Garrouste-Orgeas Maité, Troché Gilles, Azoulay Elie, Caubel Antoine, de Lassence Arnaud, Cheval Christine, Montesino Laurent, Thuong Marie, Vincent François, Cohen Yves, Timsit Jean-François
Service de Réanimation Polyvalente, Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France.
Intensive Care Med. 2004 Mar;30(3):437-43. doi: 10.1007/s00134-003-2095-2. Epub 2004 Feb 6.
To examine the association between body mass index (BMI) and mortality in adult intensive care unit (ICU) patients. DESIGN. A prospective multi-center study.
None.
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.
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/m(2). 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/m(2) 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/m(2) was protective of mortality (odds ratio 0.60, 95% confidence intervals 0.40-0.88).
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.
探讨成年重症监护病房（ICU）患者体重指数（BMI）与死亡率之间的关联。设计：一项前瞻性多中心研究。
无。
在6个内科及外科ICU中进行了一项为期2年的队列研究（生成OUTCOMEREA数据库）。在每个参与研究的ICU中，每天收集以下信息：人口统计学信息、入院时的身高和体重、合并症、严重程度评分（简化急性生理学评分II [SAPS II]、逻辑器官功能障碍评分[LOD]和序贯器官衰竭评估[SOFA]）、ICU住院时间和医院住院时间，以及ICU死亡率和医院死亡率。
共检查了1698例患者，并根据BMI将其分为4组：<18.5、18.5 - 24.9、25 - 29.9和>30 kg/m²。这些组在年龄、性别、入院类别（内科、择期手术、非择期手术）、ICU住院时间和医院住院时间以及合并症方面存在显著差异。除SOFA评分外，4组患者入院时及最初2天内的病情严重程度相似。总体医院死亡率为31.3%（1698例患者中有532例）。通过多因素分析，BMI低于18.5 kg/m²与死亡率增加独立相关（比值比1.63；95%置信区间1.11 - 2.39）。其他BMI类别均与较高死亡率无关，甚至BMI>30 kg/m²对死亡率有保护作用（比值比0.60，95%置信区间0.40 - 0.88）。
在这一大型危重症患者队列中，低BMI与较高死亡率独立相关，高BMI与较低死亡率相关。由于目前可用的评分系统中没有BMI，需要进一步研究以确定加入BMI是否会提高评分预测死亡率的有效性。
