Jake V Hinton, Nattaya Raykateeraroj, Chin J Ker, Boris Waldman, Je Min Suh, David Pilcher, Rinaldo Bellomo, Dong Kyu Lee, Laurence Weinberg
{"title":"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。","authors":"Jake V Hinton, Nattaya Raykateeraroj, Chin J Ker, Boris Waldman, Je Min Suh, David Pilcher, Rinaldo Bellomo, Dong Kyu Lee, Laurence Weinberg","doi":"10.1016/j.accpm.2025.101634","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The impact of body mass index (BMI) on morbidity and mortality in very old individuals with acute, critical illness is poorly understood.</p><p><strong>Methods: </strong>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/m<sup>2</sup>), normal weight (20 kg/m<sup>2</sup> ≤ BMI < 25.0 kg/m<sup>2</sup>), overweight (25.0 kg/m<sup>2</sup> ≤ BMI < 30 kg/m<sup>2</sup>), or obese (BMI ≥ 30 kg/m<sup>2</sup>). We estimated the association between admission BMI and clinical outcomes, with in-hospital mortality as the primary outcome.</p><p><strong>Results: </strong>The median BMI of the cohort was 24.4 kg/m<sup>2</sup> (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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Australian new zealand clinical trials registry number: </strong>ACTRN12625000297426.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101634"},"PeriodicalIF":4.7000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The effect of body mass index on short-term outcomes in nonagenarians and centenarians with critical illness: a retrospective cohort study.\",\"authors\":\"Jake V Hinton, Nattaya Raykateeraroj, Chin J Ker, Boris Waldman, Je Min Suh, David Pilcher, Rinaldo Bellomo, Dong Kyu Lee, Laurence Weinberg\",\"doi\":\"10.1016/j.accpm.2025.101634\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The impact of body mass index (BMI) on morbidity and mortality in very old individuals with acute, critical illness is poorly understood.</p><p><strong>Methods: </strong>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/m<sup>2</sup>), normal weight (20 kg/m<sup>2</sup> ≤ BMI < 25.0 kg/m<sup>2</sup>), overweight (25.0 kg/m<sup>2</sup> ≤ BMI < 30 kg/m<sup>2</sup>), or obese (BMI ≥ 30 kg/m<sup>2</sup>). We estimated the association between admission BMI and clinical outcomes, with in-hospital mortality as the primary outcome.</p><p><strong>Results: </strong>The median BMI of the cohort was 24.4 kg/m<sup>2</sup> (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.</p><p><strong>Conclusions: </strong>In nonagenarians and centenarians admitted to the ICU, higher BMI was linked to lower in-hospital mortality, suggesting a protective effect. 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The effect of body mass index on short-term outcomes in nonagenarians and centenarians with critical illness: a retrospective cohort study.
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.
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.
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