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Observational Study
. 2015 Jan-Feb;22(1):23-30.
doi: 10.1155/2015/938930. Epub 2014 Nov 6.

The association between obesity and outcomes in critically ill patients

Stephan Wardell, Alastair Wall, Rhonda Bryce, John A Gjevre, Karen Laframboise, John Kilpatrick Reid
Observational Study

The association between obesity and outcomes in critically ill patients

Stephan Wardell et al. Can Respir J. 2015 Jan-Feb.

Abstract
in English, French

Background: Obesity rates are increasing worldwide, particularly in North America. The impact of obesity on the outcome of critically ill patients is unclear.

Methods: A prospective observational cohort study of consecutive patients admitted to a tertiary critical care unit in Canada between January 10, 2008 and March 31, 2009 was conducted. Exclusion criteria were age <18 years, admission <24 h, planned cardiac surgery, pregnancy, significant ascites, unclosed surgical abdomen and brain death on admission. Height, weight and abdominal circumference were measured at the time of intensive care unit (ICU) admission. Coprimary end points were ICU mortality and a composite of ICU mortality, reintubation, ventilator-associated pneumonia, line sepsis and ICU readmission. Subjects were stratified as obese or nonobese, using two separate metrics: body mass index (BMI) ≥ 30 kg/m(2) and a novel measurement of 75th percentile for waist-to-height ratio (WHR).

Results: Among 449 subjects with a BMI ≥ 18.5 kg/m(2), both BMI and WHR were available for comparative analysis in 348 (77.5%). Neither measure of obesity was associated with the primary end points. BMI ≥ 3 0 kg/m(2) was associated with a lower odds of six-month mortality than the BMI <30 kg/m(2) group (adjusted OR 0.59 [95% CI 0.36 to 0.97]; P=0.04) but longer intubation times (adjusted RR 1.56 [95% CI 1.17 to 2.07]; P=0.003) and longer ICU length of stay (adjusted RR 1.67 [95% CI 1.21 to 2.31]; P=0.002). Conversely, measurement of 75th percentile for WHR was associated only with decreased ICU readmission (OR 0.23 [95% CI 0.07 to 0.79]; P=0.02).

Conclusions: Obesity was not necessarily associated with worse outcomes in critically ill patients.

HISTORIQUE :: Le taux d’obésité augmente dans le monde, particulièrement en Amérique du Nord. On connaît mal les répercussions de l’obésité sur l’issue des patients gravement malades.

MÉTHODOLOGIE :: Les chercheurs ont mené une étude d’observation prospective auprès d’une cohorte de patients consécutifs admis dans une unité tertiaire de soins intensifs au Canada entre le 10 janvier 2008 et le 31 mars 2009. Étaient exclus les patients de moins de 18 ans, admis moins de 24 heures, subissant une opération cardiaque planifiée ou présentant une grossesse, une ascite marquée, un abdomen chirurgical ouvert ou une mort cérébrale à l’admission. La taille, le poids et le tour de taille étaient mesurés au moment de l’admission à l’unité de soins intensifs (USI). Les coparamètres primaires étaient la mortalité à l’USI et un composite de mortalité à l’USI, de réintubation, de pneumonie associée à la ventilation, de sepsis du cathéter et de réadmission à l’USI. Les sujets étaient stratifiés entre les obèses et les non-obèses, selon deux mesures distinctes : indice de masse corporelle (IMC) d’au moins 30 kg/m2 et nouvelle mesure du ratio entre le tour de taille et la taille (TTT) au 75e percentile.

RÉSULTATS :: Chez les 449 sujets dont l’IMC était d’au moins 18,5 kg/m2, l’IMC et la TTT de 348 (77,5 %) d’entre eux étaient disponibles pour l’analyse comparative. Aucune des mesures d’obésité ne s’associait aux paramètres primaires. Le groupe ayant un IMC d’au moins 30 kg/m2 présentait un risque plus faible de mortalité au bout de six mois que le groupe dont l’IMC était inférieur à 30 kg/m2 (RC rajusté 0,59 [95 % IC 0,36 à 0,97]; P=0,04), mais qui était intubé plus longtemps (RR rajusté 1,56 [95 % IC 1,17 à 2,07]; P=0,003) et une hospitalisation plus longue à l’USI (RR rajusté 1,67 [95 % IC 1,21 à 2,31]; P=0,002). Par contre, une mesure du TTT au 75e percentile s’associait seulement à une diminution des admissions à l’USI (RC 0,23 [95 % IC 0,07 à 0,79]; P=0,02).

CONCLUSIONS :: L’obésité ne s’associait pas nécessairement à une issue plus néfaste chez les patients gravement malades.

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Figures

Figure 1)
Figure 1)
Classification of obesity according to body mass index (BMI) ≥30 kg/m2 versus the 75th percentile of waist-to-height ratio (WHR75). The figure shows that there was a substantial portion of patients who were classified as obese according to BMI, but not by WHR75. Conversely, there were very few patients who were categorized as obese according to WHR75 but not confirmed by BMI ≥30 kg/m2. Obese by WHR only, n=6 (1.7%); agreed obesity by both WHR and BMI, n=84 (24.1%); obese by BMI only, n=62 (17.8%); agreed nonobesity by both WHR and BMI, n=196 (56.3%)
See this image and copyright information in PMC

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