Being Overweight Is Associated With Greater Survival in ICU Patients

Results From the Intensive Care Over Nations Audit

Yasser Sakr, Ilmi Alhussami, Rahul Nanchal, Richard G Wunderink, Tommaso Pellis, Xavier Wittebole, Ignacio Martin-Loeches, Bruno François, Marc Leone, Jean Louis Vincent, Intensive Care Over Nations Investigators, Erminio Sisillo

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)2623-32
Number of pages10
JournalCritical Care Medicine
Volume43
Issue number12
DOIs
Publication statusPublished - Dec 2015

Fingerprint

Critical Care
Body Mass Index
Survival
Thinness
Length of Stay
Infection
Weights and Measures
Hospital Mortality
Critical Illness

Keywords

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Critical Illness
  • Cross Infection
  • Female
  • Hospital Mortality
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Male
  • Middle Aged
  • Obesity
  • Overweight
  • Proportional Hazards Models
  • Severity of Illness Index
  • Sex Factors
  • Thinness
  • Journal Article
  • Research Support, Non-U.S. Gov't

Cite this

Being Overweight Is Associated With Greater Survival in ICU Patients : Results From the Intensive Care Over Nations Audit. / Sakr, Yasser; Alhussami, Ilmi; Nanchal, Rahul; Wunderink, Richard G; Pellis, Tommaso; Wittebole, Xavier; Martin-Loeches, Ignacio; François, Bruno; Leone, Marc; Vincent, Jean Louis; Intensive Care Over Nations Investigators ; Sisillo, Erminio.

In: Critical Care Medicine, Vol. 43, No. 12, 12.2015, p. 2623-32.

Research output: Contribution to journalArticle

Sakr, Y, Alhussami, I, Nanchal, R, Wunderink, RG, Pellis, T, Wittebole, X, Martin-Loeches, I, François, B, Leone, M, Vincent, JL, Intensive Care Over Nations Investigators & Sisillo, E 2015, '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, pp. 2623-32. https://doi.org/10.1097/CCM.0000000000001310
Sakr, Yasser ; Alhussami, Ilmi ; Nanchal, Rahul ; Wunderink, Richard G ; Pellis, Tommaso ; Wittebole, Xavier ; Martin-Loeches, Ignacio ; François, Bruno ; Leone, Marc ; Vincent, Jean Louis ; Intensive Care Over Nations Investigators ; Sisillo, Erminio. / Being Overweight Is Associated With Greater Survival in ICU Patients : Results From the Intensive Care Over Nations Audit. In: Critical Care Medicine. 2015 ; Vol. 43, No. 12. pp. 2623-32.
@article{3ba8601399d14e94abfd31688aee7a60,
title = "Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit",
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.",
keywords = "Adult, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Critical Illness, Cross Infection, Female, Hospital Mortality, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Obesity, Overweight, Proportional Hazards Models, Severity of Illness Index, Sex Factors, Thinness, Journal Article, Research Support, Non-U.S. Gov't",
author = "Yasser Sakr and Ilmi Alhussami and Rahul Nanchal and Wunderink, {Richard G} and Tommaso Pellis and Xavier Wittebole and Ignacio Martin-Loeches and Bruno Fran{\cc}ois and Marc Leone and Vincent, {Jean Louis} and {Intensive Care Over Nations Investigators} and Erminio Sisillo",
year = "2015",
month = "12",
doi = "10.1097/CCM.0000000000001310",
language = "English",
volume = "43",
pages = "2623--32",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Being Overweight Is Associated With Greater Survival in ICU Patients

T2 - 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 - Intensive Care Over Nations Investigators

AU - Sisillo, Erminio

PY - 2015/12

Y1 - 2015/12

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.

AB - 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.

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Body Mass Index

KW - Critical Illness

KW - Cross Infection

KW - Female

KW - Hospital Mortality

KW - Humans

KW - Intensive Care Units

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - Obesity

KW - Overweight

KW - Proportional Hazards Models

KW - Severity of Illness Index

KW - Sex Factors

KW - Thinness

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1097/CCM.0000000000001310

DO - 10.1097/CCM.0000000000001310

M3 - Article

VL - 43

SP - 2623

EP - 2632

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 12

ER -