Underweight but not overweight is associated with excess mortality in septic ICU patients.
BMI
Critically ill
Fluid management
Intensive care
Obesity paradox
Sepsis
Journal
Wiener klinische Wochenschrift
ISSN: 1613-7671
Titre abrégé: Wien Klin Wochenschr
Pays: Austria
ID NLM: 21620870R
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
20
03
2021
accepted:
25
06
2021
pubmed:
17
9
2021
medline:
23
2
2022
entrez:
16
9
2021
Statut:
ppublish
Résumé
Higher survival has been shown for overweight septic patients compared with normal or underweight patients in the past. This study aimed at investigating the management and outcome of septic ICU patients in different body mass index (BMI) categories in a large multicenter database. In total, 16,612 patients of the eICU collaborative research database were included. Baseline characteristics and data on organ support were documented. Multilevel logistic regression analysis was performed to fit three sequential regression models for the binary primary outcome (ICU mortality) to evaluate the impact of the BMI categories: underweight (<18.5 kg/m Management strategies were similar across BMI categories. Underweight patients evidenced higher rates of ICU mortality. This finding persisted after adjusting in model 2 (aOR 1.54, 95% CI 1.15-2.06; p = 0.004) and model 3 (aOR 1.57, 95%CI 1.16-2.12; p = 0.003). No differences were found regarding ICU mortality between normal and overweight patients (aOR 0.93, 95%CI 0.81-1.06; p = 0.29). Obese patients evidenced a lower risk of ICU mortality compared to normal weight, a finding which persisted across all models (model 2: aOR 0.83, 95%CI 0.69-0.99; p = 0.04; model 3: aOR 0.82, 95%CI 0.68-0.98; p = 0.03). The protective effect of obesity and the negative effect of underweight were significant in individuals > 65 years only. In this cohort, underweight was associated with a worse outcome, whereas obese patients evidenced lower mortality. Our analysis thus supports the thesis of the obesity paradox.
Sections du résumé
BACKGROUND
BACKGROUND
Higher survival has been shown for overweight septic patients compared with normal or underweight patients in the past. This study aimed at investigating the management and outcome of septic ICU patients in different body mass index (BMI) categories in a large multicenter database.
METHODS
METHODS
In total, 16,612 patients of the eICU collaborative research database were included. Baseline characteristics and data on organ support were documented. Multilevel logistic regression analysis was performed to fit three sequential regression models for the binary primary outcome (ICU mortality) to evaluate the impact of the BMI categories: underweight (<18.5 kg/m
RESULTS
RESULTS
Management strategies were similar across BMI categories. Underweight patients evidenced higher rates of ICU mortality. This finding persisted after adjusting in model 2 (aOR 1.54, 95% CI 1.15-2.06; p = 0.004) and model 3 (aOR 1.57, 95%CI 1.16-2.12; p = 0.003). No differences were found regarding ICU mortality between normal and overweight patients (aOR 0.93, 95%CI 0.81-1.06; p = 0.29). Obese patients evidenced a lower risk of ICU mortality compared to normal weight, a finding which persisted across all models (model 2: aOR 0.83, 95%CI 0.69-0.99; p = 0.04; model 3: aOR 0.82, 95%CI 0.68-0.98; p = 0.03). The protective effect of obesity and the negative effect of underweight were significant in individuals > 65 years only.
CONCLUSION
CONCLUSIONS
In this cohort, underweight was associated with a worse outcome, whereas obese patients evidenced lower mortality. Our analysis thus supports the thesis of the obesity paradox.
Identifiants
pubmed: 34529131
doi: 10.1007/s00508-021-01912-0
pii: 10.1007/s00508-021-01912-0
pmc: PMC8857006
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
139-147Informations de copyright
© 2021. The Author(s).
