Intensive Care Medicine

, 35:1152 | Cite as

The impact of obesity on outcomes after critical illness: a meta-analysis

  • Charles W. HogueJr
  • Joshua D. Stearns
  • Elizabeth Colantuoni
  • Karen A. Robinson
  • Tracey Stierer
  • Nanhi Mitter
  • Peter J. Pronovost
  • Dale M. Needham



To assess whether obesity is associated with mortality or other adverse intensive care unit (ICU) and post-ICU outcomes.


A meta-analysis of studies from PubMed and EMBASE databases.


Twenty-two studies (n = 88,051 patients) were included. Pooled analysis demonstrated no difference in ICU mortality, but lower hospital mortality for obese and morbidly obese subjects (RR 0.76; 95% CI 0.59, 0.92; RR 0.83; 95% CI 0.66, 1.04, respectively) versus normal weight subjects. There was no association between obesity and duration of mechanical ventilation or ICU stay. Morbidly obese versus normal weight patients had longer hospitalizations. No study reported physical function, mental health, or quality of life outcomes after discharge.


Obesity is not associated with increased risk for ICU mortality, but may be associated with lower hospital mortality. There is a critical lack of research on how obesity may affect complications of critical illness and patient long-term outcomes.


Intensive care Critical illness Mortality Body weight Meta-analysis 


  1. 1.
    Akinnusi M, Pineda L, El Solh A (2008) Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med 36:151–158PubMedCrossRefGoogle Scholar
  2. 2.
    Oliveros H, Villamor E (2008) Obesity and mortality in critically ill adults: a systematic review and meta-analysis. Obesity 16:515–521PubMedCrossRefGoogle Scholar
  3. 3.
    Thompson D, Eldesberg J, Colditz G, Bird A, Oster G (1999) Lifetime health and economic consequences of obesity. Arch Intern Med 159:2177–2183PubMedCrossRefGoogle Scholar
  4. 4.
    Flegal K, Graubard B, Williamson D, Gail M (2005) Excess deaths associated with underweight, overweight, and obesity. J Am Med Assoc 293:1861–1867CrossRefGoogle Scholar
  5. 5.
    Pieracci F, Barie P, Pomp A (2006) Critical care of the bariatric patient. Crit Care Med 34:1796–1804PubMedCrossRefGoogle Scholar
  6. 6.
    Ebert T, Shankar H, Haake R (2006) Perioperative considerations for patients with morbid obesity. Anesth Clin North Am 24:621–636CrossRefGoogle Scholar
  7. 7.
    Marik P, Doyle H, Varon J (2003) Is obesity protective during critical illness? An analysis of a National ICU database. Crit Care Shock 6:156–162Google Scholar
  8. 8.
    Finkielman J, Gajic O, Afessa B (2004) Underweight is independently associated with mortality in post-operative and non-operative patients admitted to the intensive care unit: a retrospective study. BMC Emerg Med 4:1–7CrossRefGoogle Scholar
  9. 9.
    Garrouste-Orgeas M, Troché G, Azoulay E, Caubel A, de Lassence A, Cheval C, Montesino L, Thuong M, Vincent F, Cohen Y, Timsit J (2004) Body mass index. An additional prognostic factor in ICU patients. Intensive Care Med 30:437–443PubMedCrossRefGoogle Scholar
  10. 10.
    Nasraway S Jr, Albert M, Donnelly A, Ruthazer R, Shikora S, Saltzman E (2006) Morbid obesity is an independent determinant of death among surgical critical ill patients. Crit Care Med 34:964–970PubMedCrossRefGoogle Scholar
  11. 11.
    Bochicchio G, Joshi M, Bochicchio K, Nehman S, Tracy J, Scalea T (2006) Impact of obesity in the critically ill trauma patient: a prospective study. J Am Coll Surg 203Google Scholar
  12. 12.
    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
  13. 13.
    O’Brien J Jr, Phillips G, Ali N, Lucarelli M, Marsh C, Lemeshow S (2006) Body mass index is not independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med 34:738–744PubMedCrossRefGoogle Scholar
