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Body mass index

An additional prognostic factor in ICU patients

Abstract

Objective

To examine the association between body mass index (BMI) and mortality in adult intensive care unit (ICU) patients.

Design

A prospective multi-center study.

Interventions

None.

Methods

A cohort study (yielding the OUTCOMEREA database) was conducted over 2 years in 6 medical-surgical ICUs. In each participating ICU, the following were collected daily: demographic information, admission height and weight, comorbidities, severity scores (SAPS II, LOD, and SOFA), ICU and hospital lengths of stay, and ICU and hospital mortality rates.

Results

A total of 1,698 patients were examined and divided into 4 groups based on BMI: <18.5, 18.5–24.9, 25–29.9, and >30 kg/m2. These groups differed significantly for age, gender, admission category (medical, scheduled surgery, unscheduled surgery), ICU and hospital lengths of stay, and comorbidities. Severity at admission and within the first 2 days was similar in the 4 groups, except for the SOFA score. Overall hospital mortality was 31.3% (532 out of 1,698 patients). By multivariate analysis, a BMI below 18.5 kg/m2 was independently associated with increased mortality (odds ratio 1.63; 95% confidence intervals 1.11–2.39). None of the other BMI categories were associated with higher mortality and even a BMI>30 kg/m2 was protective of mortality (odds ratio 0.60, 95% confidence intervals 0.40–0.88).

Conclusions

A low BMI was independently associated with higher mortality and a high BMI with lower mortality in this large cohort of critically ill patients. Since BMI is absent from currently available scoring systems, further studies are needed to determine whether adding BMI would improve the effectiveness of scores in predicting mortality.

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Acknowledgments

We thank A. Wolfe, MD, for help in preparing this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Maité Garrouste-Orgeas.

Additional information

The members of the OUTCOMEREA study group are listed in the appendix.

Financial support: OUTCOMEREA is supported by non-exclusive educational grants from Aventis Pharma, France, Wyeth, and the Centre National de la Recherche Scientifique (CNRS).

Electronic Supplementary Material

Appendix

Appendix

List of members of the OUTCOMEREA study group, including all authors of the present manuscript (in italics).

Scientific committee

Timsit, Jean-François MD, staff physician, ICU, Hôpital Bichat, Paris, France.

Troché, Gilles MD, staff physician, Hôpital A. Béclère, Clamart, France.

Moine, Pierre MD, PhD, staff physician, DAR, Hôpital Lariboisière, Paris, France.

De Lassence, Arnaud MD, staff physician, ICU, Hôpital Louis Mourier, Colombes, France.

Azoulay, Elie MD, staff physician, ICU, Hôpital Saint Louis, Paris, France.

Cohen, Yves MD, Professor, ICU, Hôpital Avicenne, Bobigny, France.

Garrouste-Orgeas, Maïté MD, staff physician, ICU, Hôpital Saint Joseph, Paris, France.

Fosse, Jean-Philippe MD, staff physician, ICU, Hôpital Avicenne, Bobigny, France.

Soufir, Lilia MD, staff physician, ICU, Hôpital saint Joseph, Paris, France.

Zahar, Jean-Ralph MD, attending physician, Microbiology department, Hôpital Necker, Paris, France.

Adrie, Christophe MD, staff physician, ICU, Hôpital Delafontaine, Saint Denis, France.

Carlet, Jean MD, staff physician, ICU, Hôpital Saint Joseph, Paris, France.

L’Hériteau, François MD, attending physician, ICU, Hôpital Bichat, Paris, France.

Biostatistical and informatics expertise

Chevret, Sylvie MD PhD, Professor, Medical Computer Sciences and Biostatistics Department, Hôpital Saint Louis, Paris, France.

Alberti, Corinne MD, staff physician, Medical Computer Sciences and Biostatistic Department, Hôpital Saint Louis, Paris, France.

Lecorre, Frederik, informatician, Supelec, France.

Nakache, Didier, informatician, Conservatoire National des Arts et Métiers (CNAM), Paris, France.

Investigators of the OutcomeRea database

Bornstain, Caroline MD, staff physician, ICU, Hôpital Européen Georges Pompidou, Paris, France.

Thuong, Marie MD, staff physician, ICU, Hôpital Delafontaine, Saint Denis, France.

Costa de Beauregard, Marie-Alliette MD, staff physician, Nephrology, Hôpital Tenon, Paris, France.

Colin, Jean-Pierre MD, staff physician, ICU, Hôpital de Dourdan, Dourdan, France.

Le Miere, Eric MD, attending physician, ICU, Hôpital Louis Mourier, Colombes, France.

Caubel, Antoine MD, attending physician, ICU, Hôpital Saint Joseph, Paris, France.

Marie, William MD, attending physician, ICU, Hôpital Saint Joseph, Paris, France.

Cheval, Christine MD, staff physician, SICU, Hôpital Saint Joseph, Paris, France.

Vantalon, Eric MD, staff physician, SICU, Hôpital Saint Joseph, Paris, France.

Clec’h, Christophe MD, staff physician, ICU, Hôpital Avicenne, Bobigny, France.

Vincent, François MD, staff physician, Nephrology, Hôpital Tenon, Paris, France.

Salah, Amar MD, staff physician, ICU, Hôpital Louis Mourier, Colombes, France.

Montesino, Laurent MD, attending physician, ICU, Hôpital Bichat, Paris, France.

Pigné, Etienne MD, staff physician, ICU, Hôpital Louis Mourier, Colombes, France.

Boyer, Alexandre MD, staff physician, ICU, Hôpital Pellegrin, Bordeaux, France.

Tuil, Olivier MD, staff physician, ICU, Hôpital Avicenne, Bobigny, France.

Mourvillier, Bruno MD, Staff physician, ICU, Hôpital d’Aulnay sous bois, France.

Jamali, Samir MD, staff physician, ICU, Hôpital de Dourdan, Dourdan, France.

Moreau, Delphine MD, staff physician, ICU, Hôpital Saint Louis, Paris, France.

Thiery, Guillaume MD, staff physician, ICU, Hôpital Saint Louis, Paris, France.

Duguet, Alexandre MD, attending physician, Hôpital Pitié-Salpétriere, Paris, France.

Laplace, Christian MD, attending physician, ICU, Hôpital Kremlin-Bicêtre, Bicêtre, France.

Lazard, Thierry MD, staff physician, ICU, Hôpital de la Croix St Simon, Paris, France.

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Garrouste-Orgeas, M., Troché, G., Azoulay, E. et al. Body mass index. Intensive Care Med 30, 437–443 (2004). https://doi.org/10.1007/s00134-003-2095-2

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Keywords

  • Intensive care unit
  • Body mass index
  • Evaluation studies
  • Severity scores
  • Mortality