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The relationship between a lower body mass index and reintubation among critically ill patients: a multicenter
Toshinori Maezawa1,2, Masaaki Sakuraya3,4, Tadahiro Goto5
1Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan. toshinori.hds@gmail.com.
Insights
Underweight patients in critical care face a higher risk of reintubation after mechanical ventilation. This study confirms that a lower body mass index (BMI) is a significant factor in this increased risk.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Clinical Nutrition
Background:
- Underweight patients in intensive care units (ICUs) have a higher risk of in-hospital mortality due to reduced physiological reserve.
- The association between low body mass index (BMI) and the risk of reintubation in mechanically ventilated patients is not well-established.
Purpose of the Study:
- To investigate the relationship between body mass index (BMI) and the risk of reintubation in adult patients requiring mechanical ventilation.
Main Methods:
- A retrospective cohort study utilized data from the Japanese Intensive care PAtient Database (JIPAD) from 2018-2023.
- Included were adult patients on mechanical ventilation for ≥24 hours, with reintubation defined as mechanical ventilation within 72 hours post-extubation.
- Multivariable logistic regression analyzed BMI categories (underweight, normal, overweight, obesity) adjusting for known risk factors.
Main Results:
- The study included 41,016 patients; the overall reintubation rate was 5.9%.
- Underweight patients (BMI <18.5 kg/m²) had the highest reintubation rate (8.4%) and a significantly increased risk (aOR 1.58).
- Obesity (BMI ≥30.0 kg/m²) was associated with a lower reintubation risk (aOR 0.69), and this association persisted in age-stratified analyses.
Conclusions:
- A lower body mass index (BMI) is significantly associated with an increased risk of reintubation in mechanically ventilated patients.
- This finding remained consistent across different age groups, highlighting BMI as a crucial factor in assessing reintubation risk.
Background:
Underweight critical care patients are at an increased risk of in-hospital mortality. This vulnerability is attributed to the lack of physiological reserve, which may increase the risk of reintubation in these patients. However, the association between underweight and reintubation remains unclear. We aimed to assess the association between a lower body mass index (BMI) and the risk of reintubation in mechanically ventilated patients.
Methods:
We performed a retrospective cohort study using data from the Japanese Intensive care PAtient Database (JIPAD). We included adult patients who received mechanical ventilation for at least 24 h from intensive care unit (ICU) admission between 2018 and 2023. The primary outcome was reintubation, which was defined as the reimplementation of mechanical ventilation within 72 h after extubation. BMI was categorized into five groups: underweight (< 18.5 kg/m2), slightly underweight (18.5-21.9 kg/m2), normal weight (22.0-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥ 30.0 kg/m2). We examined the relationship between BMI and reintubation and using a multivariable logistic regression analysis. We adjusted for established reintubation risk factor as a fixed effect, and facilities as a random effect. Additionally, we performed age-stratified subgroup analysis.
Results:
Of the 41,016 eligible patients from 131 ICUs, the mean BMI was 23.4 kg/m2, and the overall reintubation rate within 72 h was 5.9% (2,436 patients). This rate was the highest in the underweight group (8.4%) and the lowest in the obesity group (4.3%). Using normal weight as the reference, being underweight correlated with a higher risk of reintubation (adjusted odds ratio 1.58, [95% confidence interval 1.39-1.80]), whereas being obese correlated with a lower risk of reintubation (adjusted odds ratio, 0.69 [95% confidence interval: 0.57-0.84]). In the subgroup analysis stratified by age category, being underweight was associated with an increased risk of reintubation.
Conclusion:
A lower BMI was associated with an increased risk of reintubation. This relationship remained consistent in the age-stratified subgroup analysis. The present results indicate that a lower BMI needs to be considered an important factor when assessing an underweight patient's risk of reintubation.
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