Obesity and Critical Illness-Associated Mortality: Paradox, Persistence and Progress*

Ripoll, Juan G.; Bittner, Edward A.

doi:10.1097/ccm.0000000000005787

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…The findings of this study support previous research indicating that obesity may have a protective effect on mortality, as higher body mass index values have been linked to improved outcomes in critical conditions [ 13 , 14 ]. There may be multiple components to the protective mechanism of obesity in critical illness, which could include physiological, metabolic, and immunological factors that provide resilience during acute medical emergencies [ 6 , 7 , 13 , 14 ]. For instance, individuals who are obese may have a greater metabolic reserve, providing them with a vital advantage in managing catabolic stress during a critical illness [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous investigations have proposed that AF, a known risk factor for heightened mortality in the general and hospitalized populations, may have a less defined impact on the critically ill, particularly in relation to obesity. The presence of obesity could modulate the risk associated with AF through various mechanisms, including but not limited to metabolic reserve, inflammatory response, and differing cardiovascular dynamics [ 6 , 7 ]. Therefore, exploring the combined impact of AF and obesity on mortality in the critically ill population is crucial for developing targeted interventions and improving patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Joint effect of atrial fibrillation and obesity on mortality in critically ill patients

Zhang,

Ding,

et al. 2024

Diabetol Metab Syndr

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Background The interplay between atrial fibrillation (AF) and obesity on mortality in critically ill patients warrants detailed exploration, given their individual impacts on patient prognosis. This study aimed to assess the associations between AF, obesity, and 1-year mortality in a critically ill population. Methods Utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-IV database, we conducted a retrospective analysis of adult patients admitted to the intensive care unit. The primary endpoint was 1-year mortality, analyzed through Cox regression with hazard ratio (HR) and Kaplan-Meier survival methods. Results The study included 25,654 patients (median age 67.0 years, 40.6% female), with 39.0% having AF and 36.1% being obese. Multivariate COX regression analysis revealed that AF was associated with a 14.7% increase in the risk of 1-year mortality (p < 0.001), while obesity was linked to a 13.9% reduction in mortality risk (p < 0.001). The protective effect of obesity on mortality was similar in patients with (HR = 0.85) and without AF (HR = 0.86). AF led to a slightly higher risk of mortality in patients without obesity (HR = 1.16) compared to those with obesity (HR = 1.13). Kaplan-Meier survival curves highlighted that non-obese patients with AF had the lowest survival rate, whereas the highest survival was observed in obese patients without AF. Conclusions AF significantly increased 1-year mortality risk in critically ill patients, whereas obesity was associated with a decreased mortality risk. The most adverse survival outcomes were identified in non-obese patients with AF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Joint effect of atrial fibrillation and obesity on mortality in critically ill patients

Zhang,

Ding,

et al. 2024

Diabetol Metab Syndr

View full text Add to dashboard Cite

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Obesity and Extracorporeal Membrane Oxygenation (ECMO): Analysis of Outcomes

Ripoll,

ElSaban,

Nabzdyk

et al. 2024

Journal of Cardiothoracic and Vascular Anesthesia

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The obesity paradox and 90 day mortality in chronic critically ill patients: a cohort study using a large clinical database

Xu,

Lu,

Wang

et al. 2024

Eur J Med Res

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Background This study investigates the obesity paradox, where obesity is linked to lower mortality in certain patient groups, focusing on its impact on long-term mortality in chronic critically ill (CCI) patients. Methods We retrospectively analyzed CCI patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database’s Intensive Care Unit, categorizing them into six groups based on Body Mass Index (BMI). Using stepwise multivariable Cox regression and restricted cubic spline models, we examined the association between BMI and 90 day mortality, accounting for confounding variables through subgroup analyses. Results The study included 1996 CCI patients, revealing a 90 day mortality of 34.12%. Overweight and obese patients exhibited significantly lower mortality compared to normal-weight individuals. Adjusted analysis showed lower mortality risks in overweight and obese groups (HRs 0.60 to 0.72, p < 0.001). The cubic spline model indicated a negative correlation between BMI and 90 day mortality, with subgroup analyses highlighting interactions with age. Conclusion Our findings confirm the obesity paradox in CCI patients, especially among the elderly (65–85 years) and very elderly (≥ 85 years). The results suggest a beneficial association of higher BMI in older CCI patients, though caution is advised for those under 45.

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Obesity and Critical Illness-Associated Mortality: Paradox, Persistence and Progress*

Cited by 4 publications

References 17 publications

Joint effect of atrial fibrillation and obesity on mortality in critically ill patients

Joint effect of atrial fibrillation and obesity on mortality in critically ill patients

Obesity and Extracorporeal Membrane Oxygenation (ECMO): Analysis of Outcomes

The obesity paradox and 90 day mortality in chronic critically ill patients: a cohort study using a large clinical database

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