Impact of weight in outcomes for critically ill kids

July 7, 2020

It’s been hypothesized that obesity can lead to worse outcomes in critical illness and an investigation provides some answers.

Over the past several years, the effect of obesity on morbidity and mortality on a number of diseases has become apparent. An investigation in Pediatrics explores whether obesity leads to worse outcomes in children who are critically ill.1

Investigators ran a secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study, which was a prospective, multinational observational study. Participants in the study were aged from 3 months to 25 years and had been recruited across North America, Europe, Asia, and Australia. They were divided into 4 groups: underweight, normal weight, overweight, and obese.

Of the 3719 patients included in the study, 542 were given a primary diagnosis of sepsis. In the cohort, 1059 were underweight; 1649 were normal weight; 423 were overweight; and 588 were obese. In the main cohort, the 28-day mortality rate was 3.6%. Within the sepsis cohort, the overall mortality rate was 9.1% and was found to vary significantly by weight status (15.4% in underweight, 6.6% in normal weight, 3.6% in overweight, and 4.7% in obese). In a fully adjusted model, the 28-day mortality risk was 2.9-fold higher in the underweight group versus the normal weight group in the sepsis cohort and 1.8-fold higher in the overall cohort. They also found that children who were underweight had a longer stay in the intensive care unit (ICU), higher frequency of fluid overload, and an increased need for mechanical ventilation support.

The researchers concluded that children who are underweight make up a significant proportion of patients in the pediatric ICU. They also have a more complicated course during their ICU stay.

Reference

1. Ayalon I, Woo JG, Basu RK, Kaddourah A, Goldstein SL, Kaplan JM. Weight as a risk factor for mortality in critically ill patients. Pediatrics. 2020;146(1):e20192829. doi:10.1542/peds.2019-2829