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The Association Between Body Mass Index and Clinical Outcomes in Acute Lung Injury^*

^* From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA.

Correspondence to: Gordon Rubenfeld, MD, MSc,Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Mailbox 359762, 325 Ninth Ave, Seattle, WA 98104; e-mail: nodrog{at}u.washington.edu

Abstract

Background: The association between body mass index (BMI) and outcomes in critically ill patients is unclear. Our objective was to determine the association between BMI and outcomes in a population-based cohort of patients with acute lung injury (ALI).

Methods: In a prospective cohort study of all ICU patients in King County, Washington, with ALI in 1 year (1999 to 2000), 825 patients had a BMI recorded. Using multivariate analysis, patients in the abnormal BMI groups were compared to normal patients in the following areas: mortality, hospital length of stay (LOS), ICU LOS, duration of mechanical ventilation, and discharge disposition.

Results: There was no mortality difference in any of the abnormal BMI groups compared to normal-weight patients. Severely obese patients had longer hospital LOS than normal-weight patients (mean increase, 10.5 days; 95% confidence interval [CI], 4.8 to 16.2 days; p < 0.001); this was accentuated when analysis was restricted to survivors (mean increase, 14.3 days; 95% CI, 7.1 to 21.6 days; p < 0.001). ICU LOS and duration of mechanical ventilation were also longer in the severely obese group when analysis was restricted to survivors (mean increase, 5.6 days; 95% CI, 1.3 to 9.8 days; p = 0.01; and mean increase, 4.1 days; 95% CI, 0.4 to 7.7 days, respectively; p = 0.03). Severely obese patients were more likely to be discharged to a rehabilitation or skilled nursing facility than to home.

Conclusions: BMI is not associated with mortality in patients with ALI, but severe obesity is associated with increased morbidity and resource utilization in the hospital and after discharge.

Key Words: acute lung injury • body mass index • ICU • length of stay • mechanical ventilation • mortality