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. 2025 Jun 25;20(6):e0325452.
doi: 10.1371/journal.pone.0325452. eCollection 2025.

Association between body mass index and long-term all-cause mortality in critically ill patients without malignant tumors

Jian Deng  1 , Linyan Zhao  1
Affiliations

Association between body mass index and long-term all-cause mortality in critically ill patients without malignant tumors

Jian Deng et al. PLoS One. .

Abstract

Background: The "obesity paradox" in certain diseases has been reported in previous studies. This study aimed to investigate the relationship between BMI and long-term mortality in all critically ill patients without malignant tumors who were admitted to the ICU.

Methods: Using the MIMIC-IV 2.2 database, we included all ICU admissions for patients without malignant tumors and categorized them into four groups based on the World Health Organization (WHO) obesity criteria. The relationship between BMI and 90-day, 180-day, and 1-year mortality was analyzed using univariate and multivariate Cox regression models, along with restricted cubic spline (RCS) models to account for potential non-linear associations.

Results: A total of 19,089 patients were included, with 90-day, 180-day, and 1-year mortality rates of 18.35%, 20.80%, and 23.96%, respectively. Overweight and obese patients exhibited significantly lower mortality rates compared to underweight and normal-weight individuals at all time points. After adjusting for confounders, higher BMI remained a protective factor for long-term mortality (HR 0.65-0.72, P < 0.001). RCS curves demonstrated a U-shaped relationship between BMI and mortality, and subgroup analyses confirmed the protective effect of higher BMI in different subgroups.

Conclusion: The "obesity paradox" may apply to critically ill patients without malignant tumors.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the participant selection.
Fig 2
Fig 2. Kaplan-Meier curve for mortality by BMI category.
Fig 3
Fig 3. The association between BMI and 1-year mortality in the critically ill patients after adjusting for confounding factors.
See this image and copyright information in PMC

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