Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit. Crit Care Med 2015 Dec;43(12):2623-32
Date
10/03/2015Pubmed ID
26427591DOI
10.1097/CCM.0000000000001310Scopus ID
2-s2.0-84947486694 (requires institutional sign-in at Scopus site) 107 CitationsAbstract
OBJECTIVE: To assess the effect of body mass index on ICU outcome and on the development of ICU-acquired infection.
DESIGN: A substudy of the Intensive Care Over Nations audit.
SETTING: Seven hundred thirty ICUs in 84 countries.
PATIENTS: All adult ICU patients admitted between May 8 and 18, 2012, except those admitted for less than 24 hours for routine postoperative monitoring (n = 10,069). In this subanalysis, only patients with complete data on height and weight (measured or estimated) on ICU admission in order to calculate the body mass index were included (n = 8,829).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Underweight was defined as body mass index less than 18.5 kg/m, normal weight as body mass index 18.5-24.9 kg/m, overweight as body mass index 25-29.9 kg/m, obese as body mass index 30-39.9 kg/m, and morbidly obese as body mass index greater than or equal to 40 kg/m. The mean body mass index was 26.4 ± 6.5 kg/m. The ICU length of stay was similar among categories, but overweight and obese patients had longer hospital lengths of stay than patients with normal body mass index (10 [interquartile range, 5-21] and 11 [5-21] vs 9 [4-19] d; p < 0.01 pairwise). ICU mortality was lower in morbidly obese than in normal body mass index patients (11.2% vs 16.6%; p = 0.015). In-hospital mortality was lower in morbidly obese and overweight patients and higher in underweight patients than in those with normal body mass index. In a multilevel Cox proportional hazard analysis, underweight was independently associated with a higher hazard of 60-day in-hospital death (hazard ratio, 1.32; 95% CI, 1.05-1.65; p = 0.018), whereas overweight was associated with a lower hazard (hazard ratio, 0.79; 95% CI, 0.71-0.89; p < 0.001). No body mass index category was associated with an increased hazard of ICU-acquired infection.
CONCLUSIONS: In this large cohort of critically ill patients, underweight was independently associated with a higher hazard of 60-day in-hospital death and overweight with a lower hazard. None of the body mass index categories as independently associated with an increased hazard of infection during the ICU stay.
Author List
Sakr Y, Alhussami I, Nanchal R, Wunderink RG, Pellis T, Wittebole X, Martin-Loeches I, François B, Leone M, Vincent JL, Intensive Care Over Nations InvestigatorsAuthor
Rahul Sudhir Nanchal MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAge Factors
Aged
Aged, 80 and over
Body Mass Index
Critical Illness
Cross Infection
Female
Hospital Mortality
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Obesity
Overweight
Proportional Hazards Models
Severity of Illness Index
Sex Factors
Thinness