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Weight as a Risk Factor for Mortality in Critically Ill Patients
Itay Ayalon1, Jessica G Woo2,3, Rajit K Basu4
1Pediatric Intensive Care Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Insights
Critically ill children who are underweight face higher mortality and more complex intensive care unit (ICU) courses. Overweight and obese children did not show increased mortality risk in this study.
Area of Science:
- Pediatric critical care medicine
- Nutritional science
- Epidemiology
Background:
- Obesity is a growing concern in pediatric populations.
- Understanding the impact of nutritional status on critically ill children is crucial for improving outcomes.
- Previous research has yielded conflicting results regarding the association between body weight and mortality in pediatric intensive care units (PICUs).
Purpose of the Study:
- To investigate the association between body weight status (underweight, normal weight, overweight, and obesity) and mortality in critically ill children.
- To explore whether nutritional status influences the outcomes of children admitted to the PICU, particularly those with sepsis.
Main Methods:
- Secondary analysis of the prospective, multinational Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology (AWARE) study.
- Inclusion of patients aged 3 months to 25 years from diverse geographical regions.
- Categorization of patients into four weight groups based on Body Mass Index (BMI) percentile for age and sex: underweight, normal weight, overweight, and obese.
Main Results:
- A total of 3719 patients were analyzed, with 542 diagnosed with sepsis.
- Underweight patients exhibited significantly higher 28-day mortality rates in both the overall cohort (5.8%) and the sepsis subcohort (15.4%) compared to normal weight, overweight, and obese groups.
- Overweight and obese children did not show an increased risk of mortality; underweight patients experienced longer ICU stays, increased need for mechanical ventilation, and higher rates of fluid overload.
Conclusions:
- Underweight status is a significant risk factor for increased short-term mortality and a more complicated clinical course in critically ill children.
- Nutritional status, particularly being underweight, plays a critical role in the outcomes of pediatric patients in the intensive care setting.
- Further research is warranted to elucidate the mechanisms underlying the adverse outcomes associated with underweight status in critically ill children.
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.
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