• Chansong Choi, Ryan J Lennon, Dae Hee Choi, Laura Piccolo Serafim, Alina M Allen, Patrick S Kamath, Vijay H Shah, de MoraesAlice GalloAGDepartment of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic College of Medicine, Rochester,, and Douglas A Simonetto.
• Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
• J Intensive Care Med. 2021 Jul 5: 8850666211029827.

BackgroundObesity paradox is a phenomenon in which obesity increases the risk of obesity-related chronic diseases but paradoxically is associated with improved survival among obese patients with these diagnoses.ObjectivesThe aim of this study was to explore the obesity paradox among critically ill patients with cirrhosis admitted to the Intensive Care Unit.MethodsA retrospective cohort of 1,143 consecutive patients with cirrhosis admitted to the ICU between January of 2006 and December of 2015 was analyzed. Primary outcome of interest was in-hospital mortality with secondary end points including ICU and short-term mortality at 30 days post ICU admission.ResultsLogistic regression with generalized additive models was used, controlling for clinically relevant and statistically significant factors to determine the adjusted relationship between body mass index (BMI) and ICU, post-ICU in-hospital, and 30 day mortality following ICU discharge. ICU and hospital length of stay was similar across all BMI classes. Adjusted ICU mortality was also similar when stratified by BMI. However, a significant reduction in post-ICU hospital mortality was observed in class I and II obese patients with cirrhosis (BMI 30-39.9 kg/m2) compared to normal BMI (OR = 0.41; 95% CI, 0.20 to 0.83; P = 0.014). Similarly, overweight (BMI 25-29.9 kg/m2) and class I and II obese patients with cirrhosis had significantly lower 30-day mortality following ICU discharge (OR = 0.52, 95% CI 0.31 to 0.87; P = 0.014; OR = 0.50, 95% CI 0.29 to 0.86; P = 0.012, respectively) compared to those with normal BMI.ConclusionThe signal of obesity paradox is suggested among critically ill patients with cirrhosis.

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