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Body mass index is associated with hospital mortality in critically ill patients: an observational cohort study.
Crit Care Med. 2013 Aug; 41(8):1878-83.CC

Abstract

OBJECTIVE

Obesity is associated with a variety of diseases, which results in a decreased overall life expectancy. Nevertheless, some studies suggest that being overweight may reduce hospital mortality of certain patient groups, referred to as obesity paradox. Conflicting results for critically ill patients are reported. Therefore, we wished to investigate the association of body mass index and hospital mortality in critically ill patients.

DESIGN

Observational cohort study in Dutch critically ill patients.

SETTING

A dataset from the Dutch National Intensive Care Evaluation registry that includes patients admitted to Dutch ICUs was used.

PATIENTS

One hundred fifty-four thousand three hundred and eight ICU patients of teaching and nonteaching units in urban and nonurban hospitals.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We used logistic regression analysis, correcting for case mix (Simplified Acute Physiology Score II, age, gender, admission type, neoplasm, AIDS, hematologic malignancy, immunologic insufficiency, mechanical ventilation, and calendar year), to determine the relationship between body mass index and hospital mortality. Body mass index was included in the model as a continuous nonlinear covariate in a restricted regression spline transformation. To facilitate interpretation, adjusted odds ratios were calculated for the World Health Organization-based body mass index classes. Body mass index was found to be significantly associated with hospital mortality, with risks quickly increasing for underweight patients (body mass index < 18.5 kg/m). Obese and seriously obese patients, with a body mass index of 30-39.9 kg/m, had the lowest risk of death with an adjusted odds ratio of 0.86 (0.83-0.90).

CONCLUSIONS

This large observational database shows an inverse association between obesity and hospital mortality in critically ill patients that could not be explained by a variety of known confounders.

Authors+Show Affiliations

Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. p.pickkers@ic.umcn.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23685638

Citation

Pickkers, Peter, et al. "Body Mass Index Is Associated With Hospital Mortality in Critically Ill Patients: an Observational Cohort Study." Critical Care Medicine, vol. 41, no. 8, 2013, pp. 1878-83.
Pickkers P, de Keizer N, Dusseljee J, et al. Body mass index is associated with hospital mortality in critically ill patients: an observational cohort study. Crit Care Med. 2013;41(8):1878-83.
Pickkers, P., de Keizer, N., Dusseljee, J., Weerheijm, D., van der Hoeven, J. G., & Peek, N. (2013). Body mass index is associated with hospital mortality in critically ill patients: an observational cohort study. Critical Care Medicine, 41(8), 1878-83. https://doi.org/10.1097/CCM.0b013e31828a2aa1
Pickkers P, et al. Body Mass Index Is Associated With Hospital Mortality in Critically Ill Patients: an Observational Cohort Study. Crit Care Med. 2013;41(8):1878-83. PubMed PMID: 23685638.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Body mass index is associated with hospital mortality in critically ill patients: an observational cohort study. AU - Pickkers,Peter, AU - de Keizer,Nicolette, AU - Dusseljee,Joost, AU - Weerheijm,Daan, AU - van der Hoeven,Johannes G, AU - Peek,Niels, PY - 2013/5/21/entrez PY - 2013/5/21/pubmed PY - 2013/9/28/medline SP - 1878 EP - 83 JF - Critical care medicine JO - Crit Care Med VL - 41 IS - 8 N2 - OBJECTIVE: Obesity is associated with a variety of diseases, which results in a decreased overall life expectancy. Nevertheless, some studies suggest that being overweight may reduce hospital mortality of certain patient groups, referred to as obesity paradox. Conflicting results for critically ill patients are reported. Therefore, we wished to investigate the association of body mass index and hospital mortality in critically ill patients. DESIGN: Observational cohort study in Dutch critically ill patients. SETTING: A dataset from the Dutch National Intensive Care Evaluation registry that includes patients admitted to Dutch ICUs was used. PATIENTS: One hundred fifty-four thousand three hundred and eight ICU patients of teaching and nonteaching units in urban and nonurban hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used logistic regression analysis, correcting for case mix (Simplified Acute Physiology Score II, age, gender, admission type, neoplasm, AIDS, hematologic malignancy, immunologic insufficiency, mechanical ventilation, and calendar year), to determine the relationship between body mass index and hospital mortality. Body mass index was included in the model as a continuous nonlinear covariate in a restricted regression spline transformation. To facilitate interpretation, adjusted odds ratios were calculated for the World Health Organization-based body mass index classes. Body mass index was found to be significantly associated with hospital mortality, with risks quickly increasing for underweight patients (body mass index < 18.5 kg/m). Obese and seriously obese patients, with a body mass index of 30-39.9 kg/m, had the lowest risk of death with an adjusted odds ratio of 0.86 (0.83-0.90). CONCLUSIONS: This large observational database shows an inverse association between obesity and hospital mortality in critically ill patients that could not be explained by a variety of known confounders. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/23685638/Body_mass_index_is_associated_with_hospital_mortality_in_critically_ill_patients:_an_observational_cohort_study_ L2 - https://dx.doi.org/10.1097/CCM.0b013e31828a2aa1 DB - PRIME DP - Unbound Medicine ER -