Impact of Body Mass Index on Outcomes Following Critical Care

Tremblay, Alain; Bandi, Venkata

doi:10.1378/chest.123.4.1202

Cited by 277 publications

(172 citation statements)

References 22 publications

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“…In addition the LOS was increased in post-operative patients with low BMI . Other studies report no correlation between low BMI and mortality or LOS in the ICU [27,28]. In our study, 9% of our patients were underweight and our results support published data regarding no effect of BMI in outcomes.…”

Section: Discussionsupporting

confidence: 90%

“…Obesity and severe obesity have been found to be a protective factor for mortality compared to patients with normal BMI in various disease processes including cardiovascular diseases, congestive heart failure, ESRD and [27,28]. In our population, we found higher prevalence of obesity and morbid obesity and lower prevalence of underweight patients when compared with other reports [11,21,28 and 29].…”

Section: Discussionsupporting

confidence: 51%

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Body mass index have no effect in hospital mortality or intensive care outcomes in an inner city population

Venkatram¹,

Rapaka²,

Anwer³

et al. 2013

Intern Med Inside

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Background: The relationship between body mass index and outcome in the intensive care unit is controversial. The objective was to evaluate the incidence and effect of different body mass indexes on mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay among critically ill medical patients. Methods: Retrospective, single center study in a medical intensive care unit of an inner city teaching hospital. All patients with available BMI levels on admission were included. Results: There were 1,988 patients admitted to the intensive care unit between January to December 2008; 1,797 (90.3%) were analyzed. Based in body mass index, 162 (9%) patients were underweight, 598 (33%) normal, 774 (43%) overweight/ obese and 263 (14.6%) severe obesity. Patients with obesity/severe obesity were more likely to be female (p<0.0001); to have hypertension (p=<0.0001), diabetes mellitus (p=<0.0001) and obstructive sleep apnea (p=<0.0001) as comorbid conditions. Severely obese patients had lower APACHE IV scores (66 ± 33 vs. 71 ± 32, p=0.035) and higher like hood of mechanical ventilation (105 (40%) vs. 180 (28%), p=<0.0007) when compared to normal. Underweight patients were sicker (APACHE IV 80 ± 32 vs. 71 ± 32, p=0.002) and more likely to have HIV infection (55 (36.6%) vs. 164 (26%), p=0.008) and cancer (22 vs. 51, p=0.017) compared to normal. Neither underweight, obesity nor severe obesity were associated with an increased risk of hospital mortality, (odd ratio=1.162; 95% confidence interval, 0.57-2.34 for underweight, odd ratio=1.04; 95% confidence interval, 0.62-1.75 for overweight/obese, odd ratio=1.23; 95% confidence interval, 0.64-2.39 for severe obesity). There were no differences in hospital length of stay or days on mechanical ventilation between the different body mass index groups. However, intensive care unit length of stay were significantly longer in the severe obese group by 1.2 days (95% confidence interval, 1.00-1.09; p=0.0015) compared with all the other groups. Conclusion: Body mass index in critically ill inner city patients is not associated with increased mortality. Severely obese patients have a longer intensive care unit length of stay, but not hospital stay. In our inner city MICU population, the prevalence of obesity and severe obesity is higher than reported.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 51%

Body mass index have no effect in hospital mortality or intensive care outcomes in an inner city population

Venkatram¹,

Rapaka²,

Anwer³

et al. 2013

Intern Med Inside

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“…20,29,36,37 Most previous studies were consistent in that underweight subjects were more likely to die. 15,[24][25][26][27][28][29] The underweight group may include more patients with advanced malignancies or severe COPD, which could explain an association between being underweight and worse outcomes. Another possible explanation is that lean patients are less tolerant of a highly catabolic state because they have less adipose tissue.…”

Section: Discussionmentioning

confidence: 99%

The Dose-Response Relationship Between Body Mass Index and Mortality in Subjects Admitted to the ICU With and Without Mechanical Ventilation

et al. 2015

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BACKGROUND: Obesity has been associated with increased mortality in the general population, whereas a paradoxical relationship between higher body mass index and lower mortality has been referred to as the obesity paradox in critically ill patients. However, it remains unknown whether a particular subgroup is most affected. The aim of the present study is to elucidate whether obesity is associated with lower mortality in the ICU population by comparing subjects with and without mechanical ventilation. METHODS: A total of 334,238 subjects from a nationwide database who were discharged between July 2010 and March 2012 and who were admitted to general ICUs during their hospitalization were included in this study. The primary outcome was in-hospital mortality. RESULTS: Of all subjects evaluated, 23.3% were started on mechanical ventilation within the first 2 d after ICU admission. Compared with the non-ventilated group, the ventilated group was more likely to have sepsis, pneumonia, or coma. The ventilated group underwent more procedures within the first 2 d after ICU admission compared with the non-ventilated group. A restricted cubic spline function showed lower mortality in subjects with a higher body mass index among the ventilated group, whereas mortality was increased with increasing body mass index in the non-ventilated group. CONCLUSIONS: This study shows that a high body mass index is associated with low mortality in the mechanically ventilated group, whereas the non-ventilated group showed a reverse J-shaped association. There was a higher mortality rate in underweight subjects in both groups.

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“…Exclusion criteria included patients with BMI less than 18.5 (underweight persons are physiologically distinct from persons of other weight classifications), 31 patients who were dead on arrival, and patients with burns (physiological and clinical factors affecting outcomes differ between burn and nonburn patients). 32 Additionally, patients transferred to another acute care facility before 1 week were Canonical correlation analysis is useful when the underlying dimensions representing the combinations of variables are unknown.…”

Section: Patients and Settingmentioning

confidence: 99%

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

Lee

Hervey

Berg

et al. 2016

American Journal of Critical Care

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Background Allocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients. Objectives To determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable. Methods A trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center. Patients were stratified into 3 groups: nonobese (normal weight, overweight), obese, and morbidly obese. Three canonical correlation analyses were used to determine the relationship between patient/injury characteristics and hospital resource usage. Results In a sample of 9771 patients, 71.2% were non-obese, 23.8% obese, and 5.0% morbidly obese. For patient/injury characteristics, Injury Severity Score and physiological complications were significant variables for all 3 groups. Scores on the Glasgow Coma Scale were significant for nonobese patients only. For resource usage, intensive care unit length of stay and procedures were significant variables for all 3 groups. Conclusions Associations between body mass index and outcomes have been noted when assessed as independent variables. However, when resource usage was assessed as a multifaceted outcome variable, injury factors (higher Injury Severity Score, lower scores on the Glasgow Coma Scale, more physiological complications) were associated with resource usage (increased length of stay in the intensive care unit and increased number of procedures). These findings provide clinicians a new perspective for evaluating the complex relationship between patient/injury characteristics and hospital resource usage.

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Impact of Body Mass Index on Outcomes Following Critical Care

Cited by 277 publications

References 22 publications

Body mass index have no effect in hospital mortality or intensive care outcomes in an inner city population

Body mass index have no effect in hospital mortality or intensive care outcomes in an inner city population

The Dose-Response Relationship Between Body Mass Index and Mortality in Subjects Admitted to the ICU With and Without Mechanical Ventilation

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

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