The effect of body mass index on short-term outcomes in nonagenarians and centenarians with critical illness: a retrospective cohort study.

IF 4.7 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine Pub Date : 2025-09-29 DOI:10.1016/j.accpm.2025.101634

Jake V Hinton, Nattaya Raykateeraroj, Chin J Ker, Boris Waldman, Je Min Suh, David Pilcher, Rinaldo Bellomo, Dong Kyu Lee, Laurence Weinberg

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引用次数: 0

Abstract

Background: The impact of body mass index (BMI) on morbidity and mortality in very old individuals with acute, critical illness is poorly understood.

Methods: We conducted a bi-national, retrospective, entropy-weighted cohort study of 12,510 nonagenarians and centenarians admitted to the intensive care unit (ICU) over a 15-year period. Based on their admission BMI, patients were classified as underweight (BMI < 20 kg/m²), normal weight (20 kg/m² ≤ BMI < 25.0 kg/m²), overweight (25.0 kg/m² ≤ BMI < 30 kg/m²), or obese (BMI ≥ 30 kg/m²). We estimated the association between admission BMI and clinical outcomes, with in-hospital mortality as the primary outcome.

Results: The median BMI of the cohort was 24.4 kg/m² (IQR 21.8-27.5). Of the 12,510 eligible patients, 5,471 (43.7%) were categorized as normal weight, 1,526 (12.2%) underweight, 3,914 (31.3%) overweight, and 1,599 (12.8%) obese. After entropy weighting, increasing BMI was negatively associated with mortality (P < 0.001). In-hospital mortality occurred in 699 (12.8%) normal weight, 223 (14.6%) underweight (RR 1.18; 95% CI 1.02 to 1.36; P=0.030), 504 (12.9%) overweight (RR 0.97; 95% CI 0.87 to 1.08; P = 0.580), and 172 (10.8%) obese (RR 0.76; 95% CI 0.64 to 0.90; P = 0.001) patients. BMI was not associated with binary requirements for inotropes, invasive ventilation, or renal replacement therapy.

Conclusions: In nonagenarians and centenarians admitted to the ICU, higher BMI was linked to lower in-hospital mortality, suggesting a protective effect. These results emphasize the need for individualized risk assessment in older ICU patients.

Australian new zealand clinical trials registry number: ACTRN12625000297426.

查看原文本刊更多论文

体重指数对九十岁和百岁危重病患者短期预后的影响：一项回顾性队列研究。

背景：身体质量指数（BMI）对高龄急性危重症患者发病率和死亡率的影响尚不清楚。方法：我们进行了一项两国、回顾性、熵加权队列研究，研究对象是在15年内入住重症监护病房（ICU）的12510名90多岁和百岁老人。根据入院BMI将患者分为体重过轻（BMI 2）、正常体重（20 kg/m2≤BMI 2）、超重（25.0 kg/m2≤BMI 2）、肥胖（BMI≥30 kg/m2）。我们估计了入院BMI和临床结局之间的关系，住院死亡率是主要结局。结果：该队列的中位BMI为24.4 kg/m2 （IQR 21.8-27.5）。在12510例符合条件的患者中，5471例（43.7%）被归类为体重正常，1526例（12.2%）体重不足，3914例（31.3%）超重，1599例（12.8%）肥胖。经熵加权后，BMI的增加与死亡率呈负相关(P)。结论：在入住ICU的90岁及百岁老人中，较高的BMI与较低的住院死亡率相关，提示具有保护作用。这些结果强调了对老年ICU患者进行个性化风险评估的必要性。澳大利亚新西兰临床试验注册号：ACTRN12625000297426。

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来源期刊

Anaesthesia Critical Care & Pain Medicine ANESTHESIOLOGY-

CiteScore

6.70

自引率

5.50%

发文量

150

审稿时长

18 days

期刊介绍： Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.