Being Overweight Is Associated With Greater Survival in ICU Patients

Sakr, Yasser; Alhussami, Ilmi; Nanchal, Rahul; Wunderink, Richard G.; Pellis, Tommaso; Wittebole, Xavier; Martín‐Loeches, Ignacio; Dalmay, François; Léone, Marc; Vincent, Jean‐Louis

doi:10.1097/ccm.0000000000001310

Cited by 120 publications

(107 citation statements)

References 32 publications

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“…Furthermore, our findings suggested that there was a trend towards extended periods of ventilation, longer ICU and hospital LOS in obese patients, as prior studies have reported (Papadimitriou-Olivgeris et al, 2016;Sakr et al, 2015). This finding is mainly attributed to higher risks of nosocomial infection and respiratory complications (Sakr et al, 2008) that are associated with obesity.…”

Section: Discussionsupporting

confidence: 72%

“…Nonetheless, in partial alignment with the large global audit ICON (Sakr et al, 2015), which included more than ten thousand patients in 730 ICUs, a sub-analysis of sepsis patients (n = 2696) suggested that a lower adjusted HR for 60-day in-hospital mortality was associated with being overweight, although obese or morbidly obese patients did not experience the same benefits. However, the summed proportion of obese and morbidly obese participants was relatively small compared with that in our cohort (19.1% v 34.3%), which might explain the insufficient power to Figure 4.…”

Section: Discussionmentioning

confidence: 99%

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Increased body mass index linked to greater short- and long-term survival in sepsis patients: A retrospective analysis of a large clinical database

et al. 2019

International Journal of Infectious Diseases

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Objectives: We investigated the impact of obesity (proxied as body mass index (BMI)), on short-and long-term mortality in sepsis patients. Methods: We conducted a retrospective analysis with adult sepsis ICU patients in a US medical institution from 2001 to 2012 in the MIMIC-III database. The WHO BMI categories were used. Multivariate logistic regression assessed the relationships between BMI and 30-day and 1-year mortality. Results: In total, 5563 patients were enrolled. Obese patients tended to be younger (P < 0.001), to be female (P < 0.001), to acquire worse SOFA scores (P < 0.001), and to receive more aggressive treatment compared with their normal weight counterparts. Obese patients had notably longer mechanical ventilation periods and ICU and hospital lengths of stay (LOSs). In the final model, overweight and obese patients had lower 30-day (OR 0.77, 95% CI 0.66-0.91; OR 0.65, 95% CI 0.56-0.77, respectively) and 1-year (OR 0.83, 95% CI 0.71-0.96; OR 0.70, 95% CI 0.60-0.81, respectively) mortality risks than normal weight patients. In contrast, underweight patients had worse 30-day and 1-year outcomes compared with normal weight patients (P = 0.01, P < 0.001, respectively). In morbidly obese, severe sepsis and septic shock patients, obesity remained protective. Conclusions: Obesity was correlated with short-and long-term survival advantages in sepsis patients.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Increased body mass index linked to greater short- and long-term survival in sepsis patients: A retrospective analysis of a large clinical database

et al. 2019

International Journal of Infectious Diseases

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“…Interestingly, higher CBT values were reported in overweight patients. Of note, the overweight ICU patients had a better outcome than those with normal BMI [32]. Low temperature values were previously reported in patients with traumatic brain injury [33,34].…”

Section: Discussionmentioning

confidence: 52%

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

et al. 2020

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Background: Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods: A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results: Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value < 36.9°C (p < 0.001) and an amplitude > 0.6°C (p < 0.001) had a higher 28-day mortality rate. Among the patients with head trauma, mesor and amplitude were identified as independent risk factors (HR = 0.40, 95% CI [0.23-0.70], p = 0.001 and HR = 4.73, 95% CI [1. 38-16.22], p = 0.01). Conclusions:Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.

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“…Obesity and mortality in ICU are inversely associated as shown by recent studies [38, 39] and meta-analyses [5, 6, 40]. In particular, ARDS obese patients, in whom diaphragmatic function is challenging, have a lower mortality risk when compared with non-obese patients [7–9].…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic function is enhanced in fatty and diabetic fatty rats

Jong

Carreira

et al. 2017

PLoS ONE

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BackgroundObesity is associated with a decrease in mortality in the intensive care unit (ICU) (the "obesity paradox"). We hypothesized that obesity may paradoxically improve diaphragmatic function.MethodsDiaphragm contractility was prospectively recorded in vitro in adult male Zucker lean (control), fatty, and diabetic fatty rats, at rest, after 12h mechanical ventilation and after fatigue. We analyzed diaphragm morphology, cytokines, and protein expression of the protein kinase signaling pathways.ResultsDiaphragm active-force (AF) was higher in fatty (96±7mN.mm-2,P = 0.02) but not in diabetic fatty rats (90±17mN.mm-2) when compared with controls (84±8mN.mm-2). Recovery from fatigue was improved in fatty and diabetic fatty groups compared with controls. Ventilator-induced diaphragmatic dysfunction was observed in each group, but AF remained higher in fatty (82±8mN.mm-2,P = 0.03) compared with controls (70±8mN.mm-2). There was neutral lipid droplet accumulation in fatty and diabetic fatty. There were shifts towards a higher cross-sectional-area (CSA) of myosin heavy chain isoforms (MyHC)-2A fibers in fatty and diabetic fatty compared with control rats (P = 0.002 and P<0.001, respectively) and a smaller CSA of MyHC-2X in fatty compared with diabetic fatty and control rats (P<0.001 and P<0.001, respectively). The phosphorylated total-protein-kinase-B (pAKT)/AKT ratio was higher in fatty (182±58%,P = 0.03), but not in diabetic fatty when compared with controls and monocarboxylate-transporter-1 was higher in diabetic fatty (147±36%,P = 0.04), but not in fatty.ConclusionsDiaphragmatic force is increased in Zucker obese rats before and after mechanical ventilation, and is associated with activation of AKT pathway signaling and complex changes in morphology.

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Being Overweight Is Associated With Greater Survival in ICU Patients

Cited by 120 publications

References 32 publications

Increased body mass index linked to greater short- and long-term survival in sepsis patients: A retrospective analysis of a large clinical database

Increased body mass index linked to greater short- and long-term survival in sepsis patients: A retrospective analysis of a large clinical database

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

Diaphragmatic function is enhanced in fatty and diabetic fatty rats

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