Association of Obesity With Clinical Outcomes in Neurocritically Ill Patients

Abstract

Background: To evaluate whether the obesity paradox exists in neurocritically ill patients.Methods: This was a retrospective, observational study of patient admitted to the neurosurgical intensive care unit (ICU) from January 2013 to December 2019. The subjects were classified into two groups: the non-obese group (body mass index [BMI] < 25 kg/m2) and the overweighted or obese group (BMI ≥ 25 kg/m2). The primary endpoint was in-hospital mortality. Results: A total of 527 patients were included in this study. The mean BMI was 23.7 ± 3.6 kg/m2. Of all neurosurgical patients, 157 patients were overweighted or obese. There were no significant differences in in-hospital mortality, 28-day mortality, and ICU mortality between the two groups (all p > 0.05). BMI on ICU admission was similar between survivors and non-survivors at discharge (p = 0.596). In the multivariable analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score on ICU admission, invasive intracranial pressure (ICP) monitoring, and use of more than one hyperosmolar agent were identified to be significantly associated with in-hospital mortality. However, BMI on ICU admission, and serum albumin level were not associated with in-hospital mortality. The obesity demonstrated a borderline significance relationship with the probability of in-hospital mortality (p=0.073). Conclusions: In this study, BMI on ICU admission, and serum albumin level demonstrated a lack of significant association with in-hospital mortality. Clinical factors including APHCHE II score, ICP monitoring, and hyperosmolar therapy were identified to be associated with prognosis in neurocritically ill patients. Eventually, the impact of the obesity paradox on these patients remains unclear.