Being overweight or obese is associated with decreased mortality in critically ill patients: A retrospective analysis of a large regional Italian multicenter cohort

Sakr, Yasser; Elia, Cristina; Mascia, Luciana; Barberis, B; Cardellino, Silvano; Livigni, Sergio; Fiore, Gilberto; Filippini, Claudia; Ranieri, V. Marco

doi:10.1016/j.jcrc.2012.08.013

Cited by 51 publications

(53 citation statements)

References 39 publications

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“…The characteristics of the study group are shown in Table 1[16,17]. Female patients were significantly older than male patients (66 ± 16 years vs. 63.4 ± 15.6 years, P < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…All adult patients (> 18 years old) admitted to the 24 Italian ICUs participating in the Piedmont Intensive Care Unit Network were included in this prospective multicenter observational study conducted between 3 April 2006 and 29 September 2006 [16,17]. These ICUs represent 75% of the ICUs in the region of Piedmont; in particular, peripheral and central hospitals of the provinces of Torino, Cuneo, Asti and Alessandria.…”

Section: Methodsmentioning

confidence: 99%

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The influence of gender on the epidemiology of and outcome from severe sepsis

et al. 2013

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IntroductionThe impact of gender on outcome in critically ill patients is unclear. We investigated the influence of gender on the epidemiology of severe sepsis and associated morbidity and mortality in a large cohort of ICU patients in the region of Piedmont in Italy.MethodsThis was a post-hoc analysis of data from a prospective, multicenter, observational study in which all patients admitted to one of 24 participating medical and/or surgical ICUs between 3 April 2006 and 29 September 2006 were included.ResultsOf the 3,902 patients included in the study, 63.5% were male. Female patients were significantly older than male patients (66 ± 16 years vs. 63 ± 16 years, P < 0.001). Female patients were less likely to have severe sepsis and septic shock on admission to the ICU and to develop these syndromes during the ICU stay. ICU mortality was similar in men and women in the whole cohort (20.1% vs. 19.8%, P = 0.834), but in patients with severe sepsis was significantly greater in women than in men (63.5% vs. 46.4%, P = 0.007). In multivariate logistic regression analysis with ICU outcome as the dependent variable, female gender was independently associated with a higher risk of ICU death in patients with severe sepsis (odds ratio = 2.33, 95% confidence interval = 1.23 to 4.39, P = 0.009) but not in the whole cohort (odds ratio = 1.07, 95% confidence interval = 0.87 to 1.34).ConclusionIn this large regional Italian cohort of ICU patients, there were more male than female admissions. The prevalence of severe sepsis was lower in women than in men, but female gender was independently associated with a higher risk of death in the ICU for patients with severe sepsis.

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“…The characteristics of the study group are shown in Table 1[16,17]. Female patients were significantly older than male patients (66 ± 16 years vs. 63.4 ± 15.6 years, P < 0.001).…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The influence of gender on the epidemiology of and outcome from severe sepsis

et al. 2013

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“…Several studies have shown a relation between high BMI and lower mortality in ICU patients [4,5,7,8], but results are not consistent [21]. However, a recent very large observational cohort study in 154.308 patients provided more evidence on this so-called obesity paradox [9].…”

Section: Discussionmentioning

confidence: 99%

Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients

et al. 2014

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IntroductionHigher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship.MethodsThis retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110 cm2 for females and 170 cm2 for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables.ResultsThis study included 240 patients, 94 female and 146 male patients. Mean age was 57 years; mean BMI, 25.6 kg/m2. Muscle area for females was significantly lower than that for males (102 ± 23 cm2 versus 158 ± 33 cm2; P < 0.001). Low-muscle area was observed in 63% of patients for both females and males. Mortality was 29%, significantly higher in females than in males (37% versus 23%; P = 0.028). Low-muscle area was associated with higher mortality compared with normal-muscle area in females (47.5% versus 20%; P = 0.008) and in males (32.3% versus 7.5%; P < 0.001). Independent predictive factors for mortality were low-muscle area, sex, and APACHE II score, whereas BMI and admission diagnosis were not. Odds ratio for low-muscle area was 4.3 (95% confidence interval, 2.0 to 9.0, P < 0.001). When applying sex-specific cutoffs to all patients, muscle mass appeared as primary predictor, not sex.ConclusionsLow skeletal muscle area, as assessed by CT scan during the early stage of critical illness, is a risk factor for mortality in mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not sex. BMI is not an independent predictor of mortality when muscle area is accounted for.

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“…Severe obesity is widely accepted as a risk factor for increased mortality and morbidity [5,11], but being overweight and having mild obesity may have a paradoxical effect in lowering observed overall mortality, and even in decreasing mortality after certain cardiovascular events, a phenomenon known as the obesity paradox [5,[9][10][11]44]. In addition, obese patients have better than expected surgical outcomes when critically ill [45,46] and during the perioperative period [8,47]. Similarly, either a lower incidence and/or mortality from ARDS was observed in several studies of obese patients compared to normal weight patients [12][13][14].…”

Section: Discussionmentioning

confidence: 99%