Intensive Care Medicine

, Volume 34, Issue 11, pp 1999–2009 | Cite as

Obesity is associated with increased morbidity but not mortality in critically ill patients

  • Yasser Sakr
  • Christian Madl
  • Daniela Filipescu
  • Rui Moreno
  • Johan Groeneveld
  • Antonio Artigas
  • Konrad Reinhart
  • Jean-Louis Vincent



To investigate the possible impact of obesity on morbidity and mortality in intensive care unit (ICU) patients included in the European observational sepsis occurrence in acutely ill patients (SOAP) study.


Planned substudy from the SOAP database.


One hundred and ninety-eight ICUs in 24 European countries.


All patients admitted to one of the participating ICUs. Patients were classified, according to their body mass index (BMI), as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), obese (30–39.9 kg/m2), and very obese (≥40 kg/m2).

Measurements and results

The BMI was available in 2,878 (91%) of the 3,147 patients included in the SOAP study; 120 patients (4.2%) were underweight, 1,206 (41.9%) had a normal BMI, 1,047 (36.4%) were overweight, 424 (14.7%) were obese, and 81 (2.8%) were very obese. Obese and very obese patients more frequently developed ICU-acquired infections than patients in lower BMI categories. Very obese patients showed a trend towards longer ICU [median (IQ): 4.1 (1.8–12.1) vs. 3.1 (1.7–7.2) days, P = 0.056) and hospital lengths of stay [14.3 (8.4–27.4) vs. 12.3 (5.1–24.4), days P = 0.077] compared to those with a normal BMI. However, there were no significant differences among the groups in ICU or hospital mortality rates. In a multivariate Cox regression analysis, none of the BMI categories was associated with an increased risk of 60-day in-hospital death.


BMI did not have a significant impact on mortality in this mixed population of ICU patients.


Body mass index Multicentre Outcome Intensive care Nosocomial infection 



The SOAP study was supported by an unlimited grant from Abbott, Baxter, Eli Lilly, GlaxoSmithKline, and NovoNordisk. These companies had no involvement at any stage of the study design, in the collection and analysis of data, in writing the manuscript, or in the decision to submit for publication.


