The impact of obesity on outcomes after critical illness: a meta-analysis

Hogue, Charles W.; Stearns, Joshua D.; Colantuoni, Elizabeth; Robinson, Karen A.; Stierer, Tracey L.; Mitter, Nanhi; Pronovost, Peter J.; Needham, Dale M.

doi:10.1007/s00134-009-1424-5

Cited by 283 publications

(245 citation statements)

References 51 publications

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“…Similar to inconsistent relationship mortality and MV, the data for ICU and hospital LOS varies as well. Some studies reports a higher ICU and hospital LOS across all BMI groups [20,23] while others reports no correlation [17]. In our study although the Hospital LOS were similar between BMI groups, The ICU LOS was higher in severely obese patients.…”

Section: Icu Los (Mean ± Sd)contrasting

confidence: 57%

“…Population based studies suggest a U or J shaped curve indicating a higher mortality at the extremes of BMIs [8][9][10]. The association of BMI with mortality in the intensive care unit (ICU) is controversial with reports suggesting no relation [11][12][13], increased [14][15][16] or decreased hospital mortality [17]. The role of BMI for length of stay (LOS) on mechanical ventilation (MV) and ICU LOS is equally inconsistent [11,[18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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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: Icu Los (Mean ± Sd)contrasting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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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“…However, the impact of obesity on outcomes in patients admitted to the ICU has not been definitively determined. Although 3 meta-analyses [12][13][14] regarding the impact of obesity on outcomes in critically ill subjects showed that obesity might exert a favorable effect on mortality, definitive SEE THE RELATED EDITORIAL ON PAGE 1083 conclusions have not been available due to statistical heterogeneity. A recent Dutch study 15 including Ͼ 150,000 subjects demonstrated a paradoxical relationship, with a higher BMI associated with a lower mortality in critically ill subjects.…”

Section: Introductionmentioning

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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“…7 On the other hand, a meta-analysis published in 2009 indicated that hospitalized, acutely ill, obese patients were protected from poor outcomes. 8 This meta-analysis included a total of 88,051 obese and non-obese patients from 22 studies. Mortality of obese patients was statistically lower than in patients who were not obese.…”

Section: Introductionmentioning

confidence: 99%

Impact of obesity on mortality in hospitalized patients with pneumonia due to 2009 H1N1 Influenza A virus versus other etiologies.

Espinosa-Ginic¹,

Hurt²,

Furmanek³

et al. 2017

JRI

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The impact of obesity on outcomes after critical illness: a meta-analysis

Abstract: Obesity is not associated with increased risk for ICU mortality, but may be associated with lower hospital mortality. There is a critical lack of research on how obesity may affect complications of critical illness and patient long-term outcomes.

Cited by 283 publications

References 51 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

Impact of obesity on mortality in hospitalized patients with pneumonia due to 2009 H1N1 Influenza A virus versus other etiologies.

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