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Open Access Highly Accessed Research

Lower short- and long-term mortality associated with overweight and obesity in a large cohort study of adult intensive care unit patients

Swapna Abhyankar*, Kira Leishear, Fiona M Callaghan, Dina Demner-Fushman and Clement J McDonald

Author Affiliations

Lister Hill National Center for Biomedical Communications, National Library of Medicine National Institutes of Health, 8600 Rockville Pike, Building 38A/7N707, Bethesda, MD 20894, USA

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Critical Care 2012, 16:R235  doi:10.1186/cc11903

Published: 18 December 2012

Abstract

Introduction

Two thirds of United States adults are overweight or obese, which puts them at higher risk of developing chronic diseases and of death compared with normal-weight individuals. However, recent studies have found that overweight and obesity by themselves may be protective in some contexts, such as hospitalization in an intensive care unit (ICU). Our objective was to determine the relation between body mass index (BMI) and mortality at 30 days and 1 year after ICU admission.

Methods

We performed a cohort analysis of 16,812 adult patients from MIMIC-II, a large database of ICU patients at a tertiary care hospital in Boston, Massachusetts. The data were originally collected during the course of clinical care, and we subsequently extracted our dataset independent of the study outcome.

Results

Compared with normal-weight patients, obese patients had 26% and 43% lower mortality risk at 30 days and 1 year after ICU admission, respectively (odds ratio (OR), 0.74; 95% confidence interval (CI), 0.64 to 0.86) and 0.57 (95% CI, 0.49 to 0.67)); overweight patients had nearly 20% and 30% lower mortality risk (OR, 0.81; 95% CI, 0.70 to 0.93) and OR, 0.68 (95% CI, 0.59 to 0.79)). Severely obese patients (BMI ≥ 40 kg/m2) did not have a significant survival advantage at 30 days (OR, 0.94; 95% CI, 0.74 to 1.20), but did have 30% lower mortality risk at 1 year (OR, 0.70 (95% CI, 0.54 to 0.90)). No significant difference in admission acuity or ICU and hospital length of stay was found across BMI categories.

Conclusion

Our study supports the hypothesis that patients who are overweight or obese have improved survival both 30 days and 1 year after ICU admission.