• Critical care medicine · Apr 2018

    Medical Versus Surgical ICU Obese Patient Outcome: A Propensity-Matched Analysis to Resolve Clinical Trial Controversies.

    • Audrey De Jong, Daniel Verzilli, Mustapha Sebbane, Marion Monnin, Fouad Belafia, Moussa Cisse, Matthieu Conseil, Julie Carr, Boris Jung, Gérald Chanques, Nicolas Molinari, and Samir Jaber.
    • Intensive Care Unit and Department of Anesthesiology, University of Montpellier Saint-Eloi Hospital, Montpellier, France.
    • Crit. Care Med. 2018 Apr 1; 46 (4): e294-e301.

    ObjectivesTo determine the short- and long-term mortality of obese ICU patients following medical as opposed to surgical admission and the relation between obesity and mortality.DesignRetrospective analysis of prospectively collected data, using a propensity score-matched analysis of patients with medical or surgical admission.SettingOne French mixed medical-surgical ICU.PatientsCritically ill obese patients (body mass index ≥ 30 kg/m) and nonobese patients admitted during a 14-year period.InterventionsNone.Measurements And Main ResultsSeven-hundred ninety-one obese patients and 4,644 nonobese patients were included, 338 (43%) and 2,367 (51%) medical and 453 (57%) and 2,277 (49%) surgical obese and nonobese patients, respectively. Mortality was significantly higher in medical than in surgical obese patients in ICU (25% vs 12%; p < 0.001) and up to 365 days (36% vs 18%; p < 0.001) post ICU admission. One-to-one propensity score matching generated 260 pairs with well-balanced baseline characteristics. After matching on propensity score, mortality was still significantly higher in medical patients both in the ICU (21% vs 13%; p = 0.03) and up to 365 days (30% vs 20%; p = 0.01) post ICU admission. Obesity was not significantly associated with mortality both in univariate analysis (140 obese patients [15%] in the dead group vs 651 [14%] in the alive group; p = 0.72) and multivariate analysis (odds ratio, 1.09 [95% CI, 0.86-1.38]; p = 0.49) after adjustment for Simplified Acute Physiology Score II, age, category of admission, history of cardiac disease, and history of respiratory disease.ConclusionsAfter careful matching, the data suggest that ICU mortality in obese population was higher in the medical group than in the surgical group and remains significantly higher 365 days post ICU admission.

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