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Weight as a Risk Factor for Mortality in Critically Ill Patients.
Pediatrics. 2020 08; 146(2)Ped

Abstract

OBJECTIVES

To explore the hypothesis that obesity is associated with increased mortality and worse outcomes in children who are critically ill.

METHODS

Secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study, a prospective, multinational observational study. Patients between 3 months and 25 years across Asia, Australia, Europe, and North America were recruited for 3 consecutive months. Patients were divided into 4 groups (underweight, normal weight, overweight, and obese) on the basis of their BMI percentile for age and sex.

RESULTS

A total of 3719 patients were evaluated, of whom 542 (14%) had a primary diagnosis of sepsis. One thousand fifty-nine patients (29%) were underweight, 1649 (44%) were normal weight, 423 (11%) were overweight, and 588 (16%) were obese. The 28-day mortality rate was 3.6% for the overall cohort and 9.1% for the sepsis subcohort and differed significantly by weight status (5.8%, 3.1%, 2.2%, and 1.8% for subjects with underweight, normal weight, overweight, and obesity, respectively, in the overall cohort [P < .001] and 15.4%, 6.6%, 3.6%, and 4.7% in the sepsis subcohort, respectively [P = .003]). In a fully adjusted model, 28-day mortality risk was 1.8-fold higher in the underweight group versus the normal weight group in the overall cohort and 2.9-fold higher in the sepsis subcohort. Patients who were overweight and obese did not demonstrate increased risk in their respective cohorts. Patients who were underweight had a longer ICU length of stay, increased need for mechanical ventilation support, and a higher frequency of fluid overload.

CONCLUSIONS

Patients who are underweight make up a significant proportion of all patients in the PICU, have a higher short-term mortality rate, and have a more complicated ICU course.

Authors+Show Affiliations

Pediatric Intensive Care Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.Divisions of Biostatistics and Epidemiology and. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and.Division of Critical Care Medicine, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia.Center for Acute Care Nephrology, and.Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and. Center for Acute Care Nephrology, and. Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and jennifer.kaplan@cchmc.org. Critical Care Medicine.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Video-Audio Media

Language

eng

PubMed ID

32620676

Citation

Ayalon, Itay, et al. "Weight as a Risk Factor for Mortality in Critically Ill Patients." Pediatrics, vol. 146, no. 2, 2020.
Ayalon I, Woo JG, Basu RK, et al. Weight as a Risk Factor for Mortality in Critically Ill Patients. Pediatrics. 2020;146(2).
Ayalon, I., Woo, J. G., Basu, R. K., Kaddourah, A., Goldstein, S. L., & Kaplan, J. M. (2020). Weight as a Risk Factor for Mortality in Critically Ill Patients. Pediatrics, 146(2). https://doi.org/10.1542/peds.2019-2829
Ayalon I, et al. Weight as a Risk Factor for Mortality in Critically Ill Patients. Pediatrics. 2020;146(2) PubMed PMID: 32620676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Weight as a Risk Factor for Mortality in Critically Ill Patients. AU - Ayalon,Itay, AU - Woo,Jessica G, AU - Basu,Rajit K, AU - Kaddourah,Ahmad, AU - Goldstein,Stuart L, AU - Kaplan,Jennifer M, AU - ,, Y1 - 2020/07/03/ PY - 2020/04/30/accepted PY - 2021/08/01/pmc-release PY - 2020/7/6/pubmed PY - 2020/9/15/medline PY - 2020/7/5/entrez JF - Pediatrics JO - Pediatrics VL - 146 IS - 2 N2 - OBJECTIVES: To explore the hypothesis that obesity is associated with increased mortality and worse outcomes in children who are critically ill. METHODS: Secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study, a prospective, multinational observational study. Patients between 3 months and 25 years across Asia, Australia, Europe, and North America were recruited for 3 consecutive months. Patients were divided into 4 groups (underweight, normal weight, overweight, and obese) on the basis of their BMI percentile for age and sex. RESULTS: A total of 3719 patients were evaluated, of whom 542 (14%) had a primary diagnosis of sepsis. One thousand fifty-nine patients (29%) were underweight, 1649 (44%) were normal weight, 423 (11%) were overweight, and 588 (16%) were obese. The 28-day mortality rate was 3.6% for the overall cohort and 9.1% for the sepsis subcohort and differed significantly by weight status (5.8%, 3.1%, 2.2%, and 1.8% for subjects with underweight, normal weight, overweight, and obesity, respectively, in the overall cohort [P < .001] and 15.4%, 6.6%, 3.6%, and 4.7% in the sepsis subcohort, respectively [P = .003]). In a fully adjusted model, 28-day mortality risk was 1.8-fold higher in the underweight group versus the normal weight group in the overall cohort and 2.9-fold higher in the sepsis subcohort. Patients who were overweight and obese did not demonstrate increased risk in their respective cohorts. Patients who were underweight had a longer ICU length of stay, increased need for mechanical ventilation support, and a higher frequency of fluid overload. CONCLUSIONS: Patients who are underweight make up a significant proportion of all patients in the PICU, have a higher short-term mortality rate, and have a more complicated ICU course. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/32620676/Weight_as_a_Risk_Factor_for_Mortality_in_Critically_Ill_Patients_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=32620676 DB - PRIME DP - Unbound Medicine ER -