Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis.
<h4>Background</h4>Obesity paradox refers to lower mortality in subjects with higher body mass index (BMI), and has been documented under a variety of condition. However, whether obesity paradox exists in adults requiring mechanical ventilation in intensive critical units (ICU) remains c...
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| _version_ | 1850076704422232064 |
|---|---|
| author | Yonghua Zhao Zhiqiang Li Tao Yang Meiping Wang Xiuming Xi |
| author_facet | Yonghua Zhao Zhiqiang Li Tao Yang Meiping Wang Xiuming Xi |
| author_sort | Yonghua Zhao |
| collection | DOAJ |
| description | <h4>Background</h4>Obesity paradox refers to lower mortality in subjects with higher body mass index (BMI), and has been documented under a variety of condition. However, whether obesity paradox exists in adults requiring mechanical ventilation in intensive critical units (ICU) remains controversial.<h4>Methods</h4>MEDLINE, EMBASE, China Biology Medicine disc (CBM) and CINAHL electronic databases were searched from the earliest available date to July 2017, using the following search terms: "body weight", "body mass index", "overweight" or "obesity" and "ventilator", "mechanically ventilated", "mechanical ventilation", without language restriction. Subjects were divided into the following categories based on BMI (kg/m2): underweight, < 18.5 kg/m2; normal, 18.5-24.9 kg/m2; overweight, BMI 25-29.9 kg/m2; obese, 30-39.9 kg/m2; and severely obese > 40 kg/m2. The primary outcome was mortality, and included ICU mortality, hospital mortality, short-term mortality (<6 months), and long-term mortality (6 months or beyond). Secondary outcomes included duration of mechanical ventilation, length of stay (LOS) in ICU and hospital. A random-effects model was used for data analyses. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale.<h4>Results</h4>A total of 15,729 articles were screened. The final analysis included 23 articles (199,421 subjects). In comparison to non-obese patients, obese patients had lower ICU mortality (odds ratio (OR) 0.88, 95% CI 0.0.84-0.92, I2 = 0%), hospital mortality (OR 0.83, 95% CI 0.74-0.93, I2 = 52%), short-term mortality (OR 0.81, 95% CI 0.74-0.88, I2 = 0%) as well as long-term mortality (OR 0.69, 95% CI 0.60-0.79, I2 = 0%). In comparison to subjects with normal BMI, obese patients had lower ICU mortality (OR 0.88, 95% CI 0.82-0.93, I2 = 5%). Hospital mortality was lower in severely obese and obese subjects (OR 0.71, 95% CI 0.53-0.94, I2 = 74%, and OR 0.80, 95% CI 0.73-0.89, I2 = 30%). Short-term mortality was lower in overweight and obese subjects (OR 0.82, 95% CI 0.75-0.90, I2 = 0%, and, OR 0.75, 95% CI 0.66-0.84, I2 = 8%, respectively). Long-term mortality was lower in severely obese, obese and overweight subjects (OR 0.39, 95% CI 0.18-0.83, and OR 0.63, 95% CI 0.46-0.86, I2 = 56%, and OR 0.66, 95% CI 0.57-0.77, I2 = 0%). All 4 mortality measures were higher in underweight subjects than in subjects with normal BMI. Obese subjects had significantly longer duration on mechanical ventilation than non-obese group (mean difference (MD) 0.48, 95% CI 0.16-0.80, I2 = 37%), In comparison to subjects with normal BMI, severely obese BMI had significantly longer time in mechanical ventilation (MD 1.10, 95% CI 0.38-1.83, I2 = 47%). Hospital LOS did not differ between obese and non-obese patients (MD 0.05, 95% CI -0.52 to 0.50, I2 = 80%). Obese patients had longer ICU LOS than non-obese patients (MD 0.38, 95% CI 0.17-0.59, I2 = 70%). Hospital LOS and ICU LOS did not differ significantly in subjects with different BMI status.<h4>Conclusions</h4>In ICU patients receiving mechanical ventilation, higher BMI is associated with lower mortality and longer duration on mechanical ventilation. |
| format | Article |
