Weight as a Risk Factor for Mortality in Critically Ill Patients

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.