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• W2894884393 abstract "SESSION TITLE: Outcomes and Management of Viral Infections in the ICU SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 04:30 PM - 05:30 PM PURPOSE: Acute respiratory distress syndrome (ARDS) is a severe complication of influenza infection. Obese patients carried poor outcomes when infected with the influenza virus.However, an “obesity paradox” was reported in ARDS population; obesity was associated with lower mortality rate in patients with ARDS. This study aims to assess the clinical performance of obese patients who had influenza infection complicating ARDS. METHODS: The multicenter retrospective study was conducted in 8 tertiary medical centers in Taiwan from January to March 2016 . Patients who were 18 or older, diagnosed with ARDS and confirmed influenza infection were included. We recorded demographic data, lab test results, ventilator parameters, grade of ARDS, comorbidities, and disease severity as evaluated by Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) score. Obesity was defined as body mass index 30 or over. Mortality was assessed through Cox regression analysis to adjust for patient characteristic and disease severity. Ventilator days and length of hospital and ICU stay were evaluated using analysis of covariance (ANCOVA). RESULTS: 282 patients were included. The median age was 60 years (interquartile age[IQR], 52-68), 37.2% were female (37.2%). The overall 30-day mortality was 23% and 60-day mortality was 31.2% in the corhort. 14.7 % patients were obese. Obese patients had a significant lower 30-day mortality rate(4.9% versus 26.2%, adjusted hazard ratio [aHR] = 0.19, 95% Confidence interval[CI] = 0.04-0.81, p=0.025) compared to non-obese patients after adjusting for age, gender, BMI, comorbidities and APACHE II score. No statistical difference was found between obese and non-obese patients in 60-day mortality( 24.4 versus 32.6%, aHR = 0.76, 95% CI = 0.35-1.66, p=0.49), as well as ventilator days, ICU or hospital length of stay, cardiovascular or neurological complicationAfter confounders were adjusted, obese patients had lower grade of ARDS compared to non-obese patients (average grade=1.3 versus 1.6, p=0.049). Serum c-reactive protein was statistically lower in obese patients(11.8 vs 15.97mg/L, p=0.028). No statistical difference was noted between the two groups in serum lactate, white blood cell count, and SOFA score at day 1, day 3, and day 7. CONCLUSIONS: Obesity was associated with significant lower 30-day but not 60-day mortality in severe influenza complicating ARDS. The finding may be explained by lower ARDS severity and systemic inflammatory response in obese patients. While tied to poor outcome in influenza infection, obesity had a interestingly protective effect in severe influenza complicating ARDS. CLINICAL IMPLICATIONS: The Obesity paradox, a phenomenon describing better clinical outcome in obese patients, does exist in influenza infection complication ARDS. Obesity may be considered as a protective factor attenuating inflammation and lung injury. DISCLOSURES: No relevant relationships by Wei-cheng Chen, source=Web Response No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Chi Chan Lee, source=Web Response No relevant relationships by Shinn-Jye Liang, source=Web Response" @default.
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• W2894884393 date "2018-10-01" @default.
• W2894884393 modified "2023-09-24" @default.
• W2894884393 title "OBESITY PARADOX? A MULTICENTER RETROSPECTIVE STUDY ASSESSING PATIENTS WITH SEVERE INFLUENZA COMPLICATING ARDS" @default.
• W2894884393 doi "https://doi.org/10.1016/j.chest.2018.08.125" @default.
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