  1. 1.
    Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288:1723–1727PubMedCrossRefGoogle Scholar
  2. 2.
    Katzmarzyk PT, Janssen I, Ardern CI (2003) Physical inactivity, excess adiposity and premature mortality. Obes Rev 4:257–290PubMedCrossRefGoogle Scholar
  3. 3.
    Willett WC, Dietz WH, Colditz GA (1999) Guidelines for healthy weight. N Engl J Med 341:427–434PubMedCrossRefGoogle Scholar
  4. 4.
    McGee DL (2005) Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol 15:87–97PubMedCrossRefGoogle Scholar
  5. 5.
    Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, Hollenbeck A, Leitzmann MF (2006) Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 355:763–778PubMedCrossRefGoogle Scholar
  6. 6.
    Yan LL, Daviglus ML, Liu K, Stamler J, Wang R, Pirzada A, Garside DB, Dyer AR, Van Horn L, Liao Y, Fries JF, Greenland P (2006) Midlife body mass index and hospitalization and mortality in older age. JAMA 295:190–198PubMedCrossRefGoogle Scholar
  7. 7.
    Hedlund J, Hansson LO, Ortqvist A (1995) Short- and long-term prognosis for middle-aged and elderly patients hospitalized with community-acquired pneumonia: impact of nutritional and inflammatory factors. Scand J Infect Dis 27:32–37PubMedCrossRefGoogle Scholar
  8. 8.
    Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr (1999) Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 341:1097–1105PubMedCrossRefGoogle Scholar
  9. 9.
    Grady KL, White-Williams C, Naftel D, Costanzo MR, Pitts D, Rayburn B, VanBakel A, Jaski B, Bourge R, Kirklin J (1999) Are preoperative obesity and cachexia risk factors for postheart transplant morbidity and mortality: a multi-institutional study of preoperative weight–height indices. Cardiac transplant research database (CTRD) Group. J Heart Lung Transplant 18:750–763PubMedCrossRefGoogle Scholar
  10. 10.
    Varon J, Marik P (2001) Management of the obese critically ill patient. Crit Care Clin 17:187–200PubMedCrossRefGoogle Scholar
  11. 11.
    Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I, Fleury JC (2004) Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med 32:998–1003PubMedCrossRefGoogle Scholar
  12. 12.
    Salazar DE, Corcoran GB (1988) Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med 84:1053–1060PubMedCrossRefGoogle Scholar
  13. 13.
    Stokholm KH, Brochner-Mortensen J, Hoilund-Carlsen PF (1980) Increased glomerular filtration rate and adrenocortical function in obese women. Int J Obes 4:57–63PubMedGoogle Scholar
  14. 14.
    Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L (1996) Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest 109:144–151PubMedCrossRefGoogle Scholar
  15. 15.
    Kress JP, Pohlman AS, Alverdy J, Hall JB (1999) The impact of morbid obesity on oxygen cost of breathing (VO(2RESP)) at rest. Am J Respir Crit Care Med 160:883–886PubMedGoogle Scholar
  16. 16.
    Vaughan RW, Conahan TJ III (1980) Part I: cardiopulmonary consequences of morbid obesity. Life Sci 26:2119–2127PubMedCrossRefGoogle Scholar
  17. 17.
    Vaughan RW, Bauer S, Wise L (1975) Volume and pH of gastric juice in obese patients. Anesthesiology 43:686–689PubMedCrossRefGoogle Scholar
  18. 18.
    Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr (2006) Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med 354:2340–2348PubMedCrossRefGoogle Scholar
  19. 19.
    Darvall KA, Sam RC, Silverman SH, Bradbury AW, Adam DJ (2007) Obesity and thrombosis. Eur J Vasc Endovasc Surg 33:223–233PubMedCrossRefGoogle Scholar
  20. 20.
    El Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J (2001) Morbid obesity in the medical ICU. Chest 120:1989–1997PubMedCrossRefGoogle Scholar
  21. 21.
    Tremblay A, Bandi V (2003) Impact of body mass index on outcomes following critical care. Chest 123:1202–1207PubMedCrossRefGoogle Scholar
  22. 22.
    Goulenok C, Monchi M, Chiche JD, Mira JP, Dhainaut JF, Cariou A (2004) Influence of overweight on ICU mortality: a prospective study. Chest 125:1441–1445PubMedCrossRefGoogle Scholar
  23. 23.
    Brown CV, Neville AL, Rhee P, Salim A, Velmahos GC, Demetriades D (2005) The impact of obesity on the outcomes of 1, 153 critically injured blunt trauma patients. J Trauma 59:1048–1051PubMedGoogle Scholar
  24. 24.
    Ray DE, Matchett SC, Baker K, Wasser T, Young MJ (2005) The effect of body mass index on patient outcomes in a medical ICU. Chest 127:2125–2131PubMedCrossRefGoogle Scholar
  25. 25.
    Bochicchio GV, Joshi M, Bochicchio K, Nehman S, Tracy JK, Scalea TM (2006) Impact of obesity in the critically ill trauma patient: a prospective study. J Am Coll Surg 203:533–538PubMedCrossRefGoogle Scholar
  26. 26.
    Aldawood A, Arabi Y, Dabbagh O (2006) Association of obesity with increased mortality in the critically ill patient. Anaesth Intensive Care 34:629–633PubMedGoogle Scholar
  27. 27.
    Peake SL, Moran JL, Ghelani DR, Lloyd AJ, Walker MJ (2006) The effect of obesity on 12-month survival following admission to intensive care: a prospective study. Crit Care Med 34:2929–2939PubMedGoogle Scholar
  28. 28.
    Alban RF, Lyass S, Margulies DR, Shabot MM (2006) Obesity does not affect mortality after trauma. Am Surg 72:966–969PubMedGoogle Scholar
  29. 29.
