Sex-Specific Obesity Paradox in Critically Ill Patients... : Critical Care Medicine (original) (raw)

Clinical Investigation

Sex-Specific Obesity Paradox in Critically Ill Patients With Severe Acute Kidney Injury: A Retrospective Analysis

Jung, Hyo Jin MD1; Seo, Yu Jin MS2; Jung, Jiyun PhD3,4; Lee, Jangwook MD, PhD4,5; Park, Jae Yoon MD, PhD4,5,6; Kim, Yong Chul MD, PhD7; Lee, Sung Woo MD, PhD8; Ban, Tae Hyun MD, PhD9; Park, Woo Yeong MD, PhD10; Kim, Kipyo MD, PhD11; Kim, Hyosang MD, PhD12; Kim, Kyeongmin MD, PhD13; Jung, Hee-Yeon MD, PhD1; Choi, Ji-Young MD, PhD1; Cho, Jang-Hee MD, PhD1; Park, Sun-Hee MD, PhD1; Kim, Chan-Duck MD, PhD1; Lim, Jeong-Hoon MD, PhD1; Kim, Yong-Lim MD, PhD1

1 Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.

2 Department of Statistics, Kyungpook National University, Daegu, South Korea.

3 Data Management and Statistics Institute, Dongguk University Ilsan Hospital, Goyang, South Korea.

4 Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea.

5 Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea.

6 Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, South Korea.

7 Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.

8 Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Gyeonggi-do, South Korea.

9 Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

10 Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea.

11 Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea.

12 Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

13 Department of Internal Medicine, Daejeon Eulji University Hospital, College of Medicine, Eulji University, Daejeon, South Korea.

Drs. Yong-Lim Kim and Jeong-Hoon Lim contributed equally to this study as co-corresponding authors.

Drs. H. J. Jung, J.-H. Lim, and Y.-L. Kim were involved in conceptualization. Ms. J. Jung and Drs. J. Lee, J. Y. Park, Y. C. Kim, S. W. Lee, Ban, W. Y. Park, Kipyo Kim, H. Kim, Kyeongmin Kim, H.-Y. Jung, Choi, Cho, S.-H. Park, C.-D. Kim, J.-H. Lim, and Y.-L. Kim were involved in data curation. Ms. Seo and Ms. J. Jung were involved in formal analysis. Drs. J. Y. Park and J.-H. Lim were involved in funding acquisition. Ms. Seo and Drs. J.-H. Lim and Y.-L. Kim were involved in investigation. Ms. Seo and Dr. J.-H. Lim were involved in methodology and visualization. Drs. H. J. Jung and J.-H. Lim were involved in writing the original draft. Drs. J.-H. Lim and Y.-L. Kim were involved in project administration, supervision, validation, and reviewing and editing the writing.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

This research was supported by a grant of the Korea Health Technology Research and Development Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HR22C1832; to Dr. Lim). This work was supported by the National Research Foundation of Korea grant funded by the Korea government (Ministry of Science and ICT) (RS-2024-00449995; to Dr. Lim).

The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]; [email protected]

Abstract

OBJECTIVES:

Although obesity is typically correlated with adverse outcomes in various diseases, certain acute critical illnesses exhibit a phenomenon known as the obesity paradox. This study evaluated sex-specific differences in the prognostic implications of the body mass index (BMI) of patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).

DESIGN:

A multicenter retrospective cohort study.

SETTING:

Data from eight tertiary hospitals in Korea.

PATIENTS:

A total of 3805 critically ill patients receiving CRRT. Patients were categorized into four BMI groups: underweight, normal weight, overweight, and obese.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

There were 2308 male and 1497 female patients. The 90-day mortality risk significantly differed among BMI groups in the overall patient population and the male subpopulation but not the female subpopulation. Following adjustment for confounding variables, the 90-day mortality risk was higher in the underweight group than in the obese group (hazard ratio [HR], 1.20; 95% CI, 1.05–1.36; p = 0.006). Among male patients, the 90-day mortality risk was higher in both the underweight and normal weight groups than in the obese group (underweight: HR, 1.30; 95% CI, 1.10–1.53; p = 0.002 and normal weight: HR, 1.18; 95% CI, 1.04–1.35; p = 0.010); however, no such association was observed among female patients. Subgroup analysis demonstrated the obesity paradox in male patients of old age, with septic AKI, or with low albumin levels.

CONCLUSIONS:

There were sex differences in the association between BMI and mortality in critically ill patients with severe AKI. Although the precise distribution of fat mass and muscle mass was not identified, obese male patients had a more favorable prognosis, which was not evident among female patients. These findings highlight the importance of considering sex-specific factors in understanding the complex relationship between obesity and mortality in critically ill patients with AKI.