Références
Crit Care Med. 2019 May;47(5):643-650
pubmed: 30789403
Crit Care. 2017 Feb 22;21(1):36
pubmed: 28222804
Crit Care Med. 2014 Aug;42(8):1766-74
pubmed: 24717466
Sci Rep. 2021 Jan 15;11(1):1615
pubmed: 33452302
Sci Data. 2018 Sep 11;5:180178
pubmed: 30204154
Crit Care Clin. 2010 Oct;26(4):583-96
pubmed: 20970043
BMC Anesthesiol. 2017 Aug 31;17(1):118
pubmed: 28859605
BMC Anesthesiol. 2017 Oct 25;17(1):147
pubmed: 29070011
Int J Inflam. 2015;2015:734857
pubmed: 26064774
J Clin Endocrinol Metab. 2004 Jun;89(6):2548-56
pubmed: 15181022
Intensive Care Med. 2020 Jan;46(1):57-69
pubmed: 31784798
Lancet. 2002 Apr 20;359(9315):1412
pubmed: 11978348
Am Heart J. 2020 Apr;222:73-82
pubmed: 32018204
Eur J Epidemiol. 2014 Nov;29(11):801-12
pubmed: 25354991
Arch Gerontol Geriatr. 2012 Jan-Feb;54(1):78-81
pubmed: 21628078
Obesity (Silver Spring). 2013 Dec;21(12):E762-9
pubmed: 23526732
Crit Care Med. 2020 Sep;48(9):e776-e782
pubmed: 32590388
Semin Respir Crit Care Med. 2019 Oct;40(5):594-603
pubmed: 31826260
JAMA. 2018 Jan 2;319(1):62-75
pubmed: 29297082
Intensive Care Med. 2009 Jul;35(7):1152-70
pubmed: 19189078
Int J Obes Relat Metab Disord. 2001 Oct;25(10):1407-15
pubmed: 11673759
Intensive Care Med. 2017 Dec;43(12):1820-1828
pubmed: 28936626
Sci Transl Med. 2014 Oct 15;6(258):258ra143
pubmed: 25320235
Int J Infect Dis. 2019 Oct;87:109-116
pubmed: 31357061
Int J Med Inform. 2021 Jan;145:104312
pubmed: 33126059
Int J Epidemiol. 2019 Dec 1;48(6):1783-1794
pubmed: 31292615
BMJ Open. 2018 Sep 12;8(9):e021979
pubmed: 30209156
J Intensive Care Med. 2022 Jan;37(1):83-91
pubmed: 33213268
Innate Immun. 2014 Jan;20(1):61-7
pubmed: 23606514
Crit Care Med. 2013 Feb;41(2):580-637
pubmed: 23353941
Sci Rep. 2020 Oct 29;10(1):18671
pubmed: 33122713
Crit Care. 2020 Aug 31;24(1):534
pubmed: 32867859
JAMA. 2016 Apr 12;315(14):1469-79
pubmed: 26975785
Eur J Intern Med. 2020 Jun;76:76-81
pubmed: 32143899
Eur J Public Health. 2018 Apr 1;28(2):295-300
pubmed: 29036436
J Obes. 2020 Feb 17;2020:1508764
pubmed: 32211204
Crit Care. 2013 Apr 17;17(2):R72
pubmed: 23594407
Lancet Respir Med. 2014 May;2(5):380-6
pubmed: 24740011
Eur J Intern Med. 2021 Jan;83:74-77
pubmed: 33059966
Med Care. 1998 Jan;36(1):8-27
pubmed: 9431328
J Crit Care. 2015 Jun;30(3):518-24
pubmed: 25575851
BMC Obes. 2016 Feb 20;3:12
pubmed: 26904203
Med Care. 2017 Jul;55(7):698-705
pubmed: 28498196
Crit Care Med. 2020 Jan;48(1):41-48
pubmed: 31651422
J Thorac Dis. 2020 Feb;12(Suppl 1):S37-S47
pubmed: 32148924
Crit Care Med. 2015 Mar;43(3):519-26
pubmed: 25479111