  14. 14.
    Milberg J, Davis D, Steinberg K, Hudson L (1995) Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983–1993. J Am Med Assoc 273:306–309CrossRefGoogle Scholar
  15. 15.
    Cheung A, Tansey C, Tomlinson G, Diaz-Granados N, Matté A, Barr A, Mehta S, Mazer C, Guest C, Stewart T, Al-Saidi F, Cooper A, Cook D, Slutsky A, MS H (2006) Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 174:538–544PubMedCrossRefGoogle Scholar
  16. 16.
    Hopkins R, Weaver L, Collingridge D, Parkinson R, Chan K, Orme J Jr (2005) Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 171:340–347PubMedCrossRefGoogle Scholar
  17. 17.
    Wells G, O’Connell D, Peterson J, Welch V, Tugwell P (2000) The Newcastle-Ottawa scale for re-assessing the quality of nonrandomised studies in meta-analysis.
  18. 18.
    Stevens R, Dowdy D, Michaels R, Mendez-Tellez P, Pronovost P, Needham D (2007) Neuromuscular dysfunction acquired in critical illness: a systematic review. Int Care Med 33:1876–1891CrossRefGoogle Scholar
  19. 19.
    Smith R, Chong T, Hedrick T, Hughes M, Evans H, McElearney S, Pruett T, Sawyer R (2007) Does body mass index affect infection-related outcomes in the intensive care unit? Surg Infect 8:581–588CrossRefGoogle Scholar
  20. 20.
    Tremblay A, Bandi V (2003) Impact of body mass index on outcomes following critical care. Chest 123:1202–1207PubMedCrossRefGoogle Scholar
  21. 21.
    Newell M, Bard M, Goettler C, Toschlog E, Schenarts P, Sagraves S, Holbert D, Pories W, Rotondo M (2007) Body mass index and outcomes in critically injured blunt trauma patients: weighing the impact. J Am Coll Surg 204:1056–1064PubMedCrossRefGoogle Scholar
  22. 22.
    Higgins J, Thompson S (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRefGoogle Scholar
  23. 23.
    O’Brien J Jr, Welsh C, Fish R, Ancukiewicz M, Kramer A, National Heart L, and Blood Institute Acute Respiratory Distress Syndrome Network (2004) Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med 140:338–345Google Scholar
  24. 24.
    Morris A, Stapleton R, Rubenfeld G, Hudson L, Caldwell E, Steinberg K (2007) The association between body mass index and clinical outcomes in acute lung injury. Chest 131:342–348PubMedCrossRefGoogle Scholar
  25. 25.
    Neville A, Brown C, Weng J, Demetriades D, Velmahos G (2004) Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg 139:983–987PubMedCrossRefGoogle Scholar
  26. 26.
    Brown C, Neville A, Rhee P, Salim A, Velmahos G, Demetriades D (2005) The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma 59:1048–1051PubMedCrossRefGoogle Scholar
  27. 27.
    Byrnes M, McDaniel M, Moore M, Helmer S, Smith R (2005) The effect of obesity on outcomes among injured patients. J Trauma 58:232–237PubMedCrossRefGoogle Scholar
  28. 28.
    Alban R, Lyass S, Margulies D, Shabot M (2006) Obesity does not affect mortality after trauma. Am Surg 10:966–969Google Scholar
  29. 29.
    Brown C, Rhee P, Neville A, Sangthong B, Salim A, Demetriades D (2006) Obesity and traumatic brain injury. J Trauma 61:572–576PubMedCrossRefGoogle Scholar
  30. 30.
    Ciesla D, Moore E, Johnson J, Burch J, Cothren C, Sauaia A (2006) Obesity increases risk for organ failure after severe trauma. J Am Coll Surg 203:539–545PubMedCrossRefGoogle Scholar
  31. 31.
    El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J (2001) Morbid obesity in the medical ICU. Chest 120:1989–1997PubMedCrossRefGoogle Scholar
  32. 32.
    Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I, Fleury J (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
  33. 33.
    Goulenok C, Monchi M, Chiche J, Mira J, Dhainaut J, Cariou A (2004) Influence of overweight on ICU mortality. Chest 125:1441–1445PubMedCrossRefGoogle Scholar
  34. 34.
