Impact of Obesity on Outcomes in a Multiethnic Cohort of Medical Intensive Care Unit Patients

Trivedi, Vrinda; Jean, Raymonde; Genese, Frank; Saini, Anjeet K.; Mangulabnan, Van Derick; Bavishi, Chirag

doi:10.1177/0885066616646099

Cited by 13 publications

(11 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 199,421 subjects participated in the 23 studies, which consisted of 14 prospective [ 8 , 13 , 18 – 29 ] and 9 retrospective cohort studies [ 9 – 12 , 30 – 35 ]. Fourteen studies were from North America [ 9 , 10 , 12 , 13 , 19 , 20 , 21 , 25 , 27 , 28 , 30 , 32 – 34 ], one from South America [ 31 ], five from Europe [ 8 , 18 , 22 , 23 , 24 , 29 ], and two from Australia [ 26 , 35 ]. In seven studies [ 8 , 9 , 18 , 19 , 22 , 31 , 32 ], BMIs was classified only into obese versus non-obese ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…A variety of factors contribute to the association between obesity and mortality, including a series of physiological changes that result in poor stresses related to acute inflammatory and immune responses, or in many comorbidities including diabetes, cardiovascular events, respiratory diseases and cancer [ 11 ]. However, “obesity paradox” (namely, lower mortality in obese subjects) has also been reported in ICU patients in other studies [ 12 – 13 ]. The relationship between obesity and mortality of ICU patients thus remain largely unclear[ 14 ].…”

Section: Introductionmentioning

confidence: 86%

See 1 more Smart Citation

Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis

Zhao

Yang

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

BackgroundObesity paradox refers to lower mortality in subjects with higher body mass index (BMI), and has been documented under a variety of condition. However, whether obesity paradox exists in adults requiring mechanical ventilation in intensive critical units (ICU) remains controversial.MethodsMEDLINE, EMBASE, China Biology Medicine disc (CBM) and CINAHL electronic databases were searched from the earliest available date to July 2017, using the following search terms: “body weight”, “body mass index”, “overweight” or “obesity” and “ventilator”, “mechanically ventilated”, “mechanical ventilation”, without language restriction. Subjects were divided into the following categories based on BMI (kg/m2): underweight, < 18.5 kg/m2; normal, 18.5–24.9 kg/m2; overweight, BMI 25–29.9 kg/m2; obese, 30–39.9 kg/m2; and severely obese > 40 kg/m2. The primary outcome was mortality, and included ICU mortality, hospital mortality, short-term mortality (<6 months), and long-term mortality (6 months or beyond). Secondary outcomes included duration of mechanical ventilation, length of stay (LOS) in ICU and hospital. A random-effects model was used for data analyses. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale.ResultsA total of 15,729 articles were screened. The final analysis included 23 articles (199,421 subjects). In comparison to non-obese patients, obese patients had lower ICU mortality (odds ratio (OR) 0.88, 95% CI 0.0.84–0.92, I2 = 0%), hospital mortality (OR 0.83, 95% CI 0.74–0.93, I2 = 52%), short-term mortality (OR 0.81, 95% CI 0.74–0.88, I2 = 0%) as well as long-term mortality (OR 0.69, 95% CI 0.60–0.79, I2 = 0%). In comparison to subjects with normal BMI, obese patients had lower ICU mortality (OR 0.88, 95% CI 0.82–0.93, I2 = 5%). Hospital mortality was lower in severely obese and obese subjects (OR 0.71, 95% CI 0.53–0.94, I2 = 74%, and OR 0.80, 95% CI 0.73–0.89, I2 = 30%). Short-term mortality was lower in overweight and obese subjects (OR 0.82, 95% CI 0.75–0.90, I2 = 0%, and, OR 0.75, 95% CI 0.66–0.84, I2 = 8%, respectively). Long-term mortality was lower in severely obese, obese and overweight subjects (OR 0.39, 95% CI 0.18–0.83, and OR 0.63, 95% CI 0.46–0.86, I2 = 56%, and OR 0.66, 95% CI 0.57–0.77, I2 = 0%). All 4 mortality measures were higher in underweight subjects than in subjects with normal BMI. Obese subjects had significantly longer duration on mechanical ventilation than non-obese group (mean difference (MD) 0.48, 95% CI 0.16–0.80, I2 = 37%), In comparison to subjects with normal BMI, severely obese BMI had significantly longer time in mechanical ventilation (MD 1.10, 95% CI 0.38–1.83, I2 = 47%). Hospital LOS did not differ between obese and non-obese patients (MD 0.05, 95% CI -0.52 to 0.50, I2 = 80%). Obese patients had longer ICU LOS than non-obese patients (MD 0.38, 95% CI 0.17–0.59, I2 = 70%). Hospital LOS and ICU LOS did not differ significantly in subjects with different BMI status.ConclusionsIn ICU patients receiving mechanical ventilation, higher BMI is associated...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 86%

Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis

Zhao

Yang

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…They concluded that lower BMI is associated with an increased mortality rate and worsened functional status at the time of discharge. A cohort of 699 patients also demonstrated that the obese patients have lower in-hospital mortality, though, the ndings were not witnessed among the older group of the obese patients, which suggests further studies to elaborate the possible connection between age, obesity, and fatal outcomes in intensive care units [24]. Nasraway et al showed during a cohort study in the UK that BMI > 40 was an independent cause of death in ICU-admitted surgery patients.…”

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

Mahmoodpoor

Karrubi

Hosseini

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Obesity, a wide-ranging disorder all around the world, is associated with significant morbidity and mortality in the general population. Regarding the present controversies, this study aims to evaluate the possible association of body mass index (BMI) and mortality in patients admitted to intensive care units.Methods: During this cross-sectional study, all patients admitted to the intensive care unit of two university affiliated hospitals in northwest of Iran from November 2017 to March 2019 were enrolled. The demographic characteristics of patients, length of stay in the intensive care unit and hospital, organ failure, mortality, duration of mechanical ventilation and vasopressor-therapy, type of nutrition, the occurrence of nosocomial infection, type of admission (medical, surgical, trauma) were recorded for all patients. According to the WHO classification of BMI, patients were divided into the six groups, and the data were analyzed accordingly.Results: Of the 502 patients studied, 267 were male (53.2%) and 235 were female (46.8%). The highest mortality rate was observed among the obesity class II patients (35 < BMI < 40) with 28.6%, while the lowest rate was observed in the normal-weight patients (18.5 < BMI < 25) with 3.9%. The highest length of hospital stay was seen in patients with BMI > 30 with 12 days of hospitalizations. APACHE II and waist circumference had a statistically significant relationship with the mortality rate of patients (P-value < 0.001).Conclusion: The current study showed that BMI could be related to mortality, regardless of waist circumference and APACHE II score. However, considering waist circumference and APACHE II score as confounding factors, BMI does not have a significant effect on mortality and only affect the morbidity of patients.

show abstract

“…2 Ironically, ICU patients with obesity may actually have a greater likelihood of survival when compared with healthy body weight comparators. 3…”

mentioning

confidence: 99%

“…2 Ironically, ICU patients with obesity may actually have a greater likelihood of survival when compared with healthy body weight comparators. 3 Hypotheses exist regarding why obese patients may demonstrate improved survival in critical illness. 3,4 Appropriate medication dosing between obese and nonobese patients may contribute to observed differences in patient morbidity and mortality outcomes.…”

mentioning

confidence: 99%

Impact of Norepinephrine Weight-Based Dosing Compared With Non–Weight-Based Dosing in Achieving Time to Goal Mean Arterial Pressure in Obese Patients With Septic Shock

Droege

Ernst

2017

Ann Pharmacother

View full text Add to dashboard Cite

Obesity presents a growing challenge in critically ill patients because of variable medication pharmacokinetics and pharmacodynamics. Vasopressors used in the treatment of septic shock, including norepinephrine, are dosed using weight-based (WB) or non-weight-based (NWB) strategies. Retrospective research has evaluated the effect of total body weight and body mass index on vasopressor requirements, consequently finding that obese patients require less total vasopressor per kilogram to obtain clinical end points such as mean arterial pressure. Although this effect is not completely understood, this may suggest that a NWB dosing strategy is preferred over a WB strategy in obese patients to minimize potential for error.

show abstract

Impact of Obesity on Outcomes in a Multiethnic Cohort of Medical Intensive Care Unit Patients

Abstract: Our study supports the hypothesis that obesity is associated with decreased mortality during critical illness. However, this finding was not observed among elderly obese patients. Further studies should explore the interaction between age, obesity, and outcomes in critical illness.

Cited by 13 publications

References 29 publications

Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis

Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis

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

Impact of Norepinephrine Weight-Based Dosing Compared With Non–Weight-Based Dosing in Achieving Time to Goal Mean Arterial Pressure in Obese Patients With Septic Shock

Contact Info

Product

Resources

About