    O’Brien JM Jr, Phillips GS, Ali NA, Lucarelli M, Marsh CB, Lemeshow S (2006) Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med 34:738–744PubMedCrossRefGoogle Scholar
  30. 30.
    Nasraway SA Jr, Albert M, Donnelly AM, Ruthazer R, Shikora SA, Saltzman E (2006) Morbid obesity is an independent determinant of death among surgical critically ill patients. Crit Care Med 34:964–970PubMedCrossRefGoogle Scholar
  31. 31.
    Neville AL, Brown CV, Weng J, Demetriades D, Velmahos GC (2004) Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg 139:983–987PubMedCrossRefGoogle Scholar
  32. 32.
    Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34:344–353PubMedCrossRefGoogle Scholar
  33. 33.
    Sakr Y, de Pont AC, Lovstad RZ, Reinhart K, Vincent JL (2006) Does obesity in the ICU influence outcome? Intensive Care Med 32:58 (abstract)Google Scholar
  34. 34.
    Le Gall J-R, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRefGoogle Scholar
  35. 35.
    Vincent JL, Moreno R, Takala J, Willatts S, de Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
  36. 36.
    (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874Google Scholar
  37. 37.
    Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter P, Sprung C, Colardyn FC, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicentric, prospective study. Crit Care Med 26:1793–1800PubMedGoogle Scholar
  38. 38.
    National Institutes of Health NHLBI Obesity Education Initiative Expert Panel (1998) Clinical guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: the Evidence Report. US Department of Health and Human Services, WashingtonGoogle Scholar
  39. 39.
    Alpert MA, Hashimi MW (1993) Obesity and the heart. Am J Med Sci 306:117–123PubMedCrossRefGoogle Scholar
  40. 40.
    Galanos AN, Pieper CF, Kussin PS, Winchell MT, Fulkerson WJ, Harrell FE Jr, Teno JM, Layde P, Connors AF Jr, Phillips RS, Wenger NS (1997) Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. SUPPORT investigators. The study to understand prognoses and preferences for outcome and risks of treatments. Crit Care Med 25:1962–1968PubMedCrossRefGoogle Scholar
  41. 41.
    Akinnusi ME, Pineda LA, El Solh AA (2008) Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med 36:151–158PubMedCrossRefGoogle Scholar
  42. 42.
    Bray GA (1992) Pathophysiology of obesity. Am J Clin Nutr 55:488S–494SPubMedGoogle Scholar
  43. 43.
    Rose DK, Cohen MM, Wigglesworth DF, DeBoer DP (1994) Critical respiratory events in the postanesthesia care unit. Patient, surgical, and anesthetic factors. Anesthesiology 81:410–418PubMedCrossRefGoogle Scholar
  44. 44.
    Smetana GW, Lawrence VA, Cornell JE (2006) Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 144:581–595PubMedGoogle Scholar
  45. 45.
    Ray CS, Sue DY, Bray G, Hansen JE, Wasserman K (1983) Effects of obesity on respiratory function. Am Rev Respir Dis 128:501–506PubMedGoogle Scholar
  46. 46.
    Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A (1994) Sleep apnea and sleep disruption in obese patients. Arch Intern Med 154:1705–1711PubMedCrossRefGoogle Scholar
  47. 47.
    Drenick EJ, Bale GS, Seltzer F, Johnson DG (1980) Excessive mortality and causes of death in morbidly obese men. JAMA 243:443–445PubMedCrossRefGoogle Scholar
  48. 48.
    Burki NK, Baker RW (1984) Ventilatory regulation in eucapnic morbid obesity. Am Rev Respir Dis 129:538–543PubMedGoogle Scholar
  49. 49.
    O’Brien JM Jr, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM (2004) Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med 140:338–345PubMedGoogle Scholar
  50. 50.
    Morris AE, Stapleton RD, Rubenfeld GD, Hudson LD, Caldwell E, Steinberg KP (2007) The association between body mass index and clinical outcomes in acute lung injury. Chest 131:342–348PubMedCrossRefGoogle Scholar
  51. 51.
    Moreno R, Apolone G, Miranda DR (1998) Evaluation of the uniformity of fit of general outcome prediction models. Intensive Care Med 24:40–47PubMedCrossRefGoogle Scholar
  52. 52.
    Patel PA, Grant BJ (1999) Application of mortality prediction systems to individual intensive care units. Intensive Care Med 25:977–982PubMedCrossRefGoogle Scholar
  53. 53.
    Hebl MR, Xu J (2001) Weighing the care: physicians’ reactions to the size of a patient. Int J Obes Relat Metab Disord 25:1246–1252PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Yasser Sakr
    • 1
  • Christian Madl
    • 2
  • Daniela Filipescu
    • 3
  • Rui Moreno
    • 4
  • Johan Groeneveld
    • 5
  • Antonio Artigas
    • 6
  • Konrad Reinhart
    • 1
  • Jean-Louis Vincent
    • 7
  1. 1.Department of Anaesthesiology and Intensive CareFriedrich-Schiller-University JenaJenaGermany
  2. 2.Intensive Care Unit 13H1, Department of Internal Medicine IVMedical University of ViennaViennaAustria
  3. 3.Department of Anesthesiology and Cardiac Intensive CareInstitute of Cardiovascular DiseasesBucharestRomania
  4. 4.Department of Intensive CareHospital de St Antonio dos CapuchosLisbonPortugal
  5. 5.Department of Intensive CareVU University Medical CenterAmsterdamThe Netherlands
  6. 6.Department of Intensive CareSabadell HospitalSabadellSpain
  7. 7.Department of Intensive Care, Hôpital ErasmeUniversité libre de BruxellesBrusselsBelgium

Personalised recommendations