Weight as a Risk Factor for Mortality in Critically Ill Patients

AWARE Investigators

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations

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.

Original languageEnglish
Article numbere20192829
JournalPediatrics
Volume146
Issue number2
DOIs
StatePublished - 1 Aug 2020
Externally publishedYes

Funding

FundersFunder number
Gambro Renal Products
Pediatric Nephrology Center of Excellence at Cincinnati Children’s Hospital Medical Center
National Institutes of Health
National Institute of Diabetes and Digestive and Kidney DiseasesP50DK096418
Cincinnati Children's Hospital Medical Center

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