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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.CC

Abstract

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.

Authors+Show Affiliations

1Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany. 2Department of Medicine, Medical College of Wisconsin, Milwaukee, WI. 3Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 4Intensive Care Unit, Santa Maria degli Angeli, Pordenone, Italy. 5Critical Care Department, Cliniques Universitaires St Luc, UCL, Brussels, Belgium. 6St. James's University Hospitals, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Center for Health Sciences, Dublin, Ireland. 7Critical Care Center, Corporacion Sanitaria Parc Taulí, CIBER Enfermedades Respiratorias, Parc Tauli, University Institute, Sabadell, Spain. 8Service de Réanimation Polyvalente, CHU Dupuytren, Limoges cedex, France. 9Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France. 10Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26427591

Citation

Sakr, Yasser, et al. "Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit." Critical Care Medicine, vol. 43, no. 12, 2015, pp. 2623-32.
Sakr Y, Alhussami I, Nanchal R, et al. Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit. Crit Care Med. 2015;43(12):2623-32.
Sakr, Y., Alhussami, I., Nanchal, R., Wunderink, R. G., Pellis, T., Wittebole, X., Martin-Loeches, I., François, B., Leone, M., & Vincent, J. L. (2015). Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit. Critical Care Medicine, 43(12), 2623-32. https://doi.org/10.1097/CCM.0000000000001310
Sakr Y, et al. Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit. Crit Care Med. 2015;43(12):2623-32. PubMed PMID: 26427591.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit. AU - Sakr,Yasser, AU - Alhussami,Ilmi, AU - Nanchal,Rahul, AU - Wunderink,Richard G, AU - Pellis,Tommaso, AU - Wittebole,Xavier, AU - Martin-Loeches,Ignacio, AU - François,Bruno, AU - Leone,Marc, AU - Vincent,Jean-Louis, AU - ,, PY - 2015/10/3/entrez PY - 2015/10/3/pubmed PY - 2016/3/5/medline SP - 2623 EP - 32 JF - Critical care medicine JO - Crit Care Med VL - 43 IS - 12 N2 - 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. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/26427591/Being_Overweight_Is_Associated_With_Greater_Survival_in_ICU_Patients:_Results_From_the_Intensive_Care_Over_Nations_Audit_ L2 - https://dx.doi.org/10.1097/CCM.0000000000001310 DB - PRIME DP - Unbound Medicine ER -