    Ray D, Matchett S, Baker K, Wasser T, Young M (2005) The effect of body mass index on patient outcomes in a medical ICU. Chest 127:2125–2131PubMedCrossRefGoogle Scholar
  35. 35.
    Peake S, Moran J, Ghelani D, Lloyd A, Walker M (2006) The effect of obesity on 12-month survival following admission to intensive care: a prospective study. Crit Care Med 34:2929–2939PubMedGoogle Scholar
  36. 36.
    Rice T (2007) Obesity in acute lung injury: the “weight” is over. Chest 131:333–334Google Scholar
  37. 37.
    De Waele B, Vanmierlo B, Van Nieuwenhove Y, Delvaux G (2006) Impact of body overweight and class I, II, and III obesity on the outcome of acute biliary pancreatitis. Pancreas 32:343–345PubMedCrossRefGoogle Scholar
  38. 38.
    Duane T, Dechert T, Aboutanos M, Malhotra A, Ivatury R (2006) Obesity and outcomes after blunt trauma. J Trauma 61:1218–1221PubMedCrossRefGoogle Scholar
  39. 39.
    Fan E, Needham D, Stewart T (2005) Ventilatory management of acute lung injury and acute respiratory distress syndrome. J Am Med Assoc 294:2889–2896CrossRefGoogle Scholar
  40. 40.
    Bernard G (2005) Acute respiratory distress syndrome: a historical perspective. Am J Respir Crit Care Med 172:798–806PubMedCrossRefGoogle Scholar
  41. 41.
    Hopkins R, Weaver L, Chan K, Orme JJ (2004) Quality of life, emotional, and cognitive function following acute respiratory distress syndrome. J Int Neuropsychol Soc 10:1005–1017PubMedGoogle Scholar
  42. 42.
    Heyland D, Groll D, Caeser M (2005) Survivors of acute respiratory distress syndrome: relationship between pulmonary dysfunction and long-term health-related quality of life. Crit Care Med 33:1549–1556PubMedCrossRefGoogle Scholar
  43. 43.
    Gregg E, Cheng Y, Cadwell B, Imperatore G, Williams D, Flegal K, Narayan K, Willisamson D (2005) Secular trends in cardiovascular disease risk factors according to body mass index in US adults. J Am Med Assoc 293:1868–1874CrossRefGoogle Scholar
  44. 44.
    Allley D, Chang V (2007) The changing relationship of obesity and disability, 1988–2004. J Am Med Assoc 298:2020–2027CrossRefGoogle Scholar
  45. 45.
    Mokdad A, Ford E, Bowman B, Dietz W, Vinicor F, Bales V, Marks J (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. J Am Med Assoc 289:76–79CrossRefGoogle Scholar
  46. 46.
    Sullivan M, Karlsson J, Sjöström L, Backman L, Bengtsson C, Bouchard C, Dahlgren S, Jonsson E, Larsson B, Lindstedt S (1993) Swedish obese subjects (SOS)—an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined. Int J Obes Relat Metab Disord 17:503–512PubMedGoogle Scholar
  47. 47.
    Doll H, Petersen S, Stewart-Brown S (2000) Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obes Res 8:160–170PubMedCrossRefGoogle Scholar
  48. 48.
    Yaegashi M, Raymonde J, Zuriqat M, Noack S, Homel P (2005) Outcome of morbid obesity in the intensive care unit. J Int Care Med 20:147–154CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Charles W. HogueJr
    • 1
    • 2
  • Joshua D. Stearns
    • 1
  • Elizabeth Colantuoni
    • 1
  • Karen A. Robinson
    • 5
  • Tracey Stierer
    • 1
  • Nanhi Mitter
    • 1
  • Peter J. Pronovost
    • 1
  • Dale M. Needham
    • 3
    • 4
  1. 1.Department of Anesthesiology and Critical Care MedicineThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  2. 2.Department of Anesthesiology and Critical Care MedicineThe Johns Hopkins HospitalBaltimoreUSA
  3. 3.Division of Pulmonary and Critical Care Medicine, Department of MedicineThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Department of Physical Medicine and RehabilitationThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  5. 5.Department of MedicineThe Johns Hopkins Medical InstitutionsBaltimoreUSA

Personalised recommendations