Abstract
IntroductionAlthough numerous studies have linked extremes of weight with poor outcome in adult intensive care patients, the effect of weight on intensive care outcome has not previously been reported in the pediatric population. The aim of this study was to investigate the relationship between admission weight centile and risk-adjusted mortality in pediatric intensive care patients.MethodsData were collected on 6337 consecutively admitted patients over an 8.5 year period in a 15 bed pediatric intensive care unit (ICU) located in a university-affiliated tertiary referral children's hospital. A weight centile variable was entered into a multivariate logistic regression model that included all other pediatric index of mortality (PIM-2) variables, in order to determine whether weight centile was an independent risk factor for mortality.ResultsWeight centile was associated with mortality in both univariate and multivariate analysis, with the lowest mortality being associated with weights on the 75th centile and increasing symmetrically around this nadir. A transformed weight centile variable (absolute value of weight centile-75) was independently associated with mortality (odds ratio 1.02, P = 0.000) when entered into a multivariate logistic regression model that included the PIM-2 variables.ConclusionsIn this single-center cohort, weight centile was an independent risk factor for mortality in the ICU, with mortality increasing for patients at either end of the weight spectrum. These observations suggest that the accuracy of mortality prediction algorithms may be improved by inclusion of weight centile in the models. A prospective multicenter study should be undertaken to confirm our findings.
Highlights
Numerous studies have linked extremes of weight with poor outcome in adult intensive care patients, the effect of weight on intensive care outcome has not previously been reported in the pediatric population
No studies have addressed the impact of body weight on outcome in the pediatric intensive care unit (PICU), Larsen and colleagues [18] noted that low weight was an independent risk factor for mortality in children undergoing cardiac surgery
Admission weights at the extremes of the centile range are associated with an increased risk of mortality in the PICU, and patients with weights at the extremes of the centile range appear to be numerically over-represented in the ICU, for overweight patients this may reflect the increasing incidence of obesity in the community
Summary
Numerous studies have linked extremes of weight with poor outcome in adult intensive care patients, the effect of weight on intensive care outcome has not previously been reported in the pediatric population. A number of studies have failed to demonstrate any impact of body mass on intensive care outcome [7,8,9,10,11], whereas others have demonstrated an association between obesity and increased risk-adjusted mortality [12,13,14]. No studies have addressed the impact of body weight on outcome in the pediatric intensive care unit (PICU), Larsen and colleagues [18] noted that low weight (but not age) was an independent risk factor for mortality in children undergoing cardiac surgery. We undertook this study to explore the relationship between weight centile required for this analysis of data, which are routinely and risk-adjusted mortality in PICU patients
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