usman A., et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): guideline from the extracorporeal life support organization (ELSO) ASAIO J. 2021;67(6):601–610. PubMed PMC

Vera M., Kattan E., Born P., Rivas E., Amthauer M., Nesvadba A., et al. Intubation timing as determinant of outcome in patients with acute respiratory distress syndrome by SARS-CoV-2 infection. J Crit Care. 2021;65:164–169. PubMed PMC

Combes A., Brodie D., Bartlett R., Brochard L., Brower R., Conrad S., et al. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med. 2014;190(5):488–496. PubMed

Bercker S., Petroff D., Polze N., Karagianidis C., Bein T., Laudi S., et al. ECMO use in Germany: an analysis of 29,929 ECMO runs. PLoS One. 2021;16(12) PubMed PMC

Karagiannidis C., Slutsky A.S., Bein T., Windisch W., Weber-Carstens S., Brodie D. Complete countrywide mortality in COVID patients receiving ECMO in Germany throughout the first three waves of the pandemic. Crit Care. 2021;25(1):413. PubMed PMC

Herrmann J., Lotz C., Karagiannidis C., Weber-Carstens S., Kluge S., Putensen C., et al. Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation. Crit Care. 2022;26(1):190. PubMed PMC

Schmidt M., Hajage D., Lebreton G., Monsel A., Voiriot G., Levy D., et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med. 2020;8(11):1121–1131. PubMed PMC

Barbaro R.P., MacLaren G., Boonstra P.S., Combes A., Agerstrand C., Annich G., et al. Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international extracorporeal life support organization registry. Lancet (London, England) 2021;398(10307):1230–1238. PubMed PMC

Combes A., Hajage D., Capellier G., Demoule A., Lavoué S., Guervilly C., et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965–1975. PubMed

Zangrillo A., Biondi-Zoccai G., Landoni G., Frati G., Patroniti N., Pesenti A., et al. Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO. Crit Care. 2013;17(1):R30. PubMed PMC

Singer M., Deutschman C.S., Seymour C.W., Shankar-Hari M., Annane D., Bauer M., et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) Jama. 2016;315(8):801–810. PubMed PMC

Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet (London, England) 2022;399(10325):665–676. PubMed PMC

Chaudhuri D., Sasaki K., Karkar A., Sharif S., Lewis K., Mammen M.J., et al. Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis. Intensive Care Med. 2021;47(5):521–537. PubMed PMC

Munch M.W., Myatra S.N., Vijayaraghavan B.K.T., Saseedharan S., Benfield T., Wahlin R.R., et al. Effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support in adults with COVID-19 and severe hypoxemia: the COVID STEROID 2 randomized trial. Jama. 2021;326(18):1807–1817. PubMed PMC

Maláska J., Stašek J., Duška F., Balík M., Máca J., Hruda J., et al. Effect of dexamethasone in patients with ARDS and COVID-19 - prospective, multi-centre, open-label, parallel-group, randomised controlled trial (REMED trial): a structured summary of a study protocol for a randomised controlled trial. Trials. 2021;22(1):172. PubMed PMC

Torres A., Motos A., Cillóniz C., Ceccato A., Fernández-Barat L., Gabarrús A., et al. Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study. Intensive Care Med. 2022;48(7):850–864. PubMed PMC

Sinha P., Matthay M.A., Calfee C.S. Is a “cytokine storm” relevant to COVID-19? JAMA Intern Med. 2020;180(9):1152–1154. PubMed

Kox M., Waalders N.J.B., Kooistra E.J., Gerretsen J., Pickkers P. Cytokine levels in critically ill patients with COVID-19 and other conditions. Jama. 2020;324(15):1565–1567. PubMed PMC

Leisman D.E., Ronner L., Pinotti R., Taylor M.D., Sinha P., Calfee C.S., et al. Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Med. 2020;8(12):1233–1244. PubMed PMC

Hendren N.S., de Lemos J.A., Ayers C., Das S.R., Rao A., Carter S., et al. Association of body mass index and age with morbidity and mortality in patients hospitalized with COVID-19: results from the American Heart Association COVID-19 cardiovascular disease registry. Circulation. 2021;143(2):135–144. PubMed

Price-Haywood E.G., Burton J., Fort D., Seoane L. Hospitalization and mortality among black patients and white patients with Covid-19. N Engl J Med. 2020;382(26):2534–2543. PubMed PMC

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