• Antoine Gros, Claire Dupuis, Stéphane Ruckly, Alexandre Lautrette, Maité Garrouste-Orgeas, Marc Gainnier, Jean-Marie Forel, Guillaume Marcotte, Elie Azoulay, Yves Cohen, Carole Schwebel, Laurent Argaud, Etienne de Montmollin, Shidasp Siami, Dany Goldgran-Toledano, Michael Darmon, Jean-Francois Timsit, and OUTCOMEREA Study Group.
• Medical-Surgical Intensive Care Unit, André Mignot Hospital, Le Chesnay, France.
• Crit. Care Med. 2018 Oct 1; 46 (10): e981-e987.

ObjectivesThis study in critically ill patients with shock assessed the prognostic value of body weight variations occurring each day from day 3 to day 7 on the 30-day outcome in terms of mortality, occurrence of ventilator-associated pneumonia and of bedsore, and occurrence of length of stay.DesignRetrospective analysis of data. Multivariate subdistribution survival models were used at each day, from day 3 to day 7. The impact of body weight variations on length of stay was estimated through a multivariate negative binomial regression model.SettingProspective multicenter cohort study.PatientsCritically ill patients admitted in ICU with shock and requiring mechanical ventilation within 48 hours.InterventionNone.Measurements And Main ResultsTwo-thousand three-hundred seventy-four patients were included. Their median body weight variations increased from 0.4 kg (interquartile range, 0-4.8 kg) on day 3 to 3 kg (interquartile range, -0.4 to 8.2 kg) on day 7. Categories of body weight variations were defined depending on body weight variations interquartiles: weight loss, no weight gain, moderate and severe weight gain. A severe weight gain tended to be associated with death at days 5 and 6 (day 5: subdistribution hazard ratio, 1.27; 95% CI, 0.99-1.63; p = 0.06 and day 6: subdistribution hazard ratio, 1.43; 95% CI, 1.08-1.89; p = 0.01), a weight loss tended to be associated with bedsore, and a severe gain between at days 5 and 6 was associated with ventilator-associated pneumonia. Any body weight variations were associated with an increased length of stay.ConclusionsIn survivors at day 3, body weight variations during the first days of ICU stay might be a clinically relevant tool to prevent weight gain but also for prognostication of 30-day mortality, occurrence of ventilator-associated pneumonia, and occurrence of prolonged ICU stay.

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