Underweight but not overweight is associated with excess mortality in septic ICU patients.

Autor: Danninger T; Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria., Rezar R; Department of Cardiology, Intensive Care Medicine & Emergency Department, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria. r.rezar@salk.at., Mamandipoor B; Fondazione Bruno Kessler Research Institute, Trento, Italy., Dankl D; Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria., Koköfer A; Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria., Jung C; Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany., Wernly B; Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria.; Department of Cardiology, Intensive Care Medicine & Emergency Department, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria.; Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria., Osmani V; Fondazione Bruno Kessler Research Institute, Trento, Italy.
Jazyk: angličtina
Zdroj: Wiener klinische Wochenschrift [Wien Klin Wochenschr] 2022 Feb; Vol. 134 (3-4), pp. 139-147. Date of Electronic Publication: 2021 Sep 16.
DOI: 10.1007/s00508-021-01912-0
Abstrakt: Background: Higher survival has been shown for overweight septic patients compared with normal or underweight patients in the past. This study aimed at investigating the management and outcome of septic ICU patients in different body mass index (BMI) categories in a large multicenter database.
Methods: In total, 16,612 patients of the eICU collaborative research database were included. Baseline characteristics and data on organ support were documented. Multilevel logistic regression analysis was performed to fit three sequential regression models for the binary primary outcome (ICU mortality) to evaluate the impact of the BMI categories: underweight (<18.5 kg/m 2 ), normal weight (18.5 to < 25 kg/m 2 ), overweight (25 to < 30 kg/m 2 ) and obesity (≥ 30 kg/m 2 ). Data were adjusted for patient level characteristics (model 2) as well as management strategies (model 3).
Results: Management strategies were similar across BMI categories. Underweight patients evidenced higher rates of ICU mortality. This finding persisted after adjusting in model 2 (aOR 1.54, 95% CI 1.15-2.06; p = 0.004) and model 3 (aOR 1.57, 95%CI 1.16-2.12; p = 0.003). No differences were found regarding ICU mortality between normal and overweight patients (aOR 0.93, 95%CI 0.81-1.06; p = 0.29). Obese patients evidenced a lower risk of ICU mortality compared to normal weight, a finding which persisted across all models (model 2: aOR 0.83, 95%CI 0.69-0.99; p = 0.04; model 3: aOR 0.82, 95%CI 0.68-0.98; p = 0.03). The protective effect of obesity and the negative effect of underweight were significant in individuals > 65 years only.
Conclusion: In this cohort, underweight was associated with a worse outcome, whereas obese patients evidenced lower mortality. Our analysis thus supports the thesis of the obesity paradox.
(© 2021. The Author(s).)
Databáze: MEDLINE
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