2019 Research Forum

Samir Salameh MD R3, Tushar Bajaj MD R1, Alyssa Targovnik MS IV, Bianca Puello MS IV, Ayham Aboeed MD BMI AS AN INDICATOR OF OUTCOME IN ICU PATIENTS WITH ACUTE RESPIRATORY FAILURE

Introduction Obesity is a growing general health problem, as more than one third of the US adult population is obese and another one third is overweight ⁽ 1 ⁾ . While obesity is considered a major risk factor for the development of a number of respiratory diseases, including asthma, pulmonary hypertension, sleep apnea, obesity hypoventilation syndrome, pneumonia, and ARDS ⁽ 2 ⁾ its effect in the acute setting is not clear with few studies in the literature with conflicting results (3,4,5,6,7). The relationship between obesity and mortality and morbidity in patients with acute respiratory failure needs more clarification. Study the relationship between obesity and mortality and morbidity in patients with acute respiratory failure needs intubation. Obesity is considered currently a major health problem especially in the developed countries and its impact on health is well studied and ongoing efforts are obvious to try to deal with general health issue in chronic disorders associated with it. The role of Obesity in ICU patient with acute respiratory failure however is unclear and may be has no direct effect on mortality or morbidity with conflicting results between different studies. Study the effects of obesity in ICU patient with acute respiratory failure requiring intubation regarding days of intubation, length of stay, need for reintubation, tracheostomy, and PEG placement. • • • Objectives

Methods

1. Ogden CL, Carroll MD, Fryer CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief . 2015;(219:1-8. 2. Dixon AE, Clerisme-Beaty EM. Obesity and lung disease: a Guide to Management. Totowa, NJ: Humana Press; 2013. 3. Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008 Jan;36(1):151-8. 4. Pepper DJ, Sun J, Welsh J, et al. Increased body mass index and adjusted mortality in ICU patient with sepsis or septic shock: a systematic review and meta-analysis. Critical Care. (2016) 20:181. 5. Nasraway SA Jr, Albert M, Donnelly AM, et al. Morbid obesity is an independent determinant of death among surgical critically ill patients. Crit Care Med. 2006 Apr; 34(4):964-70. 6. Wardell S, Wall A, Bryce R, et al. The association between obesity and outcomes in critically ill patients. Can Respir J. 2015;22(1):23- 30. 7. Mullen JTI, Moorman DW, Davenport DL. The obesity paradox: body mass index and outcome in patients undergoing nonbariatric general surgery. Ann Surg. 2009 Jul; 250(1):166-72. Conclusions In summary, we found that there was not a statistically significant difference in mortality in patients classified as obese with concomitant acute respiratory failure requiring intubation. Given the small sample size in this study, further evaluation with a larger sample size is required to accurately report data. In conclusion, our study showed there was no proportional correlation between degree of obesity and mortality in obese patients with acute respiratory failure requiring intubation. Again, more randomized controlled studies are needed. References

We conducted a retrospective study of patients admitted to the intensive care unit of our institution between September 2015 and September 2017 with acute respiratory failure requiring intubation. At admission patients’ demographic information with height and weight were collected with APACHE II Score. Patients were followed until they deceased or discharged home and data about length of stay, intubation days, reintubation, mortality, tracheostomy, PEG placement collected. Patients were considered obese if BMI ≥ 30. Univariate logistic regression was employed to identify relationships between variables of interest. ROC analysis was used to identified threshold values for continuous variables. Those thresholds were then used to generate indicator variables for logistic regression. Odds ratios were calculated to interpret results.

Results The cohort of patients included a sample size of 166 patients, 59 females, 107 males. Of these, 119 (71.68%) patients survived and 47 (28.31%) died. Univariate logistic regression showed a very strong relationship between APACHE II Score and mortality (p=0.0056, odds ratio 1.0442, 95% confidence interval 1.0127 - 1.0766). We were able to predict that the probability of death increased by 51.08% for every increase in APACHE II score compared to previously calculated lower score. Gender was not found to be statistically significant as a predictor of mortality (p=0.539). ROC analysis showed a very weak (0.563) area under the curve with threshold of 21.5 as APACHE II Score. Apache II Score itself was found to be statistically significant in logic regression (p=0.0020) with an odds ratio of 2.9919, 95% (CI of 1.4910, 6.0035). This indicates the probability of death is 74.95% greater for those patients with calculated APACHE II scores ≥ 21.5 as compared to those patients with APACHE II scores ≤ 21.5. BMI was found to not be related to mortality (p=0.983). Based on logistic regression analysis. In patients with BMI ≥ 30, data failed to show any relationship between mortality and degree of obesity (p=0.848).

Acknowledgements

Mr. Brian Jean M.S. for his help with statistical analysis.

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