Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2004

Open Access 01-12-2004 | Research article

Underweight is independently associated with mortality in post-operative and non-operative patients admitted to the intensive care unit: a retrospective study

Authors: Javier D Finkielman, Ognjen Gajic, Bekele Afessa

Published in: BMC Emergency Medicine | Issue 1/2004

Login to get access

Abstract

Background

Low and high body mass index (BMI) have been recently shown to be associated with increased and decreased mortality after ICU admission, respectively. The objective of this study was to determine the impact of BMI on mortality and length of stay in patients admitted to the intensive care unit (ICU).

Methods

In this retrospective cohort study, the Acute Physiology and Chronic Health Evaluation (APACHE) III database of patients admitted to the ICUs of a tertiary academic medical center, from January 1997 to September 2002, was crossed with a Hospital Rule-based Systems database to obtain the height and weight of the patients on admission to the ICU. The cohort was divided in post-operative and non-operative groups. We created the following five subgroups based on the BMI: <18.5, 18.5 to 24.9, 25 to 29.9, 30.0 to 39.9, ≥ 40.0 Kg/m2. A multiple logistic regression analysis was used to determine the independent impact of BMI on hospital mortality. The ICU length of stay ratio was defined as the ratio of the observed to the predicted LOS. P-value < 0.05 was considered significant. The 95% confidence interval (CI) was calculated for the odds ratio (OR).

Results

BMI was available in 19,669 of the 21,790 patients in the APACHE III database; 11,215 (57%) of the patients were admitted post-operatively. BMI < 18.5 was associated with increased mortality in both post-operative (OR = 2.14, 95% CI, 1.39 to 3.28) and non-operative (OR = 1.51, 95% CI, 1.13 to 2.01) patients. Post-operative patients with a BMI between 30.0 to 39.9 had a lower mortality rate (OR = 0.68, 95% CI, 0.49 to 0.94). Post-operative patients with BMI <18.5 or BMI ≥ 40 had an ICU length of stay ratio significantly higher than patients with BMI between 18.5 to 24.9. The addition of BMI < 18.5 did not improve significantly the accuracy of our prognostic model in predicting hospital mortality.

