Obesity-related excess mortality rate in an adult intensive care unit: A risk-adjusted matched cohort study*

Bercault, N.; Boulain, Thierry; Kuteifan, Kaldhoun; Wolf, Manuel; Runge, Isabelle

doi:10.1097/01.ccm.0000119422.93413.08

Cited by 269 publications

(201 citation statements)

References 40 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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“…FERRER et al [8] have shown not only a reduction in the rate of respiratory failure but also a decrease in the rate of intensive care unit (ICU) mortality. As severely obese patients are considered at high risk of developing respiratory complications [1,9], the current authors instituted a protocol requiring early application of NIV post-extubation. It was hypothesised that the preventive use of NIV would reduce the incidence of respiratory failure and the rate of reintubation.…”

mentioning

confidence: 99%

Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients

El-Solh

Aquilina²,

Pineda³

et al. 2006

Eur Respir J

176

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Current recommendations for management of obese patients post-extubation are based on clinical experience and expert opinions. It was hypothesised that the application of noninvasive ventilation (NIV) during the first 48 h after extubation in severely obese patients would reduce post-extubation failure and avert the need for reintubation.Following protocol-driven weaning trials, 62 consecutive severely obese patients (body mass index o35 kg?m -2 ) were assigned to NIV via nasal mask immediately post-extubation and compared with 62 historically matched controls who were treated with conventional therapy. The primary end-point was the incidence of respiratory failure in the first 48 h post-extubation.Compared with conventional therapy, the institution of NIV resulted in 16% (95% confidence interval 2.9-29.3%) absolute risk reduction in the rate of respiratory failure. There was a significant difference in the intensive care unit and lengths of hospital stay between the two groups. Subgroup analysis of hypercapnic patients showed reduced hospital mortality in the NIV group compared with the control group.In conclusion, noninvasive ventilation may be effective in averting respiratory failure in severely obese patients when applied during the first 48 h post-extubation. In selected patients with chronic hypercarbia, early application of noninvasive ventilation may confer a survival benefit.

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“…17 Obesity has been shown to have a direct association with developing MSOF as well as increased mortality in the ICU. 4 It is suggested in the literature that these changes in outcome could be a result of an anomalous inflammatory response to injury in obese patients. 6 However, studies have not been able to define a clear correlation with leukocytic inflammatory response and obesity.…”

mentioning

confidence: 99%

Body Mass Index is not an Independent Predictor for Missed Injury on Chest X-ray compared with Chest Computed Tomography

Aboutanos¹,

Ivatury²,

Vanguri³

2013

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Objective: Obesity is a risk factor for morbidity and mortality in the polytraumatized patient. The aim of this study is to determine if obesity is an independent risk factor for missed injury in chest X-ray after trauma. Materials and methods:Institutional Review Board approval was obtained. We performed a retrospective review of patients who presented to a level one trauma center as the higher acuity alerts from September 2010 to July 2011. We compared the chest X-ray with the chest computed tomography (CT) findings. Variables, such as age, BMI, mechanism, admission to the ICU and mortality during the same hospital stay, were evaluated.Results: A total of 224 patients met these criteria. The majority of patients were of male gender (79%). Average age was 40 years. Average ISS was 19.7. Mean BMI was 26.7 with 103 patients with BMI < 25 and with 123 patients with BMI >25. Mechanisms included blunt (n = 167), penetrating (n = 50) and burns (n = 7). A total of 123 patients (54.4%) had undiagnosed thoracic injuries by chest X-ray that were found on chest CT scan. Eighty-five percent of patients with missed injuries on chest X-ray required ICU admission as a result of the thoracic trauma. Missed injuries were as follows; rib fractures with or without flail chest (n = 62), pneumothorax (n = 40), hemothorax (n = 42), sternal fracture (n = 15), pulmonary lacerations/contusion (n = 60), great vessel injuries (n = 6), and blunt ventricular rupture (n = 1). Strikingly, there was no significant difference in missed injury, ICU admission or mortality when obese patients were compared to nonobese patients. Conclusion:Chest X-ray undermines the degree of injury in blunt trauma patients. BMI is not an independent predictor of missed injury, ICU admission or mortality during the same hospital stay. Source of support: Nil Conflict of interest: None declared RESUMENObjetivo: La obesidad es un factor de riesgo que aumenta morbilidad y mortalidad en los pacientes politraumatizados. El objetivo de este estudio es determinar si la obesidad es un factor de riesgo independiente para lesiónes indavertidas en la radiografía de tórax después de un trauma. Métodos:Se realizo una revisión retrospectiva de los pacientes que acudieron a un centro de trauma de nivel uno como las alertas de mayor agudeza entre septiembre de 2010 julio de 2011. Se comparó la radiografía de tórax con el TC de tórax. Variables como la edad, el IMC, el mecanismo, admisión a la Unidada de Cuidaos Intensivos (UCI) y la mortalidad durante el mismo ingreso hospitalario fueron evaluados.Resultados: 224 pacientes cumplieron con estos criterios. La mayoría de los pacientes eran de sexo masculino (79%). El promedio de edad fue de 40 años. Promedio ISS fue de 19,7. El IMC promedio fue de 26,7 por 103 pacientes con IMC < 25 y con 123 pacientes con IMC> 25. Mecanismos incluidos fueron trauma cerrado (n = 167), penetrante (n = 50) y quemaduras (n = 7). 123 pacientes (54,4%) tenían heridas torácicas no diagnosticadas por radiografía de tórax que se encontraron en el TC...

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Obesity-related excess mortality rate in an adult intensive care unit: A risk-adjusted matched cohort study*

Abstract: Obesity is an independent risk factor for intensive care unit death and should be regarded as a severe comorbidity in such units.

Cited by 269 publications

References 40 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

Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients

Body Mass Index is not an Independent Predictor for Missed Injury on Chest X-ray compared with Chest Computed Tomography

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