Weight as a Risk Factor for Mortality in Critically Ill Patients
Itay Ayalon, Jessica G Woo, Rajit K Basu, Ahmad Kaddourah, Stuart L Goldstein, Jennifer M Kaplan, AWARE Investigators, Ayse A Arikan, Megan Arnold, Cody S Cruz, Michele Goldsworthy, Nancy Jaimon, Stephen Alexander, Marino Festa, Deidre Hahn, Lauren Brown, Ari Jeon, Akash D Arora, David Askenazi, Sean Bagshaw, Catherine Morgan, Rashid Alobaidi, Rajit K Basu, David S Cooper, Stuart L Goldstein, Ahmad Kaddourah, Theresa Mottes, Tara Terrell, Patricia Arnold, Christina Metcalf, Shalayna Woodley, Radovan Bogdanović, Natasa Stajić, Branko Kovacevic, Amira Peco-Antic, Aleksandra Paripovic, Patrick Brophy, Timothy E Bunchman, Duane C Williams, Michelle Hoot, Vimal Chadha, T Keefe Davis, Vikas R Dharnidharka, Leslie Walther, Edward V S Faustino, Janet Taft, Joana Tala, Katja Gist, Danielle Soranno, Il Soo Ha, Hee Gyung Kang, Rick Hackbarth, Mary Avendt-Reeber, Chloe Butler, Doug DeGraaf, Dawn Eding, Nathalie Hautala, Akunne Ndika, Eka Laksmi Hidayati, Songming Huang, Sean Kennedy, Madeline Didsbury, Hari Kushartono, Risky Vitria Prasetyo, Cherry Mammen, Matthew L Paden, Cheryl Stone, Stefano Picca, Federica Connola, James Schneider, Todd Sweberg, Aaron Kessel, David T Selewski, Susan M Hieber, Brankica Spasojević-Dimitrijeva, Ivana Ivanisevic, Jovana Putnik, Snezana Ristic, Scott Sutherland, Amy Staples, Craig Wong, Senan Hadid, Catherine Joseph, Robert P Woroniecki, Michael Zappitelli, Noha Elsaerafy, Joshua Zaritsky, Itay Ayalon, Jessica G Woo, Rajit K Basu, Ahmad Kaddourah, Stuart L Goldstein, Jennifer M Kaplan, AWARE Investigators, Ayse A Arikan, Megan Arnold, Cody S Cruz, Michele Goldsworthy, Nancy Jaimon, Stephen Alexander, Marino Festa, Deidre Hahn, Lauren Brown, Ari Jeon, Akash D Arora, David Askenazi, Sean Bagshaw, Catherine Morgan, Rashid Alobaidi, Rajit K Basu, David S Cooper, Stuart L Goldstein, Ahmad Kaddourah, Theresa Mottes, Tara Terrell, Patricia Arnold, Christina Metcalf, Shalayna Woodley, Radovan Bogdanović, Natasa Stajić, Branko Kovacevic, Amira Peco-Antic, Aleksandra Paripovic, Patrick Brophy, Timothy E Bunchman, Duane C Williams, Michelle Hoot, Vimal Chadha, T Keefe Davis, Vikas R Dharnidharka, Leslie Walther, Edward V S Faustino, Janet Taft, Joana Tala, Katja Gist, Danielle Soranno, Il Soo Ha, Hee Gyung Kang, Rick Hackbarth, Mary Avendt-Reeber, Chloe Butler, Doug DeGraaf, Dawn Eding, Nathalie Hautala, Akunne Ndika, Eka Laksmi Hidayati, Songming Huang, Sean Kennedy, Madeline Didsbury, Hari Kushartono, Risky Vitria Prasetyo, Cherry Mammen, Matthew L Paden, Cheryl Stone, Stefano Picca, Federica Connola, James Schneider, Todd Sweberg, Aaron Kessel, David T Selewski, Susan M Hieber, Brankica Spasojević-Dimitrijeva, Ivana Ivanisevic, Jovana Putnik, Snezana Ristic, Scott Sutherland, Amy Staples, Craig Wong, Senan Hadid, Catherine Joseph, Robert P Woroniecki, Michael Zappitelli, Noha Elsaerafy, Joshua Zaritsky
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.
Trial registration: ClinicalTrials.gov NCT01987921.
Conflict of interest statement
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Copyright © 2020 by the American Academy of Pediatrics.
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Source: PubMed