ArticleCritical care (London, England)2020
The obesity paradox in critically ill patients: a causal learning approach to a casual finding.
Article in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Mortality risk in patients with underweight or obesity with peripheral artery disease: a meta-analysis including 5,735,578 individuals.International journal of obesity (2005) · 2022Pooled it
- Body mass index and hospital mortality in mechanically ventilated patients with acute hypoxaemic respiratory failure: A retrospective cohort study.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- Mortality, Renal Replacement Therapy and Renal Impairment Markers in Critically Ill Patients in a Multinational Point-Prevalence ICU Cohort over 2007 to 2024: A nutritionDay Descriptive Multivariable Analysis.Journal of clinical medicine · 2026Article
- Gaps or paradoxes in clinical responses in obese patients.Intensive care medicine · 2026Article
- Estimating average causal effects with incomplete exposure and confounders.Journal of causal inference · 2026Article
- Premorbid Metabolic Syndrome Is Associated with the Hypoinflammatory Phenotype in Acute Respiratory Distress Syndrome and Sepsis.American journal of respiratory and critical care medicine · 2025Article
- A comparison of causal inference methods for evaluating multiple treatment groups.Journal of nonparametric statistics · 2025Article
- Risk factor analysis and nomogram development for survival prediction in obese patients with severe acute pancreatitis: a retrospective study.BMC gastroenterology · 2025Article
- Causal Machine Learning Methods and Use of Cross-Fitting in Settings With High-Dimensional Confounding.Statistics in medicine · 2025Article
- Leptin and Acute Lung Disorders.Comprehensive Physiology · 2025Review
- The flux of energy in critical illness and the obesity paradox.Physiological reviews · 2025Review
- Beyond body mass index: exploring the role of visceral adipose tissue in intensive care unit outcomes.BJA open · 2025Review
- Predictors of Cumulative 90-D Mortality for Septic Patients Undergoing Abdominal Surgery.The Journal of surgical research · 2025Article
- The Japanese Critical Care Nutrition Guideline 2024.Journal of intensive care · 2025Review
- Managing Refractory Hypoxemia in Acute Respiratory Distress Syndrome Obese Patients with Veno-Venous Extra-Corporeal Membrane Oxygenation: A Narrative Review.Journal of clinical medicine · 2025Review
- Joint effect of atrial fibrillation and obesity on mortality in critically ill patients.Diabetology & metabolic syndrome · 2024Article
- The impact of body mass index on long-term survival after ICU admission due to COVID-19: A retrospective multicentre study.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2023Article
- Evaluating the association between obesity and discharge functional status after pediatric injury.Journal of pediatric surgery · 2022Article
- Mapping of machine learning approaches for description, prediction, and causal inference in the social and health sciences.Science advances · 2022Review
- Obesity, leptin and host defence ofEuropean respiratory review : an official journal of the European Respiratory Society · 2022Review
Corrections and comments
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6 authors.
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Abstract
backgroundWhile obesity confers an increased risk of death in the general population, numerous studies have reported an association between obesity and improved survival among critically ill patients. This contrary finding has been referred to as the obesity paradox. In this retrospective study, two causal inference approaches were used to address whether the survival of non-obese critically ill patients would have been improved if they had been obese.
methodsThe study cohort comprised 6557 adult critically ill patients hospitalized at the Intensive Care Unit of the Ghent University Hospital between 2015 and 2017. Obesity was defined as a body mass index of ≥ 30 kg/m
resultsObesity was present in 18.9% of patients. The in-hospital mortality was 14.6% in non-obese patients and 13.5% in obese patients. The raw marginal risk difference for in-hospital mortality between obese and non-obese patients was - 1.06% (95% confidence interval (CI) - 3.23 to 1.11%, P = 0.337). The traditional approach resulted in an AON of - 2.48% (95% CI - 4.80 to - 0.15%, P = 0.037), whereas the robust approach yielded an AON of - 0.59% (95% CI - 2.77 to 1.60%, P = 0.599).
conclusionsA causal inference approach that is robust to residual confounding bias due to model misspecification and selection bias due to missing (at random) data mitigates the obesity paradox observed in critically ill patients, whereas a traditional approach results in even more paradoxical findings. The robust approach does not provide evidence that the survival of non-obese critically ill patients would have been improved if they had been obese.
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