Giuseppe
Emeritus
Impact of Obesity in Patients Infected With 2009 Influenza A(H1N1) (CHEST, abstract, edited)
[Source: Chest, full page: <cite cite="http://chestjournal.chestpubs.org/content/139/2/382.short?rss=1">Impact of Obesity in Patients Infected With 2009 Influenza A(H1N1) ? CHEST</cite>. Abstract, edited.]
Impact of Obesity in Patients Infected With 2009 Influenza A(H1N1)
1. Emili D?az, MD, PhD, 2. Alejandro Rodr?guez, MD, PhD, 3. Ignacio Martin-Loeches, MD, PhD, 4. Leonardo Lorente, MD, PhD, 5. Mar?a del Mar Mart?n, MD, 6. Juan Carlos Pozo, MD, 7. Juan Carlos Montejo, MD, 8. Angel Estella, MD, 9. ?ngel Arenzana, MD, 10. Jordi Rello, MD, PhD and 11. H1N1 SEMICYUC Working Group*
Author Affiliations
1. From the Critical Care Department (Drs D?az, Rodr?guez, and Martin-Loeches), Hospital Universitario Joan XXIII-Centro de Investigaci?n Biom?dica en red Enfermedades Respiratorias, Universitat Rovira i Virgili (URV), and Institut d?Investigaci? Sanit?ria Pere Virgili (IISPV), Tarragona; the Critical Care Department (Dr Lorente), Hospital Universitario de Canarias, Tenerife; the Critical Care Department (Dr Mart?n), Hospital de la Candelaria, Tenerife the Critical Care Department (Dr Pozo), Hospital Reina Sof?a, C?rdoba; the Critical Care Department (Dr Montejo), Hospital 12 de Octubre, Madrid the Critical Care Department (Dr Estella), Hospital Sistema Andaluz de Salud, Jerez; the Critical Care Department (Dr Arenzana), Virgen de la Macarena, Sevilla; and the Critical Care Department (Dr Rello), Vall D?Hebron Hospital, Universitat Aut?noma de Barcelona, Institut de Recerca Vall D?Hebron Centro de Investigaci?n Biom?dica en red de Enfermedades Respiratorias, Barcelona, Spain.
1. Correspondence to: Emili D?az, MD, PhD, Critical Care Department, Hospital Universitario Joan XXIII-CIBER Enfermedades Respiratorias, URV, and IISPV, Carrer Dr, Mallafre Guasch 4, (43007) Tarragona, Spain; e-mail: emilio.diaz.santos@gmail.com
Abstract
Objective:
A large proportion of patients infected with 2009 influenza A(H1N1) (A[H1N1]) are obese. Obesity has been proposed as a risk factor influencing outcome in these patients. However, its role remains unclear. We evaluate the outcome of patients who are obese and infected with A(H1N1) in the ICU, determining whether obesity is a risk factor for mortality.
Methods:
This was a prospective, observational, and multicenter study performed in 144 ICUs in Spain. Data were obtained from the Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Espa?ola de Medicina Intensiva, Cr?tica y Unidades Coronarias (GTEI/SEMICYUC) registry. Adult patients with A(H1N1) that was confirmed by real-time polymerase chain reaction were included in the analysis. Patients who were obese (BMI > 30) were compared with patients who were nonobese. Cox regression analysis was used to determine adjusted mortality. Differences of P < .05 were considered significant.
Results:
In January 2010, the GTEI/SEMICYUC registry had complete records for 416 patients. One hundred and fifty patients (36.1%) were obese, of whom 67 (44.7%) were morbidly obese (BMI > 40). Mechanical ventilation (MV) was more frequently applied in patients who were obese (64% vs 52.4%, P < .01) Patients with obesity remained on MV longer than patients who were nonobese (6.5 ? 10.3 days vs 9.3 ? 9.7 days, P = .02), had longer ICU length of stay (10.8 ? 12.1 days vs 13.7 ? 11.7 days, P = .03), and had longer hospitalization (18.2 ? 14.6 days vs 22.2 ? 16.5 days, P = .02). Mortality adjusted by severity and potential confounders identified that obesity was not significantly associated with ICU mortality (hazard ratio, 1.1; 95% CI, 0.69-1.75; P = .68).
Conclusions:
In our cohort, patients who were obese and infected with A(H1N1) did not have increased mortality. However, there was an association between obesity and higher ICU resource consumption.
Footnotes
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
*The H1N1 Sociedad Espa?ola de Medicina Intensiva, Cr?tica y Unidades Coronarias Working Group Investigators are listed in e-Appendix 1.
* Funding/Support: This work was supported by Ag?ncia de Gesti? d?Ajuts Universitaris i de Recerca [Grant 2009/SGR/1226].
#Abbreviations: A(H1N1) 2009 influenza A(H1N1) - APACHE II Acute Physiology and Chronic Health Evaluation - CDC US Centers for Disease Control and PreventionHR hazard ratio - IQR interquartile range - LOS length of stay - MV mechanical ventilation - SOFA Sequential Organ Failure Assessment
* Received May 5, 2010.
* Accepted June 24, 2010.
* ? 2011 American College of Chest Physicians
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[Source: Chest, full page: <cite cite="http://chestjournal.chestpubs.org/content/139/2/382.short?rss=1">Impact of Obesity in Patients Infected With 2009 Influenza A(H1N1) ? CHEST</cite>. Abstract, edited.]
Impact of Obesity in Patients Infected With 2009 Influenza A(H1N1)
1. Emili D?az, MD, PhD, 2. Alejandro Rodr?guez, MD, PhD, 3. Ignacio Martin-Loeches, MD, PhD, 4. Leonardo Lorente, MD, PhD, 5. Mar?a del Mar Mart?n, MD, 6. Juan Carlos Pozo, MD, 7. Juan Carlos Montejo, MD, 8. Angel Estella, MD, 9. ?ngel Arenzana, MD, 10. Jordi Rello, MD, PhD and 11. H1N1 SEMICYUC Working Group*
Author Affiliations
1. From the Critical Care Department (Drs D?az, Rodr?guez, and Martin-Loeches), Hospital Universitario Joan XXIII-Centro de Investigaci?n Biom?dica en red Enfermedades Respiratorias, Universitat Rovira i Virgili (URV), and Institut d?Investigaci? Sanit?ria Pere Virgili (IISPV), Tarragona; the Critical Care Department (Dr Lorente), Hospital Universitario de Canarias, Tenerife; the Critical Care Department (Dr Mart?n), Hospital de la Candelaria, Tenerife the Critical Care Department (Dr Pozo), Hospital Reina Sof?a, C?rdoba; the Critical Care Department (Dr Montejo), Hospital 12 de Octubre, Madrid the Critical Care Department (Dr Estella), Hospital Sistema Andaluz de Salud, Jerez; the Critical Care Department (Dr Arenzana), Virgen de la Macarena, Sevilla; and the Critical Care Department (Dr Rello), Vall D?Hebron Hospital, Universitat Aut?noma de Barcelona, Institut de Recerca Vall D?Hebron Centro de Investigaci?n Biom?dica en red de Enfermedades Respiratorias, Barcelona, Spain.
1. Correspondence to: Emili D?az, MD, PhD, Critical Care Department, Hospital Universitario Joan XXIII-CIBER Enfermedades Respiratorias, URV, and IISPV, Carrer Dr, Mallafre Guasch 4, (43007) Tarragona, Spain; e-mail: emilio.diaz.santos@gmail.com
Abstract
Objective:
A large proportion of patients infected with 2009 influenza A(H1N1) (A[H1N1]) are obese. Obesity has been proposed as a risk factor influencing outcome in these patients. However, its role remains unclear. We evaluate the outcome of patients who are obese and infected with A(H1N1) in the ICU, determining whether obesity is a risk factor for mortality.
Methods:
This was a prospective, observational, and multicenter study performed in 144 ICUs in Spain. Data were obtained from the Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Espa?ola de Medicina Intensiva, Cr?tica y Unidades Coronarias (GTEI/SEMICYUC) registry. Adult patients with A(H1N1) that was confirmed by real-time polymerase chain reaction were included in the analysis. Patients who were obese (BMI > 30) were compared with patients who were nonobese. Cox regression analysis was used to determine adjusted mortality. Differences of P < .05 were considered significant.
Results:
In January 2010, the GTEI/SEMICYUC registry had complete records for 416 patients. One hundred and fifty patients (36.1%) were obese, of whom 67 (44.7%) were morbidly obese (BMI > 40). Mechanical ventilation (MV) was more frequently applied in patients who were obese (64% vs 52.4%, P < .01) Patients with obesity remained on MV longer than patients who were nonobese (6.5 ? 10.3 days vs 9.3 ? 9.7 days, P = .02), had longer ICU length of stay (10.8 ? 12.1 days vs 13.7 ? 11.7 days, P = .03), and had longer hospitalization (18.2 ? 14.6 days vs 22.2 ? 16.5 days, P = .02). Mortality adjusted by severity and potential confounders identified that obesity was not significantly associated with ICU mortality (hazard ratio, 1.1; 95% CI, 0.69-1.75; P = .68).
Conclusions:
In our cohort, patients who were obese and infected with A(H1N1) did not have increased mortality. However, there was an association between obesity and higher ICU resource consumption.
Footnotes
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
*The H1N1 Sociedad Espa?ola de Medicina Intensiva, Cr?tica y Unidades Coronarias Working Group Investigators are listed in e-Appendix 1.
* Funding/Support: This work was supported by Ag?ncia de Gesti? d?Ajuts Universitaris i de Recerca [Grant 2009/SGR/1226].
#Abbreviations: A(H1N1) 2009 influenza A(H1N1) - APACHE II Acute Physiology and Chronic Health Evaluation - CDC US Centers for Disease Control and PreventionHR hazard ratio - IQR interquartile range - LOS length of stay - MV mechanical ventilation - SOFA Sequential Organ Failure Assessment
* Received May 5, 2010.
* Accepted June 24, 2010.
* ? 2011 American College of Chest Physicians
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