What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Respiratory Distress Syndrome (n=2378). Intervention: Obesity (BMI ≥ 30 kg/m2) vs. Normal weight (BMI ≥ 18.5 to < 25 kg/m2). Primary outcome: In-hospital mortality (OR 0.72, 95% CI 0.55-0.94, p=0.0168).

February 12, 2021Frontiers in EndocrinologyOpen Access

Association Between Obesity and Short-And Long-Term Mortality in Patients With Acute Respiratory Distress Syndrome Based on the Berlin Definition

Q: What are the key findings of this study?

Obesity was associated with a significantly lower risk of in-hospital mortality (OR 0.72) and 1-year mortality (HR 0.80) compared to normal weight in patients with acute respiratory distress syndrome.

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Key result

Obesity linked to ~28% lower in-hospital mortality vs normal weight in ARDS patients.

OR 0.72
95% CI 0.55-0.94
P=0.0168
n=2,378

Why the study?

Previous findings on the potential protective effect of obesity in ARDS are inconsistent, with limited data on long-term prognosis and ARDS diagnosed by the Berlin definition.

Does obesity reduce short-term and long-term mortality in patients with ARDS?

Population

2,378 patients with ARDS based on the Berlin definition from the MIMIC-III database

Comparison

Four WHO BMI categories

Design

Retrospective cohort study

Follow-up

1-year follow-up

Authors

WZWei ZhangFirst People’s Hospital of Zunyi YWYadan WangShenyang Pharmaceutical University WLWeijie LiNational University of Defense Technology

Discussion

Member takes

Implication

Supports obesity paradox in ARDS but should not alter management; leaves open causal confirmation in prospective trials.

Study Design

Type

Cohort (n=2,378)

Multicenter

Structured PICO

Does obesity reduce short-term and long-term mortality in patients with ARDS?

Population

2,378 adult patients with acute respiratory distress syndrome (ARDS) based on the Berlin definition, admitted to a single-center ICU, followed for up to 1 year.

Exposure

Obesity (based on WHO body mass index categories)

Comparator

Normal weight

Outcome

In-hospital mortality and 1-year mortalityhard clinical

Main Result

Odds Ratio: 0.72 (95% CI 0.55–0.94)

Absolute Event Rate: 21.67% vs 30.56%

p-value: p=0.0168

Obesity is associated with a decreased risk of short-term and long-term mortality in patients with ARDS, supporting the existence of an 'obesity paradox' in this critical care population.

Limitations

Retrospective observational design cannot establish causality
Potential collider bias and over-diagnosis of ARDS in obese patients
Lack of information on clinical risks for ARDS such as sepsis, pneumonia, trauma, and aspiration
Height and weight recorded at ICU admission may be affected by prior fluid resuscitation
Single-center study limits generalizability to other populations and regions

Cite This Study

Zhang et al. (2021) conducted a cohort in Acute Respiratory Distress Syndrome (n=2,378). Obesity (BMI ≥ 30 kg/m2) vs. Normal weight (BMI ≥ 18.5 to < 25 kg/m2) was evaluated on In-hospital mortality (OR 0.72, 95% CI 0.55-0.94, p=0.0168). Obesity was associated with a significantly lower risk of in-hospital mortality (OR 0.72) and 1-year mortality (HR 0.80) compared to normal weight in patients with acute respiratory distress syndrome.

synapsesocial.com/papers/6aa22c2e95599a1e6e6eea02 https://doi.org/10.3389/fendo.2020.611435

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Association Between Obesity and Short-And Long-Term Mortality in Patients With Acute Respiratory Distress Syndrome Based on the Berlin Definition

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Association Between Obesity and Short-And Long-Term Mortality in Patients With Acute Respiratory Distress Syndrome Based on the Berlin Definition

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider