The impact of body mass index on long-term survival after ICU admission due to COVID-19: A retrospective multicentre study

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2023-12-01 DOI:10.1016/j.ccrj.2023.10.004

Ashwin Subramaniam MBBS MMed FRACP FCICM , Ryan Ruiyang Ling MBBS , Emma J. Ridley PhD , David V. Pilcher MBBS MRCP(UK) FRACP FCICM

{"title":"The impact of body mass index on long-term survival after ICU admission due to COVID-19: A retrospective multicentre study","authors":"Ashwin Subramaniam MBBS MMed FRACP FCICM , Ryan Ruiyang Ling MBBS , Emma J. Ridley PhD , David V. Pilcher MBBS MRCP(UK) FRACP FCICM","doi":"10.1016/j.ccrj.2023.10.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>The impact of obesity on long-term survival after intensive care unit (ICU) admission with severe coronavirus disease 2019 (COVID-19) is unclear. We aimed to quantify the impact of obesity on time to death up to two years in patients admitted to Australian and New Zealand ICUs.</p></div><div><h3>Design</h3><p>Retrospective multicentre study.</p></div><div><h3>Setting</h3><p>92 ICUs between 1st January 2020 through to 31st December 2020 in New Zealand and 31st March 2022 in Australia with COVID-19, reported in the Australian and New Zealand Intensive Care Society adult patient database.</p></div><div><h3>Participants</h3><p>All patients with documented height and weight to estimate the body mass index (BMI) were included. Obesity was classified patients according to the World Health Organization recommendations.</p></div><div><h3>Interventions and main outcome measures</h3><p>The primary outcome was survival time up to two years after ICU admission. The effect of obesity on time to death was assessed using a Cox proportional hazards model. Confounders were acute illness severity, sex, frailty, hospital type and jurisdiction for all patients.</p></div><div><h3>Results</h3><p>We examined 2,931 patients; the median BMI was 30.2 (IQR 25.6–36.0) kg/m<sup>2</sup>. Patients with a BMI ≥30 kg/m<sup>2</sup> were younger (median [IQR] age 57.7 [46.2–69.0] vs. 63.0 [50.0–73.6]; p < 0.001) than those with a BMI <30 kg/m<sup>2</sup>. Most patients (76.6%; 2,244/2,931) were discharged alive after ICU admission. The mortality at two years was highest for BMI categories <18.5 kg/m<sup>2</sup> (35.4%) and 18.5–24.9 kg/m<sup>2</sup> (31.1%), while lowest for BMI ≥40 kg/m<sup>2</sup> (14.5%). After adjusting for confounders and with BMI 18.5–24.9 kg/m<sup>2</sup> category as a reference, only the BMI ≥40 kg/m<sup>2</sup> category patients had improved survival up to 2 years (hazard ratio = 0.51; 95%CI: 0.34–0.76).</p></div><div><h3>Conclusions</h3><p>The obesity paradox appears to exist beyond hospital discharge in critically ill patients with COVID-19 admitted in Australian and New Zealand ICUs. A BMI ≥40 kg/m<sup>2</sup> was associated with a higher survival time of up to two years.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022159/pdfft?md5=f51bc221c020ffbf242635da08c6c270&pid=1-s2.0-S1441277223022159-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care and Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1441277223022159","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

The impact of obesity on long-term survival after intensive care unit (ICU) admission with severe coronavirus disease 2019 (COVID-19) is unclear. We aimed to quantify the impact of obesity on time to death up to two years in patients admitted to Australian and New Zealand ICUs.

Design

Retrospective multicentre study.

Setting

92 ICUs between 1st January 2020 through to 31st December 2020 in New Zealand and 31st March 2022 in Australia with COVID-19, reported in the Australian and New Zealand Intensive Care Society adult patient database.

Participants

All patients with documented height and weight to estimate the body mass index (BMI) were included. Obesity was classified patients according to the World Health Organization recommendations.

Interventions and main outcome measures

The primary outcome was survival time up to two years after ICU admission. The effect of obesity on time to death was assessed using a Cox proportional hazards model. Confounders were acute illness severity, sex, frailty, hospital type and jurisdiction for all patients.

Results

We examined 2,931 patients; the median BMI was 30.2 (IQR 25.6–36.0) kg/m². Patients with a BMI ≥30 kg/m² were younger (median [IQR] age 57.7 [46.2–69.0] vs. 63.0 [50.0–73.6]; p < 0.001) than those with a BMI <30 kg/m². Most patients (76.6%; 2,244/2,931) were discharged alive after ICU admission. The mortality at two years was highest for BMI categories <18.5 kg/m² (35.4%) and 18.5–24.9 kg/m² (31.1%), while lowest for BMI ≥40 kg/m² (14.5%). After adjusting for confounders and with BMI 18.5–24.9 kg/m² category as a reference, only the BMI ≥40 kg/m² category patients had improved survival up to 2 years (hazard ratio = 0.51; 95%CI: 0.34–0.76).

Conclusions

The obesity paradox appears to exist beyond hospital discharge in critically ill patients with COVID-19 admitted in Australian and New Zealand ICUs. A BMI ≥40 kg/m² was associated with a higher survival time of up to two years.

查看原文本刊更多论文

体重指数对因 COVID-19 入住 ICU 后长期生存的影响：一项回顾性多中心研究

目的2019年严重冠状病毒病（COVID-19）患者入住重症监护病房（ICU）后，肥胖对长期存活率的影响尚不清楚。我们旨在量化澳大利亚和新西兰重症监护病房收治的患者中，肥胖对其两年内死亡时间的影响。根据世界卫生组织的建议对肥胖患者进行分类。干预措施和主要结果测量主要结果为入住重症监护病房后两年内的存活时间。肥胖对死亡时间的影响采用Cox比例危险模型进行评估。所有患者的混杂因素包括急性病严重程度、性别、虚弱程度、医院类型和辖区。结果我们对2931名患者进行了检查；BMI中位数为30.2（IQR 25.6-36.0）kg/m2。与体重指数为 30 kg/m2 的患者相比，体重指数≥30 kg/m2 的患者更年轻（中位[IQR]年龄为 57.7 [46.2-69.0] vs. 63.0 [50.0-73.6]; p <0.001）。大多数患者（76.6%；2,244/2,931 例）在入住重症监护室后都活着出院。体重指数为 18.5 kg/m2 （35.4%）和 18.5-24.9 kg/m2 （31.1%）的患者两年后的死亡率最高，而体重指数≥40 kg/m2 的患者死亡率最低（14.5%）。结论在澳大利亚和新西兰重症监护病房收治的 COVID-19 重症患者中，肥胖悖论似乎在出院后仍然存在。体重指数≥40 kg/m2与较高的存活时间（长达两年）相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.