Impact of Obesity in the Critically Ill Trauma Patient: A Prospective Study

BACKGROUND: Obesity has risen at an epidemic rate over the past 20 years in the US. To our knowledge, there is an absence of data evaluating the impact of obesity in the critically ill trauma patient. METHODS: Prospective data were collected on 1,167 patients admitted to the ICU over a 2-year period. Obesity was defined as a body mass index (calculated as weight kg/height m(2)) of 30 or higher. Outcomes analyzed included infection rate, hospital and ICU length of stay, and mortality. Multiple logistic regression was used to evaluate outcomes between obese and nonobese patients for infection (infection versus noninfection) and mortality (deceased versus not deceased). Continuous outcomes such as hospital and ICU lengths of stay were evaluated using multiple linear regression analyses. RESULTS: Sixty-two of 1,167 (5.3%) patients were obese. The majority (71%) of injuries in the study cohort were blunt. Although the majority of patients were men (76%), women (10% versus 4%) were more likely to be obese (p < 0.001). Obese patients had a more than twofold increase in risk of acquiring a bloodstream, urinary tract, or respiratory infection, or being admitted to the ICU (p < 0.001), after statistically controlling for age and Injury Severity Score. When controlling for diabetes, gender, obesity, age, COPD, and Injury Severity Score, obese patients were 7.1 times (95% CI, 2.06-8.9) more likely to die in the hospital. CONCLUSIONS: Obesity is associated with a substantial increase in morbidity and mortality in the critically ill trauma patient. Future studies are warranted in both the prevention of infection and intensive care management of the obese trauma patient.