Skip to main content

Table 1  Main observational studies reporting epidemiology and outcomes in obese patients with acute respiratory distress syndrome (ARDS)

From: ARDS in Obese Patients: Specificities and Management

  O’Brien et al. (2004) [18] O’Brien et al. (2006) [9] Morris et al. (2007) [19] Gong et al. (2010) [6] Stapleton et al. (2010) [20] Anzueto et al. (2011) [7] Soto et al. (2012) [21] De Jong et al. (2018) [22]
Type of study Prospective multicenter Retrospective multicenter Prospective multicenter Prospective multicenter Retrospective multicenter Prospective multicenter Retrospective multicenter Retrospective single center
Country USA USA USA USA USA International USA France
Purpose To examine the association between excess BMI and outcome in mechanically ventilated ARDS patients To describe the influence of admission BMI on outcome of critical illness in mechanically ventilated ARDS patients To clarify the relationship between BMI and ICU outcomes, particularly in patients with ARDS To determine if BMI and obesity are associated with development of ARDS and mortality in ARDS To assess if cytokine response might be attenuated in patients who are obese and critically ill or if obesity might modify the relationship between plasma cytokines and clinical outcomes in ARDS To describe the influence of BMI on clinical outcomes in a large cohort of mechanically ventilated patients To evaluate whether BMI was associated with AKI in the ARDS patients To evaluate the relationship between 90-day mortality and driving pressure in ARDS patients according to obesity status
Main endpoints Mortality at 28 days Hospital mortality Mortality, hospital LOS, ICU LOS Development of ARDS and all-cause 60-day mortality Plasma cytokine levels Incidence of ARDS, ICU and hospital mortality Mortality at 60 days after ARDS Mortality at day 90
Included patients 902 mechanically ventilated patients with ARDS 1488 mechanically ventilated adults with ARDS included in the Project IMPACT database 825 mechanically ventilated patients with ARDS 1795 patients 1409 mechanically ventilated patients with ARDS 4968 adult patients who received mechanical ventilation for more than 12 h 751 patients with ARDS 362 mechanically ventilated ARDS patients
Period of inclusion 1996–1999 1995–2001 1999–2000 1999–2007 1996–2002 2004 1999–2010 2009–2017
Main result After risk adjustment, excess BMI was not associated with death BMI was independently associated with hospital mortality (p < 0.0001) when modeled as a continuous variable. The adjusted odds were highest for the lowest BMIs and then declined to a minimum between 35 and 40 kg/m2 No ICU mortality difference. Severely obese patients had longer hospital LOS than normal weight patients BMI was associated with ARDS on multivariable analysis. Among patients with ARDS, increasing BMI was associated with increased LOS (p = 0.007) but not with mortality Obese patients with ALI had lower levels of several pro- inflammatory cytokines. Unadjusted 90-day mortality was highest in patients who were underweight (45.9%) and lowest in patients who were obese (27.6%) (p < 0.05). After adjustment, BMI was not associated with mortality After adjustment, the BMI was significantly associated with the development of ARDS.
No differences in outcomes (duration of mechanical ventilation, LOS or ICU/hospital mortality
The prevalence of AKI increased significantly with increasing weight. On multivariable analysis, AKI was associated with increased ARDS mortality whereas BMI was associated with decreased mortality Contrary to non-obese ARDS patients, driving pressure was not associated with mortality in obese ARDS patients. Mortality rate did not differ between obese and non-obese patients, before or after multivariable analysis
  1. ICU intensive care unit, BMI body mass index, AKI acute kidney injury, LOS length of stay, ALI acute lung injury