Relationship between height and outcomes among critically ill adults: a cohort study



Many diagnostic and therapeutic interventions for critically ill adult patients are not performed according to patient size, but are standardized for an idealized 174-cm man (ideal body weight 70 kg). This study aims to determine whether critically ill patients with heights significantly different from a standardized patient have higher hospital mortality or greater resource utilization.


Retrospective cohort study of consecutive patients admitted to 210 intensive care units (ICUs) in the United Kingdom participating in the Intensive Care National Audit and Research Centre’s Case Mix Programme Database from April 1, 2009, to March 31, 2015. Primary outcome was hospital mortality, adjusted for age, comorbid disease, severity of illness, socioeconomic status and body mass index, using hierarchical modeling to account for clustering by ICU. Data were stratified by sex, and the effect of height was modeled continuously using restricted cubic splines.


The cohort included 233,308 men and 184,070 women, with overall hospital mortality of 22.5% and 20.6%, respectively. After adjustment for potential confounders, hospital mortality decreased with increasing height; predicted mortality (holding all other covariates at their mean value) decreased from 24.1 to 17.1% for women and from 29.2 to 21.0% for men across the range of heights. Similar patterns were observed for ICU mortality and several additional secondary outcomes.


Short stature may be a risk factor for mortality in critically ill patients. Further work is needed to determine which unmeasured patient characteristics and processes of care may contribute to the increased risk observed.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    WHO Expert Committee on Physical Status (1995) Physical status: the use of and interpretation of anthropometry. World Health Organization. Accessed 4 Aug 2018

  2. 2.

    Silventoinen K (2003) Determinants of variation in adult body height. J Biosoc Sci 35:263–285

    Article  PubMed  Google Scholar 

  3. 3.

    Batty GD, Barzi F, Woodward M et al (2010) Adult height and cancer mortality in Asia: the Asia Pacific Cohort Studies Collaboration. Ann Oncol 21:646–654

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Engeland A, Bjørge T, Selmer RM, Tverdal A (2003) Height and body mass index in relation to total mortality. Epidemiology 14:293–299

    PubMed  Google Scholar 

  5. 5.

    Song YM, Smith GD, Sung J (2003) Adult height and cause-specific mortality: a large prospective study of South Korean men. Am J Epidemiol 158:479–485

    Article  PubMed  Google Scholar 

  6. 6.

    Fernandez-Bustamante A, Wood CL, Tran ZV, Moine P (2011) Intraoperative ventilation: incidence and risk factors for receiving large tidal volumes during general anesthesia. BMC Anesthesiol 11:22

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Bender SP, Paganelli WC, Gerety LP et al (2015) intraoperative lung-protective ventilation trends and practice patterns: a report from the multicenter perioperative outcomes group. Anesth Analg 121:1231–1239

    Article  PubMed  Google Scholar 

  8. 8.

    Sasko B, Thiem U, Christ M, Trappe H-J, Ritter O, Pagonas N (2018) Size matters: an observational study investigating estimated height as a reference size for calculating tidal volumes if low tidal volume ventilation is required. PLoS One 13(6):e0199917

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Epstein SK, Ciubotaru RL (1996) Influence of gender and endotracheal tube size on preextubation breathing pattern. Am J Respir Crit Care Med 154:1647–1652

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Bloomfield R, Steel E, MacLennan G, Noble DW (2006) Accuracy of weight and height estimation in an intensive care unit: implications for clinical practice and research. Crit Care Med 34:2153–2157

    Article  PubMed  Google Scholar 

  11. 11.

    Leary TS, Milner QJ, Niblett DJ (2000) The accuracy of the estimation of body weight and height in the intensive care unit. Eur J Anaesthesiol 17:698–703

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Maskin LP, Attie S, Setten M et al (2010) Accuracy of weight and height estimation in an intensive care unit. Anaesth Intensive Care 38:930–934

    CAS  PubMed  Google Scholar 

  13. 13.

    Hutagalung R, Marques J, Kobylka K et al (2011) The obesity paradox in surgical intensive care unit patients. Intensive Care Med 37:1793–1799

    Article  PubMed  Google Scholar 

  14. 14.

    Hogue CW Jr, Stearns JD, Colantuoni E et al (2009) The impact of obesity on outcomes after critical illness: a meta-analysis. Intensive Care Med 35:1152–1170

    Article  PubMed  Google Scholar 

  15. 15.

    Vail EA, Harrison D, Wunsch H (2014) Relationship between patient height and outcomes among critically ill adults [Abstract]. Am J Respir Crit Care Med 189:A4536.

    Article  Google Scholar 

  16. 16.

