title: Body mass index and mortality in Korean intensive care units: a prospective multicenter cohort study.
abstract: BACKGROUND
  The level of body mass index (BMI) that is associated with the lowest mortality in critically ill patients in Asian populations is uncertain. We aimed to examine the association of BMI with hospital mortality in critically ill patients in Korea.
  
  
  METHODS
  We conducted a prospective multicenter cohort study of 3,655 critically ill patients in 22 intensive care units (ICUs) in Korea. BMI was categorized into five groups: <18.5, 18.5 to 22.9, 23.0 to 24.9 (the reference category), 25.0 to 29.9, and ≥30.0 kg/m2.
  
  
  RESULTS
  The median BMI was 22.6 (IQR 20.3 to 25.1). The percentages of patients with BMI<18.5, 18.5 to 22.9, 23.0 to 24.9, 25.0 to 29.9, and ≥30.0 were 12, 42.3, 19.9, 22.4, and 3.3%, respectively. The Cox-proportional hazard ratios with exact partial likelihood to handle tied failures for hospital mortality comparing the BMI categories <18.5, 18.5 to 22.9, 25.0 to 29.9, and ≥30.0 with the reference category were 1.13 (0.88 to 1.44), 1.03 (0.84 to 1.26), 0.96 (0.76 to 1.22), and 0.68 (0.43 to 1.08), respectively, with a highly significant test for trend (p = 0.02).
  
  
  CONCLUSIONS
  A graded inverse association between BMI and hospital mortality with a strong significant trend was found in critically ill patients in Korea.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Lim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Keimyung University, Dongsan Hospital, Daegu, Korea.
authors.forename: Won-Il
authors.initials: WI
authors.lastname: Choi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
authors.affiliation: Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chae-Man
authors.initials: CM
authors.lastname: Lim
authors.affiliation: Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Shin Ok
authors.initials: SO
authors.lastname: Koh
authors.affiliation: Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sungwon
authors.initials: S
authors.lastname: Na
authors.affiliation: Department of anesthesiology, Aju university college of medicine, Suwon, Korea.
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
authors.forename: Seok Chan
authors.initials: SC
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chungju hospital, School of medicine of Konkuk university, Chungju, Korea.
authors.forename: Ick Hee
authors.initials: IH
authors.lastname: Kim
authors.affiliation: Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Je Hyeong
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Jae Yeol
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Gangneung Asan Hospital, University of Ulsan Medical College of medicine, Gangneung, Korea.
authors.forename: Jaemin
authors.initials: J
authors.lastname: Lim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
authors.forename: Chin Kook
authors.initials: CK
authors.lastname: Rhee
authors.affiliation: Department of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Park
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, College of Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.
authors.forename: Ho Cheol
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Multimedia, Seoul Women's University, Seoul, Korea.
authors.forename: Jisook
authors.initials: J
authors.lastname: Park
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Gee Young
authors.initials: GY
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology
references.citation: Lancet. 2004 Jan 10;363(9403):157-63
references.pmid: 14726171
references.citation: Biomed Environ Sci. 2002 Mar;15(1):83-96
references.pmid: 12046553
references.citation: Intensive Care Med. 2004 Mar;30(3):437-43
references.pmid: 14767583
references.citation: Chest. 2003 Apr;123(4):1202-7
references.pmid: 12684312
references.citation: Obes Rev. 2003 Nov;4(4):257-90
references.pmid: 14649376
references.citation: Surg Infect (Larchmt). 2007 Dec;8(6):581-8
references.pmid: 18171117
references.citation: Anaesth Intensive Care. 2006 Oct;34(5):629-33
references.pmid: 17061639
references.citation: Int J Obes Relat Metab Disord. 1999 May;23(5):537-42
references.pmid: 10375058
references.citation: Am J Respir Cell Mol Biol. 2007 Apr;36(4):504-12
references.pmid: 17122368
references.citation: J Am Coll Surg. 2006 Oct;203(4):533-8
references.pmid: 17000398
references.citation: J Trauma. 2005 Feb;58(2):232-7
references.pmid: 15706181
references.citation: Infect Immun. 2003 Jul;71(7):4182-5
references.pmid: 12819114
references.citation: Am J Epidemiol. 2005 Jul 1;162(1):42-8
references.pmid: 15961585
references.citation: N Engl J Med. 2006 Aug 24;355(8):779-87
references.pmid: 16926276
references.citation: J Am Coll Cardiol. 2013 Feb 5;61(5):553-60
references.pmid: 23369419
references.citation: Intensive Care Med. 2009 Jul;35(7):1152-70
references.pmid: 19189078
references.citation: Obesity (Silver Spring). 2008 Mar;16(3):515-21
references.pmid: 18239602
references.citation: N Engl J Med. 1999 Oct 7;341(15):1097-105
references.pmid: 10511607
references.citation: Chest. 2007 Feb;131(2):342-8
references.pmid: 17296631
references.citation: Lancet. 2005 Oct 1;366(9492):1197-209
references.pmid: 16198769
references.citation: Crit Care Med. 2006 Apr;34(4):964-70; quiz 971
references.pmid: 16484910
references.citation: Circ J. 2008 Apr;72(4):521-5
references.pmid: 18362419
references.citation: Chest. 2001 Dec;120(6):1989-97
references.pmid: 11742933
references.citation: Crit Care Med. 2008 Jan;36(1):151-8
references.pmid: 18007266
references.citation: N Engl J Med. 2011 Feb 24;364(8):719-29
references.pmid: 21345101
references.citation: Crit Care Med. 2012 May;40(5):1456-63
references.pmid: 22430246
references.citation: Respirology. 2013 Aug;18(6):989-95
references.pmid: 23663287
references.citation: J Trauma. 2005 Nov;59(5):1048-51; discussion 1051
references.pmid: 16385276
references.citation: Korean J Intern Med. 2010 Jun;25(2):162-7
references.pmid: 20526389
references.citation: Int J Cardiol. 2013 Sep 20;168(1):616-20
references.pmid: 23465238
references.citation: J Immunol. 1991 Dec 1;147(11):3815-22
references.pmid: 1940369
references.citation: Chest. 2005 Jun;127(6):2125-31
references.pmid: 15947330
references.citation: Chest. 2004 Apr;125(4):1441-5
references.pmid: 15078757
references.citation: N Engl J Med. 2010 Dec 2;363(23):2211-9
references.pmid: 21121834
references.citation: Crit Care Med. 2004 Apr;32(4):998-1003
references.pmid: 15071392
references.citation: Crit Care Med. 2006 Mar;34(3):738-44
references.pmid: 16521268
references.citation: Arch Surg. 2004 Sep;139(9):983-7
references.pmid: 15381617
references.citation: J Cardiol. 2010 Jan;55(1):84-91
references.pmid: 20122553
references.citation: Crit Care Med. 2006 Dec;34(12):2929-39
references.pmid: 17075374
references.citation: Nature. 1998 Aug 27;394(6696):897-901
references.pmid: 9732873
references.citation: J Immunol. 2002 Apr 15;168(8):4018-24
references.pmid: 11937559