Does obesity impact the outcome of severely burned patients?

Pauzenberger, Reinhard; Radtke, Christine; Ederer, Ines Ana; Hacker, Stefan; Waldmann, Anna; Sternat, Nikolaus; Franke, I.; Thury, Alexander; Harpain, Lucie; Stievano, Simona

doi:10.1111/iwj.13282

Cited by 16 publications

(18 citation statements)

References 26 publications

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“…There were 18 studies 89,[127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143] (1,415,697 participants) with critically ill populations (Table S3): quadratic term for mean BMI with a linear term (Table 2) or when groups with mean BMIs <20 kg/m 2 were excluded. The interaction terms for Asian/non-Asian majority countries were non-significant.…”

Section: Critically Ill Populationsmentioning

confidence: 99%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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SummaryFasting insulin and c‐reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non‐first order polynomials or splines. All‐cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid‐19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations. The associations for general, cancer, and non‐communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re‐examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

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Section: Critically Ill Populationsmentioning

confidence: 99%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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“…Owing to the retrospective study design, the basis for data regarding psychiatric illnesses are poor and their potential impact on the long‐term outcome was not evaluated, which can be seen as a limitation. In a previously conducted study at our department, authors have shown that body mass index could not be confirmed as an independent risk factor for severely burned patients 24 . However, we have seen that obesity in burn patients can have a protective effect against mortality and provide a better outcome in the aging population.…”

Section: Discussionmentioning

confidence: 59%

“…In a previously conducted study at our department, authors have shown that body mass index could not be confirmed as an independent risk factor for severely burned patients. 24 However, we have seen that obesity in burn patients can have a protective effect against mortality and provide a better outcome in the aging population. Furthermore, this paper described gender-specific patterns in patients ≥75 years that required intensive care after the procedure for plastic surgery.…”

Section: Discussionmentioning

confidence: 99%

Intensive care in an older population: Influence of age, comorbidities and sex in 304 plastic and reconstructive surgical patients older than 75 years

Staud

Zaussinger

Holzbauer

et al. 2022

Geriatrics Gerontology Int

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Aim An aging population will lead to an increasing demand for critical care resources. Hence, we evaluated the potential influence of age, comorbidities and sex in plastic and reconstructive patients ≥75 years that were admitted to the intensive care unit (ICU). Methods We included 304 patients who required intensive care between 2000 and 2019. Besides patient demographics, medical case characteristics were statistically evaluated. Results In this study, 184 patients were female (61%) (120 male), the median age was 81.8 years (25th and 75th percentiles: 77.4–87.2) with a range of 75.0–98.9 years. The median length of stay in the ICU was 12 days (25th and 75th percentiles: 3–28) with a range of 0–382 days. The reasons for admission were burn injury (n = 230, 76%), necrotizing fasciitis (n = 34, 11%), non‐combustion‐related traumas (n = 22, 7%) and postoperative observation after plastic surgery procedures (n = 18, 6%). In total, 108 patients (36%), who were significantly older (P = 0.005) and had a significantly shorter stay (P < 0.001) compared with the surviving cohort, died during their stay in the ICU. Our multivariable logistic regression model revealed that age (odds ratio: 1.05 [1.01, 1.09]; P = 0.017) and number of operations (odds ratio: 0.75 [0.60, 0.96]; P = 0.023) were significant predictors for death in the ICU. Discussion Age plays a critical role in determining fatal outcome of old patients requiring intensive care. In contrast, sex and number of comorbidities shows no significant influence. Geriatr Gerontol Int 2022; 22: 597–602.

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“…Still, obesity was significantly associated with longer LoS and increased comorbid illness. Recent studies are implemented on larger populations, with different subgroups, and have considered the etiological context (20,23). A recent dose-response meta-analysis on the effect of BMI on the mortality of ICUadmitted patients showed that for each unit of increase in BMI, a 0.6% decrease in mortality rate is expected (24).…”

Section: Discussionmentioning

confidence: 99%

Impact of Body Mass Index on the Mortality of Critically Ill Patients Admitted to the Intensive Care Unit: An Observational Study

et al. 2020

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Background: Obesity is a severe multifactorial disorder that carries high morbidity and mortality. Objectives: This study aimed to evaluate the possible association between body mass index (BMI) and mortality in patients admitted to intensive care units (ICU). Methods: In this cross-sectional study, all patients admitted to the ICU were studied. The demographic characteristics, ICU, and hospital length of stay, organ failure, mortality, duration of mechanical ventilation, the occurrence of nosocomial infection, and type of admission were recorded for all patients. Patients were categorized based on their BMI. Results: In total, 502 patients were studied who 53.2% of them were male. Most of the death (28.6%) were recorded in the obesity class II patients, while the lowest rate (3.9%) was for the normal-weight patients (P value < 0.001). The APACHE II and waist circumference had a statistically significant association with the mortality rate (P value < 0.001). After adjusting for age and gender, a significant association was found between waist circumference and mortality rate (OR = 1.15, 95% CI = 1.03 - 1.29; P value = 0.014), APACHE II score, and mortality rate (OR = 2.79, 95% CI = 1.91 - 4.07, P value < 0.001); but there was no significant association between BMI and mortality rate. Conclusions: This study demonstrated that BMI is associated with an increased risk of mortality, regardless of age and gender. However, after adjusting for age and gender as confounding factors, BMI didn’t have a significant effect on mortality, while the APACHE II score and waist circumference affected the mortality rate.

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Does obesity impact the outcome of severely burned patients?

Cited by 16 publications

References 26 publications

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Intensive care in an older population: Influence of age, comorbidities and sex in 304 plastic and reconstructive surgical patients older than 75 years

Impact of Body Mass Index on the Mortality of Critically Ill Patients Admitted to the Intensive Care Unit: An Observational Study

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