Effect of obesity on intensive care morbidity and mortality: A meta-analysis*

Akinnusi, Morohunfolu E.; Pineda, Lilibeth A.; Solh, Ali A. El

doi:10.1097/01.ccm.0000297885.60037.6e

Cited by 440 publications

(324 citation statements)

References 49 publications

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“…Overall, 30% of ICU patients are obese and 7% morbidly obese (2). Obesity seems to confer a higher risk for development of common conditions in critically ill patients such as the acute respiratory distress syndrome (ARDS) (3) (4).…”

Section: Introductionmentioning

confidence: 99%

Body Mass Index And Acute Kidney Injury In The Acute Respiratory Distress Syndrome

Soto¹,

Frank²,

Christiani³

et al. 2011

C48. Sepsis

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Objectives-Obesity is increasingly encountered in the intensive care units (ICUs) but the relationship between obesity and acute kidney injury (AKI) is unclear. We aim to evaluate whether body mass index (BMI) was associated with AKI in the acute respiratory distress syndrome (ARDS) and to examine the association between AKI and mortality in patients with and without obesity. Interventions-NoneMeasurements and Main Results-AKI was defined as meeting the "Risk" category according to modified Risk Injury Failure Loss End-stage (RIFLE) criteria based on Creatinine (Cr) and glomerular filtration rate (GFR) since urine output was only available on the day of ICU admission. BMI was calculated from height and weight on ICU admission. The prevalence of AKI increased significantly with increasing weight (p = 0.01). The odds of AKI were twice in obese and severely obese patients compared to normal BMI after adjusting for predictors of AKI (age, diabetes, APACHE III, aspiration, vasopressor use, and thrombocytopenia (platelets ≤ 80,000/ mm 3 )). After adjusting for the same predictors, BMI was significantly associated with AKI (OR adj 1.20 per 5 kg/m 2 increase in BMI, 95%CI 1.07-1.33). On multivariate analysis, AKI was associated with increased ARDS mortality (OR adj 2.76, 95%CI 1.72-4.42) while BMI was associated with decreased mortality (OR adj 0.81 per 5 kg/m 2 increase in BMI, 95%CI 0.71-0.93) after adjusting for mortality predictors.Conclusions-In ARDS patients, obesity is associated with increased development of AKI that is not completely explained by severity of illness or shock. While increased BMI is associated with decreased mortality, AKI remained associated with higher mortality even after adjusting for BMI.

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Section: Introductionmentioning

confidence: 99%

Body Mass Index And Acute Kidney Injury In The Acute Respiratory Distress Syndrome

Soto¹,

Frank²,

Christiani³

et al. 2011

C48. Sepsis

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“…The impact of BMIs in the requirement for MV and the outcome for those patients are mixed with most of the reports addressing the obese population [11,19,[45][46][47][48][49]. Pulmonary physiological changes related to elevated BMI includes a decreased lung compliance with a lower total lung capacity, functional residual capacity and residual volume and an increased airway resistance.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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“…They found no associated mortality risk with a BMI of Ն 40 kg/m 2 . Akinnusi et al 6 published another meta-analysis that compared the mortality of subjects with a BMI of Ͼ 30 kg/m 2 with that of subjects with a BMI of Ͻ 30 kg/m 2 . The authors found no difference in ICU mortality, but did find an improvement in mortality at the time of discharge.…”

mentioning

confidence: 99%

“…Data from the medical literature is inconsistent. Multiple meta-analyses suggest a lower mortality rate among critically ill obese subjects, [5][6][7] known as the obesity paradox. Oliveros and Villamor 5 showed a lower risk of mortality among medical and surgical ICU subjects with a body mass index (BMI) between 18.5 and 24.9 kg/m 2 compared with those with a BMI between 30 and 39.9 kg/m 2 .…”

mentioning

confidence: 99%

A Paradox Defined?

Shipe

2015

Respir Care

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Effect of obesity on intensive care morbidity and mortality: A meta-analysis*

Cited by 440 publications

References 49 publications

Body Mass Index And Acute Kidney Injury In The Acute Respiratory Distress Syndrome

Body Mass Index And Acute Kidney Injury In The Acute Respiratory Distress Syndrome

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

A Paradox Defined?

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