• Emma J Kooistra, Sylvia Brinkman, van der VoortPeter H JPHJDepartment of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.TIAS, School for Business and Society, Tilburg University, Tilburg, The Netherlands., Nicolette F de Keizer, Dave A Dongelmans, Matthijs Kox, and Peter Pickkers.
• Department of Critical Care, Radboud University Medical Center, Nijmegen, The Netherlands.
• Crit. Care Med. 2022 Jan 1; 50 (1): e1e10e1-e10.

ObjectivesObesity is a risk factor for severe coronavirus disease 2019 and might play a role in its pathophysiology. It is unknown whether body mass index is related to clinical outcome following ICU admission, as observed in various other categories of critically ill patients. We investigated the relationship between body mass index and inhospital mortality in critically ill coronavirus disease 2019 patients and in cohorts of ICU patients with non-severe acute respiratory syndrome coronavirus 2 viral pneumonia, bacterial pneumonia, and multiple trauma.DesignMulticenter observational cohort study.SettingEighty-two Dutch ICUs participating in the Dutch National Intensive Care Evaluation quality registry.PatientsThirty-five-thousand five-hundred six critically ill patients.InterventionsNone.Measurements And Main ResultsPatient characteristics and clinical outcomes were compared between four cohorts (coronavirus disease 2019, nonsevere acute respiratory syndrome coronavirus 2 viral pneumonia, bacterial pneumonia, and multiple trauma patients) and between body mass index categories within cohorts. Adjusted analyses of the relationship between body mass index and inhospital mortality within each cohort were performed using multivariable logistic regression. Coronavirus disease 2019 patients were more likely male, had a higher body mass index, lower Pao2/Fio2 ratio, and were more likely mechanically ventilated during the first 24 hours in the ICU compared with the other cohorts. Coronavirus disease 2019 patients had longer ICU and hospital length of stay, and higher inhospital mortality. Odds ratios for inhospital mortality for patients with body mass index greater than or equal to 35 kg/m2 compared with normal weight in the coronavirus disease 2019, nonsevere acute respiratory syndrome coronavirus 2 viral pneumonia, bacterial pneumonia, and trauma cohorts were 1.15 (0.79-1.67), 0.64 (0.43-0.95), 0.73 (0.61-0.87), and 0.81 (0.57-1.15), respectively.ConclusionsThe obesity paradox, which is the inverse association between body mass index and mortality in critically ill patients, is not present in ICU patients with coronavirus disease 2019-related respiratory failure, in contrast to nonsevere acute respiratory syndrome coronavirus 2 viral and bacterial respiratory infections.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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