Conclusions

Low BMI is associated with higher mortality in both post- and non-operative patients admitted to the ICU. LOS is increased in post-operative patients with low and high BMIs.
Literature
1.
Galanos AN, Pieper CF, Kussin PS, Winchell MT, Fulkerson WJ, Harrell FE, Teno JM, Layde P, Connors AF, Phillips RS, Wenger NS: Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. Crit Care Med. 1997, 25 (12): 1962-1968. 10.1097/00003246-199712000-00010.CrossRefPubMed
2.
Troiano RP, Frongillo EA, Sobal J, Levitsky DA: The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies. International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity. 1996, 20 (1): 63-75.
3.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW: Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999, 341 (15): 1097-1105. 10.1056/NEJM199910073411501.CrossRefPubMed
4.
Engeland A, Bjorge T, Selmer RM, Tverdal A: Height and body mass index in relation to total mortality. Epidemiology. 2003, 14 (3): 293-299. 10.1097/00001648-200305000-00008.PubMed
5.
Song YM, Sung J: Body mass index and mortality: a twelve-year prospective study in Korea. Epidemiology. 2001, 12 (2): 173-179. 10.1097/00001648-200103000-00008.CrossRefPubMed
6.
Potter JF, Schafer DF, Bohi RL: In-hospital mortality as a function of body mass index: an age-dependent variable. J Gerontol. 1988, 43: M59-63.CrossRefPubMed
7.
Landi F, Onder G, Gambassi G, Pedone C, Carbonin P, Bernabei R: Body mass index and mortality among hospitalized patients. Arch Intern Med. 2000, 160 (17): 2641-2644. 10.1001/archinte.160.17.2641.CrossRefPubMed
8.
Tremblay A, Bandi V: Impact of body mass index on outcomes following critical care. Chest. 2003, 123 (4): 1202-1207. 10.1378/chest.123.4.1202.CrossRefPubMed
9.
Garrouste-Orgeas M, Troche G, Azoulay E, Caubel A, De Lassence A, Cheval C, Montesino L, Thuong M, Vincent F, Cohen Y, Timsit JF: Body mass index. An additional prognostic factor in ICU patients. Intensive Care Med. 2004, 30 (3): 437-443. 10.1007/s00134-003-2095-2.CrossRefPubMed
10.
Zimmerman JE, Wagner DP, Knaus WA, Williams JF, Kolakowski D, Draper EA: The use of risk predictions to identify candidates for intermediate care units. Implications for intensive care utilization and cost. Chest. 1995, 108 (2): 490-499.CrossRefPubMed
11.
Keene AR, Cullen DJ: Therapeutic Intervention Scoring System: update 1983. Crit Care Med. 1983, 11 (1): 1-3.CrossRefPubMed
12.
Cullen DJ, Civetta JM, Briggs BA, Ferrara LC: Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med. 1974, 2 (2): 57-60.CrossRefPubMed
13.
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A: The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991, 100 (6): 1619-1636.CrossRefPubMed
14.
World Health Organization: Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization Technical Report Series. 1995, 854: 1-452.
15.
Finkielman JD, Morales J, Peters SG, Keegan MT, Ensminger SA, Lymp JF, Afessa B: Mortality rate and length of stay of patients admitted to the intensive care unit in July. Critical Care Medicine. 2004, 32 (5): 1161-1165. 10.1097/01.CCM.0000126151.56590.99.CrossRefPubMed
16.
Hanley JA, McNeil BJ: A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983, 148 (3): 839-843.CrossRefPubMed
17.
Knaus WA, Wagner DP, Zimmerman JE, Draper EA: Variations in mortality and length of stay in intensive care units. Ann Intern Med. 1993, 118 (10): 753-761.CrossRefPubMed
18.
Dyk D: Ocena prognozowania wynikow intensywnej terapii na podstawie APACHE III u chorych po operacji i nieoperowanych. Folia Medica Cracoviensia. 2001, 42 (4): 227-235.PubMed
19.
Choban PS, Weireter LJ, Maynes C: Obesity and increased mortality in blunt trauma. J Trauma. 1991, 31 (9): 1253-1257.CrossRefPubMed
20.
El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J: Morbid obesity in the medical ICU. Chest. 2001, 120 (6): 1989-1997. 10.1378/chest.120.6.1989.CrossRefPubMed
21.
Flancbaum L, Choban PS: Surgical implications of obesity. Annual Review of Medicine. 1998, 49: 215-234. 10.1146/annurev.med.49.1.215.CrossRefPubMed
22.
Choban PS, Flancbaum L: The impact of obesity on surgical outcomes: a review. Journal of the American College of Surgeons. 1997, 185 (6): 593-603. 10.1016/S1072-7515(97)00109-9.CrossRefPubMed
23.
O'Brien JM, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM: Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med. 2004, 140 (5): 338-346.CrossRefPubMed
Metadata
Title
Underweight is independently associated with mortality in post-operative and non-operative patients admitted to the intensive care unit: a retrospective study
Authors
Javier D Finkielman
Ognjen Gajic
Bekele Afessa
Publication date
01-12-2004
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2004
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/1471-227X-4-3

Other articles of this Issue 1/2004

BMC Emergency Medicine 1/2004 Go to the issue

Research article

Management of acute renal colic in the UK: a questionnaire survey

Research article

Beckman Access versus the Bayer ACS:180 and the Abbott AxSYM cardiac Troponin-I real-time immunoassays: an observational prospective study

Research article

A report of dangerously high carbon monoxide levels within the passenger compartment of a snow-obstructed vehicle

Research article

Impact of disaster-related mortality on gross domestic product in the WHO African Region