    Intensive Care National Audit and Research Centre (c2012) About the Case Mix Programme. Accessed 3 Aug 2018

  17. 17.

    Harrison DA, Brady AR, Rowan K (2004) Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database. Crit Care 8:R99–R111

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Raine R, Goldfrad C, Rowan K, Black N (2002) Influence of patient gender on admission to intensive care. J Epidemiol Community Health 56:418–423

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    National Health Service Digital (c2014) Health Survey for England, 2014. Accessed 3 Aug 2018

  20. 20.

    Toft-Petersen AP, Wulff J, Harrison DA, Ostermann M, Margarson M, Rowan KM, Dawson D (2018) Exploring the impact of using measured or estimated values for height and weight on the relationship between BMI and acute hospital mortality. J Crit Care 44:196–202

    Article  PubMed  Google Scholar 

  21. 21.

    Centers for Disease Control and Prevention (c2013) Defining adult overweight and obesity. Accessed 3 Aug 2018

  22. 22.

    National Health Service (c2013) Ethnic category codes. Accessed 3 Aug 2018

  23. 23.

    UK Ministry of Housing, Communities and Local Government (2015) English Indices of Deprivation 2015. Accessed 3 Aug 2018

  24. 24.

    Welsh Government (2015) Welsh Index of Multiple Deprivation. Accessed 3 Aug 2018

  25. 25.

    Northern Ireland Statistics and Research Agency (2010) Northern Ireland Multiple Deprivation Measure. Accessed 3 Aug 2018

  26. 26.

    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(1):818–829

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Harrison DA, Parry GJ, Carpenter JR et al (2007) A new risk prediction model for critical care: the Intensive Care National Audit & Research Centre (ICNARC) model. Crit Care Med 35:1091–1098

    Article  PubMed  Google Scholar 

  28. 28.

    Recombinant human protein C Worldwide evaluation in Severe Sepsis (PROWESS study group) (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709

    Article  Google Scholar 

  29. 29.

    Padkin A, Goldfrad C, Brady AR et al (2003) Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med 31:2332–2338

    Article  PubMed  Google Scholar 

  30. 30.

    Harrell F (2015) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis, 2nd edn. Springer, New York

    Google Scholar 

  31. 31.

    Jia X, Malhotra A, Saeed M, Mark RG, Talmor D (2008) Risk factors for ARDS in patients receiving mechanical ventilation for > 48 h. Chest 133:853–861

    Article  PubMed  Google Scholar 

  32. 32.

    Metnitz PG, Metnitz B, Moreno RP, Bauer P, Del Sorbo L, Hoermann C, de Carvalho SA, Ranieri VM, SAPS 3 Investigators (2009) Epidemiology of mechanical ventilation: analysis of the SAPS 3 database. Intensive Care Med 35:816–825

    Article  PubMed  Google Scholar 

  33. 33.

    Deane AM, Reid DA, Tobin AE (2008) Predicted body weight during mechanical ventilation: using arm demispan to aid clinical assessment. Crit Care Resusc 10:14

    PubMed  Google Scholar 

  34. 34.

    Liu B, Balkwill A, Banks E et al (2007) Relationship of height, weight and body mass to the risk of hip and knee replacements in middle-aged women. Rheumatology 46:861–867

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Engeland A, Tretli S, Austad G, Bjørge T (2005) Height and body mass index in relation to colorectal and gallbladder cancer among two million Norwegian men and women. Cancer Causes Control 16:987–996

    Article  PubMed  Google Scholar 

  36. 36.

    Schaumberg DA, Glynn RJ, Christen WG et al (2000) Relations of body fat distribution and height with cataract in men. Am J Clin Nutr 72:1495–1502

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Diverse Populations Collaborative Group (2005) Weight-height relationships and body mass index: some observations from the Diverse Populations Collaboration. Am J Phys Anthropol 128:220–229

    Article  Google Scholar 

  38. 38.

    Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM et al (2011) Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med 183:1666–1673

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Wunsch H, Angus DC, Harrison DA et al (2008) Variation in critical care services across North America and Western Europe. Crit Care Med 36:2787–2793

    Article  PubMed  PubMed Central  Google Scholar 

Download references


Columbia University Irving Scholars Program (to HW). The funders had no role in study design, conduct or approval of the finished manuscript.

Author information




Study design (DH, EV, HW), data analysis (DH, HW), manuscript preparation (DH, EV, HW). All authors gave final approval for the submitted manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Hannah Wunsch.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 124 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vail, E.A., Harrison, D.A. & Wunsch, H. Relationship between height and outcomes among critically ill adults: a cohort study. Intensive Care Med 44, 2122–2133 (2018).

Download citation


  • Critical care
  • Mortality
  • Length of stay
  • Stature