Obesity Does Not Increase ICU Mortality Rate in Acute Respiratory Failure

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Researchers examined whether obesity is a factor in the mortality of patients with acute respiratory failure that requires intubation.

This article is part of Pulmonology Advisor‘s coverage of the American Thoracic Society International Conference, taking place in Dallas, Texas. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2019.

DALLAS — Obesity does not correlate to a statistically significant difference in mortality rates of patients with concomitant acute respiratory failure that requires intubation, according to research presented at the American Thoracic Society International Conference, held May 17-22, in Dallas, Texas; however, because of a small sample size, further studies with larger sample sizes are needed for confirmation.

Obesity is considered to be a major risk factor in the development of many respiratory diseases, although the relationship between obesity and mortality in patients with acute respiratory failure requires further study.

For this purpose, researchers conducted a retrospective study of patients in an intensive care unit who were admitted for acute respiratory failure that required intubation between September 2015 and September 2017. Body mass index (BMI) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were collected at admission. A BMI of ≥30 classified patients as obese. Univariate logistic regression was used to determine the relationship between APACHE scores and mortality.

In a cohort of 166 patients (59 women, 107 men), 71.68% (n=119) lived and 28.31% (n=47) died. A very strong relationship was found between APACHE scores and mortality (odds ratio, 1.04; 95% CI, 1.01-1.08; P =.006), with the probability of death increasing by 51.08% for every increase in APACHE score compared with a lower score previously calculated.

A very weak (0.563) area under the curve with threshold of an APACHE score of 21.5 was found using receiver operating characteristic analysis, and logic regression found the APACHE scores to be statistically significant (odds ratio, 2.99; 95% CI, 1.49-6.00; P =.002), indicating the probability of death is 74.95% greater for participants with calculated APACHE scores ≥21.5 compared with participants with APACHE scores ≤21.5. Sex was not shown to be a statistically significant mortality predictor (P =.539), nor was BMI related to mortality (P =.983). In patients with BMIs ≥30, no relationship was found between mortality and the degree of obesity (P =.848).

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The investigators concluded that the study, “showed there was no proportional correlation between degree of obesity and mortality in obese patients with acute respiratory failure requiring intubation. Again, more randomized controlled studies are needed.”

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Salameh SS, Targovnik A, Puello B, Foster K, Aboeed A. BMI as an indicator of outcome in ICU patient with acute respiratory failure. Poster presented at: the American Thoracic Society International Conference; May 19, 2019; Dallas, TX. Abstract 1638/P57.