TY - JOUR
T1 - Body mass index and ventilator dependence in critically ill subjects in Japan
T2 - A cohort study using a nationwide database
AU - Fujinaga, Jun
AU - Suzuki, Etsuji
AU - Irie, Hiromasa
AU - Onodera, Mutsuo
N1 - Funding Information:
Dr Fujinaga is supported by Health, Labor and Welfare Policy Research Grants (Grant Number 19IA2024). Dr Suzuki is supported by Japan Society for the Promotion of Science (KAKENHI Grant Number JP20K10471). The authors have disclosed no conflicts of interest.
Funding Information:
Dr Fujinaga is supported by Health, Labor and Welfare Policy Research Grants (Grant Number 19IA2024). Dr Suzuki is supported by Japan Society for the Promotion of Science (KAKENHI Grant Number JP20K10471). The authors have disclosed no conflicts of interest. We thank the Japanese Intensive Care Patient Database, which is Working Group in the Japanese Society of Intensive Care Medicine for their help with this study.
Publisher Copyright:
© 2021 Daedalus Enterprises.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - BACKGROUND: Body mass index (BMI) can be an important indicator for health outcomes among critically ill patients. However, the association between BMI and ventilator dependence at ICU discharge among these patients remains unknown. We aimed to evaluate the association between BMI at ICU admission and ventilator dependence at the time of ICU discharge. As sec-ondary outcomes, we used ICU mortality, hospital mortality, and implementation of tracheos-tomy during ICU stay. METHODS: This is a retrospective cohort study. The data were derived from The Japanese Intensive Care Patient Database, a nationwide ICU database in Japan. We included all patients in the registry who were ≥ 16 y old, received mechanical ventilation, and were admitted to an ICU between April 2018 and March 2019. On the basis of their BMI at ICU admis-sion, subjects were classified as underweight (<18.5 kg/m2); normal weight (≥ 18.5 kg/m2 to <23 kg/m2); overweight (≥ 23 kg/m2 to < 27.5 kg/m2); or obese (≥ 27.5 kg/m2). RESULTS: Among 11,801 analyzed subjects, 388 (3.3%) subjects were ventilator-dependent at ICU discharge. Compared with normal-weight subjects, the risk for ventilator dependence at ICU discharge increased among underweight subjects even after adjusting for potential confounders and inter-ICU variance in 2-level multivariable logistic regression analysis (odds ratio 1.46 [95% CI 1.18–1.79]). Although obesity was also associated with a higher risk of ventilator dependence, the association was less clear (odds ratio 1.10 [95% CI 0.99–1.22]). The risk of ICU mortality, hospital mortality, and implementation of trache-ostomy also increased in underweight subjects. CONCLUSIONS: Critically ill underweight subjects had a higher risk of ventilator dependence at ICU discharge compared to normal-weight subjects, even after adjusting for potential confounders and inter-ICU variance. The association between BMI and ventilator dependence should be examined using information on subjects’ nutritional status and frailty in further studies.
AB - BACKGROUND: Body mass index (BMI) can be an important indicator for health outcomes among critically ill patients. However, the association between BMI and ventilator dependence at ICU discharge among these patients remains unknown. We aimed to evaluate the association between BMI at ICU admission and ventilator dependence at the time of ICU discharge. As sec-ondary outcomes, we used ICU mortality, hospital mortality, and implementation of tracheos-tomy during ICU stay. METHODS: This is a retrospective cohort study. The data were derived from The Japanese Intensive Care Patient Database, a nationwide ICU database in Japan. We included all patients in the registry who were ≥ 16 y old, received mechanical ventilation, and were admitted to an ICU between April 2018 and March 2019. On the basis of their BMI at ICU admis-sion, subjects were classified as underweight (<18.5 kg/m2); normal weight (≥ 18.5 kg/m2 to <23 kg/m2); overweight (≥ 23 kg/m2 to < 27.5 kg/m2); or obese (≥ 27.5 kg/m2). RESULTS: Among 11,801 analyzed subjects, 388 (3.3%) subjects were ventilator-dependent at ICU discharge. Compared with normal-weight subjects, the risk for ventilator dependence at ICU discharge increased among underweight subjects even after adjusting for potential confounders and inter-ICU variance in 2-level multivariable logistic regression analysis (odds ratio 1.46 [95% CI 1.18–1.79]). Although obesity was also associated with a higher risk of ventilator dependence, the association was less clear (odds ratio 1.10 [95% CI 0.99–1.22]). The risk of ICU mortality, hospital mortality, and implementation of trache-ostomy also increased in underweight subjects. CONCLUSIONS: Critically ill underweight subjects had a higher risk of ventilator dependence at ICU discharge compared to normal-weight subjects, even after adjusting for potential confounders and inter-ICU variance. The association between BMI and ventilator dependence should be examined using information on subjects’ nutritional status and frailty in further studies.
KW - Body mass index
KW - Critical illness
KW - Mechanical ventilation
KW - Obesity
KW - Underweight
KW - Ventilator dependence
UR - http://www.scopus.com/inward/record.url?scp=85113676733&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85113676733&partnerID=8YFLogxK
U2 - 10.4187/RESPCARE.08660
DO - 10.4187/RESPCARE.08660
M3 - Article
C2 - 33688093
AN - SCOPUS:85113676733
VL - 66
SP - 1433
EP - 1439
JO - Respiratory Care
JF - Respiratory Care
SN - 0020-1324
IS - 9
ER -
