Excess Body Weight Is Not Independently Associated with Outcome in Mechanically Ventilated Patients with Acute Lung Injury

O’Brien, James M.; Welsh, Carolyn H.; Fish, Ronald H.; Ancukiewicz, Marek; Kramer, Andrew M.

doi:10.7326/0003-4819-140-5-200403020-00009

Cited by 156 publications

(128 citation statements)

References 30 publications

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“…This is supported by prior studies in ALI/ARDS that showed either a trend for a protective mortality effect by obesity (3) or a significantly lower mortality in obese patients (47). However, our study differed from others that reported either a higher ICU mortality (48) or no association with 28-day mortality with obesity (49). This may be explained by differences in sample size, study design, or patient characteristics.…”

Section: Discussioncontrasting

confidence: 56%

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: Discussioncontrasting

confidence: 56%

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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“…Previous reports investigating the association between BMI and mortality in mechanically ventilated patients show inconsistent results. [16][17][18][19][20] These results must be interpreted with caution. A comparison of non-obese and morbidly obese mechanically ventilated subjects showed similar mortality in both groups.…”

Section: Discussionmentioning

confidence: 98%

“…Because underweight subjects have been reported to have a higher mortality than normal-weight subjects in the ICU, 15,24-29 combining underweight and normal-weight patients into one category may bias the results. Another report included only 807 subjects, 19 which might not be a sufficient sample size to detect differences in outcomes between different BMI categories. Four of these reports 16,17,19,20 restricted the study population to subjects with acute lung injury and ARDS.…”

Section: Discussionmentioning

confidence: 99%

“…Another report included only 807 subjects, 19 which might not be a sufficient sample size to detect differences in outcomes between different BMI categories. Four of these reports 16,17,19,20 restricted the study population to subjects with acute lung injury and ARDS. In contrast to these previous studies, the present study includes all types of ICU subjects, which may be generalizable to other populations.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding mechanically ventilated patients, some investigators suggested that a higher BMI was associated with lower mortality, 16,17 and others reported that the differences were insignificant. [18][19][20] These discrepancies may be due to differences in the patient population or the definition of obesity between the studies. It is critical to comprehensively analyze patients admitted to the ICU to elucidate the relationship between BMI and mortality in patients undergoing mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

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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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Prognosis and Outcome of the Critically Ill Obese Patient

Sakr

Zeiden

Marques

2012

Critical Care Management of the Obese Patient

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Excess Body Weight Is Not Independently Associated with Outcome in Mechanically Ventilated Patients with Acute Lung Injury

Cited by 156 publications

References 30 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

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

Prognosis and Outcome of the Critically Ill Obese Patient

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