Lower body mass index is an independent predictor of mortality in older patients with acute respiratory distress syndrome
Jia-Jun Wu,
Wei-Fan Ou,
Yu-Yi Yu,
Chieh-Liang Wu,
Tsung-Ying Yang,
Ming-Cheng Chan
Affiliations
Jia-Jun Wu
Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan No.110, Sect. 1, Jianguo N. Road, Taichung, 402, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan No.110, Sect. 1, Jianguo N. Road, Taichung, 402, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan No.110, Sect. 1, Jianguo N. Road, Taichung, 402, Taiwan
Wei-Fan Ou
Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
Yu-Yi Yu
Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan No.155, Sect.2, Linong Street, Taipei, 112, Taiwan; Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
Chieh-Liang Wu
Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan; Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan
Tsung-Ying Yang
Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan; Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan No.250, Kuo Kuang Road, Taichung, 402, Taiwan
Ming-Cheng Chan
Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan; Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan; School of Medicine, National Chung Hsing University No.250, Kuo Kuang Road, Taichung, 402, Taiwan; Corresponding author. Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. No.1650, Sect. 4, Taiwan Boulevard, Taichung, 407, Taiwan.
Background: Acute respiratory distress syndrome (ARDS) is associated with high mortality. The impacts of body mass index (BMI) on the morality of older patients with ARDS remain unclear. Methods: This is a single-center cohort study which was conducted at Taichung Veterans General Hospital, Taiwan. Adult patients admitted to the ICU needing mechanical ventilation with ARDS were included for analysis. We compared the data of older patients (age ≥65 years) with those of younger patients (Age <65 years). The factors associated with in-hospital mortality of older patients were investigated. Results: This study included a total of 728 (mean age: 66 years; men: 63%) patients, and 425 (58.4%) of them aged ≥65 years. Older patients exhibited lower body mass index (BMI) (23.8 vs 25.2), higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (28.9 vs 26.3), higher Charlson Comorbidity Index (CCI) (4.0 vs 3.4), and lower Sequential Organ Failure Assessment (SOFA) scores (10.0 vs 11.1) than younger patients. Furthermore, older patients had mortality rates similar to younger patients (40.5% vs 42.9%, P = 0.542), but had longer length of stay in the ICU (17.6 vs 15.6 days, P = 0.047). For older patients, BMI <18.5 (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.45–5.34), high SOFA score (OR, 1.20; 95% CI, 1.12–1.28), and moderate (OR, 1.95; 95% CI 1.20–3.14) or severe ARDS (OR, 2.30; 95% CI 1.26–4.22) were independent risk factors for mortality. Conclusions: In this cohort, critical ill older patients with ARDS had lower BMI, more comorbidities, and higher APACHE II scores than younger patients. Mortality rate was similar between older and younger patients. Low BMI, high SOFA score, and moderate or severe ARDS were independently associated with mortality in older patients with ARDS.