| id | doaj-art-07f8154fcceb4b799a581d72a3b17a47 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-07f8154fcceb4b799a581d72a3b17a472025-08-20T02:45:57ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01136e019866910.1371/journal.pone.0198669Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis.Yonghua ZhaoZhiqiang LiTao YangMeiping WangXiuming Xi<h4>Background</h4>Obesity paradox refers to lower mortality in subjects with higher body mass index (BMI), and has been documented under a variety of condition. However, whether obesity paradox exists in adults requiring mechanical ventilation in intensive critical units (ICU) remains controversial.<h4>Methods</h4>MEDLINE, EMBASE, China Biology Medicine disc (CBM) and CINAHL electronic databases were searched from the earliest available date to July 2017, using the following search terms: "body weight", "body mass index", "overweight" or "obesity" and "ventilator", "mechanically ventilated", "mechanical ventilation", without language restriction. Subjects were divided into the following categories based on BMI (kg/m2): underweight, < 18.5 kg/m2; normal, 18.5-24.9 kg/m2; overweight, BMI 25-29.9 kg/m2; obese, 30-39.9 kg/m2; and severely obese > 40 kg/m2. The primary outcome was mortality, and included ICU mortality, hospital mortality, short-term mortality (<6 months), and long-term mortality (6 months or beyond). Secondary outcomes included duration of mechanical ventilation, length of stay (LOS) in ICU and hospital. A random-effects model was used for data analyses. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale.<h4>Results</h4>A total of 15,729 articles were screened. The final analysis included 23 articles (199,421 subjects). In comparison to non-obese patients, obese patients had lower ICU mortality (odds ratio (OR) 0.88, 95% CI 0.0.84-0.92, I2 = 0%), hospital mortality (OR 0.83, 95% CI 0.74-0.93, I2 = 52%), short-term mortality (OR 0.81, 95% CI 0.74-0.88, I2 = 0%) as well as long-term mortality (OR 0.69, 95% CI 0.60-0.79, I2 = 0%). In comparison to subjects with normal BMI, obese patients had lower ICU mortality (OR 0.88, 95% CI 0.82-0.93, I2 = 5%). Hospital mortality was lower in severely obese and obese subjects (OR 0.71, 95% CI 0.53-0.94, I2 = 74%, and OR 0.80, 95% CI 0.73-0.89, I2 = 30%). Short-term mortality was lower in overweight and obese subjects (OR 0.82, 95% CI 0.75-0.90, I2 = 0%, and, OR 0.75, 95% CI 0.66-0.84, I2 = 8%, respectively). Long-term mortality was lower in severely obese, obese and overweight subjects (OR 0.39, 95% CI 0.18-0.83, and OR 0.63, 95% CI 0.46-0.86, I2 = 56%, and OR 0.66, 95% CI 0.57-0.77, I2 = 0%). All 4 mortality measures were higher in underweight subjects than in subjects with normal BMI. Obese subjects had significantly longer duration on mechanical ventilation than non-obese group (mean difference (MD) 0.48, 95% CI 0.16-0.80, I2 = 37%), In comparison to subjects with normal BMI, severely obese BMI had significantly longer time in mechanical ventilation (MD 1.10, 95% CI 0.38-1.83, I2 = 47%). Hospital LOS did not differ between obese and non-obese patients (MD 0.05, 95% CI -0.52 to 0.50, I2 = 80%). Obese patients had longer ICU LOS than non-obese patients (MD 0.38, 95% CI 0.17-0.59, I2 = 70%). Hospital LOS and ICU LOS did not differ significantly in subjects with different BMI status.<h4>Conclusions</h4>In ICU patients receiving mechanical ventilation, higher BMI is associated with lower mortality and longer duration on mechanical ventilation.https://storage.googleapis.com/plos-corpus-prod/10.1371/journal.pone.0198669/1/pone.0198669.pdf?X-Goog-Algorithm=GOOG4-RSA-SHA256&X-Goog-Credential=wombat-sa%40plos-prod.iam.gserviceaccount.com%2F20210221%2Fauto%2Fstorage%2Fgoog4_request&X-Goog-Date=20210221T200035Z&X-Goog-Expires=3600&X-Goog-SignedHeaders=host&X-Goog-Signature=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 |
| spellingShingle | Yonghua Zhao Zhiqiang Li Tao Yang Meiping Wang Xiuming Xi Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. PLoS ONE |
| title | Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. |
| title_full | Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. |
| title_fullStr | Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. |
| title_full_unstemmed | Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. |
| title_short | Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. |
| title_sort | is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units a systematic review and meta analysis |
| url | https://storage.googleapis.com/plos-corpus-prod/10.1371/journal.pone.0198669/1/pone.0198669.pdf?X-Goog-Algorithm=GOOG4-RSA-SHA256&X-Goog-Credential=wombat-sa%40plos-prod.iam.gserviceaccount.com%2F20210221%2Fauto%2Fstorage%2Fgoog4_request&X-Goog-Date=20210221T200035Z&X-Goog-Expires=3600&X-Goog-SignedHeaders=host&X-Goog-Signature=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 |
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