Association between Modified Body Mass Index and 30-Day and 1-Year Mortality after Intensive Care Unit Admission: A Retrospective Cohort Study.

Jung-Won Hwang,Young-Tae Jeon,Sang-Hwan Do,In-Ae Song,Yeon Lee,Tak Oh,Jaebong Lee

doi:10.3390/jcm7040081

Jung-Won Hwang, Young-Tae Jeon + Show 5 more

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https://doi.org/10.3390/jcm7040081

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Abstract

Because conventional body mass index (cBMI) does not reflect fluid accumulation, modified BMI (mBMI, serum albumin multiplied by cBMI) is a more accurate measure of malnutrition status. This study aimed to determine whether mortality after intensive care unit (ICU) admission was associated with cBMI, mBMI, and/or serum albumin levels. The medical records of patients who were admitted to a tertiary hospital ICU between 1 January 2012 and 31 July 2016 were retrospectively reviewed. In total, 6169 ICU-admitted patients were included in the analyses. Multivariate Cox regression analyses revealed that low cBMI, mBMI and albumin level were significantly associated with 30-day and 1-year mortality after ICU admission (hazard ratio < 1.0, p < 0.05). The adjusted area under the curve (AUC) of mBMI for 1-year mortality was significantly higher than that of cBMI (p < 0.001), but not significantly different from that of albumin level (p = 0.098). Low values of mBMI, cBMI and albumin were independently associated with 30-day and 1-year mortality after ICU admission. Combining cBMI and albumin (mBMI) did not increase the validity of the AUC of albumin for 1-year mortality after ICU admission. Our study showed that serum albumin alone, rather than mBMI (combining cBMI), is recommended in predicting mortality among ICU patients.

Highlights

Malnutrition is related to prognosis and mortality among patients admitted to all types of intensive care units (ICUs) [1], including medical and surgical ICUs [2,3]
The present study showed that conventional body mass index (cBMI), mBMI and albumin values at ICU admission were associated with 30-day and 1-year mortality after ICU admission
MBMI had a higher area under the curve (AUC) of association with 1-year mortality after ICU admission than cBMI before and after adjusting for covariates, mBMI did not show a significantly higher AUC than serum albumin. This means that combining cBMI and serum albumin level did not increase the validity of the AUC of albumin for mortality after ICU admission

Summary

Introduction

Malnutrition is related to prognosis and mortality among patients admitted to all types of intensive care units (ICUs) [1], including medical and surgical ICUs [2,3]. A multicenter prospective cohort study revealed that low cBMI was associated with increased mortality among ICU-admitted patients [6], and a retrospective observational study revealed that low serum albumin levels at ICU admission were associated with patient prognosis [7]. CBMI reflects obesity and the patient’s general physical status, it does not reflect fluid balance, such as fluid accumulation or dehydration. This issue is relevant after liver transplantation when patients are highly susceptible to

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