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Can body mass index predict clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome? A meta-analysis.
Crit Care. 2017 Feb 22; 21(1):36.CC

Abstract

BACKGROUND

The effects of body mass index (BMI) on the prognosis of acute respiratory distress syndrome (ARDS) are controversial. We aimed to further determine the relationship between BMI and the acute outcomes of patients with ARDS.

METHODS

We searched the Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and ISI Web of Science for trials published between 1946 and July 2016, using "BMI" or "body mass index" or "overweight" or "obese" and "ARDS" or "ALI" or "acute respiratory distress syndrome" or "acute lung injury", without limitations on publication type or language. Heterogeneity and sensitivity analyses were conducted, and a random-effects model was applied to calculate the odds ratio (OR) or mean difference (MD). Review Manager (RevMan) was used to test the hypothesis using the Mann-Whitney U test. The primary outcome was unadjusted mortality, and secondary outcomes included mechanical ventilation (MV)-free days and length of stay (LOS) in the intensive care unit (ICU) and in hospital.

RESULTS

Five trials with a total of 6268 patients were pooled in our final analysis. There was statistical heterogeneity between normal-weight and overweight patients in LOS in the ICU (I 2 = 71%, χ 2 = 10.27, P = 0.02) and in MV-free days (I 2 = 89%, χ 2 = 18.45, P < 0.0001). Compared with normal weight, being underweight was associated with higher mortality (OR 1.59, 95% confidence interval (CI) 1.22, 2.08, P = 0.0006), while obesity and morbid obesity were more likely to result in lower mortality (OR 0.68, 95% CI 0.57, 0.80, P < 0.00001; OR 0.72, 95% CI 0.56, 0.93, P = 0.01). MV-free days were much longer in patients with morbid obesity (MD 2.64, 95% CI 0.60, 4.67, P = 0.01), but ICU and hospital LOS were not influenced by BMI. An important limitation of our analysis is the lack of adjustment for age, sex, illness severity, comorbid illness, and interaction of outcome parameters.

CONCLUSIONS

Obesity and morbid obesity are associated with lower mortality in patients with ARDS.

Authors+Show Affiliations

Departments of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.Departments of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.Departments of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, 37 Gue Xue Xiang, Chengdu, 610041, Sichuan, China.Departments of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.Departments of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.Departments of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, 37 Gue Xue Xiang, Chengdu, 610041, Sichuan, China.Departments of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. liangbinmiao@163.com.Departments of Respiratory Diseases, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. niyuenantg@126.com.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

28222804

Citation

Ni, Yue-Nan, et al. "Can Body Mass Index Predict Clinical Outcomes for Patients With Acute Lung Injury/acute Respiratory Distress Syndrome? a Meta-analysis." Critical Care (London, England), vol. 21, no. 1, 2017, p. 36.
Ni YN, Luo J, Yu H, et al. Can body mass index predict clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome? A meta-analysis. Crit Care. 2017;21(1):36.
Ni, Y. N., Luo, J., Yu, H., Wang, Y. W., Hu, Y. H., Liu, D., Liang, B. M., & Liang, Z. A. (2017). Can body mass index predict clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome? A meta-analysis. Critical Care (London, England), 21(1), 36. https://doi.org/10.1186/s13054-017-1615-3
Ni YN, et al. Can Body Mass Index Predict Clinical Outcomes for Patients With Acute Lung Injury/acute Respiratory Distress Syndrome? a Meta-analysis. Crit Care. 2017 Feb 22;21(1):36. PubMed PMID: 28222804.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can body mass index predict clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome? A meta-analysis. AU - Ni,Yue-Nan, AU - Luo,Jian, AU - Yu,He, AU - Wang,Yi-Wei, AU - Hu,Yue-Hong, AU - Liu,Dan, AU - Liang,Bin-Miao, AU - Liang,Zong-An, Y1 - 2017/02/22/ PY - 2016/08/19/received PY - 2017/01/24/accepted PY - 2017/2/23/entrez PY - 2017/2/23/pubmed PY - 2018/8/29/medline KW - Adult KW - Body mass index KW - Mortality KW - Obese KW - Prognosis KW - Respiratory distress syndrome SP - 36 EP - 36 JF - Critical care (London, England) JO - Crit Care VL - 21 IS - 1 N2 - BACKGROUND: The effects of body mass index (BMI) on the prognosis of acute respiratory distress syndrome (ARDS) are controversial. We aimed to further determine the relationship between BMI and the acute outcomes of patients with ARDS. METHODS: We searched the Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and ISI Web of Science for trials published between 1946 and July 2016, using "BMI" or "body mass index" or "overweight" or "obese" and "ARDS" or "ALI" or "acute respiratory distress syndrome" or "acute lung injury", without limitations on publication type or language. Heterogeneity and sensitivity analyses were conducted, and a random-effects model was applied to calculate the odds ratio (OR) or mean difference (MD). Review Manager (RevMan) was used to test the hypothesis using the Mann-Whitney U test. The primary outcome was unadjusted mortality, and secondary outcomes included mechanical ventilation (MV)-free days and length of stay (LOS) in the intensive care unit (ICU) and in hospital. RESULTS: Five trials with a total of 6268 patients were pooled in our final analysis. There was statistical heterogeneity between normal-weight and overweight patients in LOS in the ICU (I 2 = 71%, χ 2 = 10.27, P = 0.02) and in MV-free days (I 2 = 89%, χ 2 = 18.45, P < 0.0001). Compared with normal weight, being underweight was associated with higher mortality (OR 1.59, 95% confidence interval (CI) 1.22, 2.08, P = 0.0006), while obesity and morbid obesity were more likely to result in lower mortality (OR 0.68, 95% CI 0.57, 0.80, P < 0.00001; OR 0.72, 95% CI 0.56, 0.93, P = 0.01). MV-free days were much longer in patients with morbid obesity (MD 2.64, 95% CI 0.60, 4.67, P = 0.01), but ICU and hospital LOS were not influenced by BMI. An important limitation of our analysis is the lack of adjustment for age, sex, illness severity, comorbid illness, and interaction of outcome parameters. CONCLUSIONS: Obesity and morbid obesity are associated with lower mortality in patients with ARDS. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/28222804/Can_body_mass_index_predict_clinical_outcomes_for_patients_with_acute_lung_injury/acute_respiratory_distress_syndrome_A_meta_analysis_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1615-3 DB - PRIME DP - Unbound Medicine ER -