title: Not all critically ill obese patients are the same: the influence of prior comorbidities.
abstract: Purpose. Data suggest that obesity in critical illness is associated with improved outcomes. We postulate that these findings may be influenced by preillness comorbidities. We sought to determine if critically ill obese patients without significant comorbidity had improved mortality compared to obese patients with multiple comorbidities. Materials and Methods. We analyzed data from a prospective observational study conducted in 3 tertiary ICUs. Severely obese (body mass index ≥30) adults in the ICU for ≥24 hours were identified and classified into limited comorbid illnesses (0-1) or multiple comorbidities (≥2). The primary outcome was the odds ratio (OR) of mortality at day 28. Important secondary outcomes were ICU length of stay and ICU free days in the first 28 days. Results. 598 patients were enrolled; 183 had BMI ≥30. Of these, 38 had limited comorbidities and 145 had multiple comorbidities. In unadjusted analyses, obese patients with multiple comorbidities were 4.70 times (95% CI 1.07-20.6) as likely to die by day 28 compared to patients with limited comorbidities (P = 0.04). After stratifying by admission diagnosis and adjusting for APACHE II score, the influence of comorbidities remained large and trended toward significance (OR 4.28, 95% CI 0.92-20.02, P = 0.06). In adjusted analyses, obese patients with multiple comorbidities tended to have longer ICU duration (3.06 days, SE 2.28, P = 0.18) and had significantly fewer ICU free days in the first 28 days (-3.92 days, SE 1.83, P = 0.03). Conclusions. Not all critically ill obese patients are the same. Those with less comorbidity may have better outcomes than those with multiple comorbidities. This may be important when considering prognosis and discussing care with patients and families.
authors.affiliation: Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada N6A 4V2 ; Division of Critical Care Medicine, Department of Medicine, Niagara Health System, Hamilton, ON, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont, Burlington, VT 05405, USA.
authors.forename: Renee D
authors.initials: RD
authors.lastname: Stapleton
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada K7L 2V7 ; Department of Community Health and Epidemiology, Queen's University, Kingston, ON, Canada K7L 2V7 ; Department of Medicine, Queen's University, Kingston General Hospital, Kingston, ON, Canada K7L 2V7.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland