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Original Research: CHEST INFECTIONS |

Impact of Obesity in Patients Infected With 2009 Influenza A(H1N1)

Emili Díaz, MD, PhD; Alejandro Rodríguez, MD, PhD; Ignacio Martin-Loeches, MD, PhD; Leonardo Lorente, MD, PhD; María del Mar Martín, MD; Juan Carlos Pozo, MD; Juan Carlos Montejo, MD; Angel Estella, MD; Ángel Arenzana, MD; Jordi Rello, MD, PhD; H1N1 SEMICYUC Working Group*
Author and Funding Information

From the Critical Care Department (Drs Díaz, Rodríguez, and Martin-Loeches), Hospital Universitario Joan XXIII-Centro de Investigación Biomédica en red Enfermedades Respiratorias, Universitat Rovira i Virgili (URV), and Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona; the Critical Care Department (Dr Lorente), Hospital Universitario de Canarias, Tenerife; the Critical Care Department (Dr Martín), Hospital de la Candelaria, Tenerife the Critical Care Department (Dr Pozo), Hospital Reina Sofía, Córdoba; the Critical Care Department (Dr Montejo), Hospital 12 de Octubre, Madrid the Critical Care Department (Dr Estella), Hospital Sistema Andaluz de Salud, Jerez; the Critical Care Department (Dr Arenzana), Virgen de la Macarena, Sevilla; and the Critical Care Department (Dr Rello), Vall D’Hebron Hospital, Universitat Autònoma de Barcelona, Institut de Recerca Vall D’Hebron Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Barcelona, Spain.

Correspondence to: Emili Díaz, MD, PhD, Critical Care Department, Hospital Universitario Joan XXIII-CIBER Enfermedades Respiratorias, URV, and IISPV, Carrer Dr, Mallafre Guasch 4, (43007) Tarragona, Spain; e-mail: emilio.diaz.santos@gmail.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

The H1N1 Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias Working Group Investigators are listed in e-Appendix 1.

Funding/Support: This work was supported by Agència de Gestió d’Ajuts Universitaris i de Recerca [Grant 2009/SGR/1226].


© 2011 American College of Chest Physicians


Chest. 2011;139(2):382-386. doi:10.1378/chest.10-1160
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Objective:  A large proportion of patients infected with 2009 influenza A(H1N1) (A[H1N1]) are obese. Obesity has been proposed as a risk factor influencing outcome in these patients. However, its role remains unclear. We evaluate the outcome of patients who are obese and infected with A(H1N1) in the ICU, determining whether obesity is a risk factor for mortality.

Methods:  This was a prospective, observational, and multicenter study performed in 144 ICUs in Spain. Data were obtained from the Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (GTEI/SEMICYUC) registry. Adult patients with A(H1N1) that was confirmed by real-time polymerase chain reaction were included in the analysis. Patients who were obese (BMI > 30) were compared with patients who were nonobese. Cox regression analysis was used to determine adjusted mortality. Differences of P < .05 were considered significant.

Results:  In January 2010, the GTEI/SEMICYUC registry had complete records for 416 patients. One hundred and fifty patients (36.1%) were obese, of whom 67 (44.7%) were morbidly obese (BMI > 40). Mechanical ventilation (MV) was more frequently applied in patients who were obese (64% vs 52.4%, P < .01) Patients with obesity remained on MV longer than patients who were nonobese (6.5 ± 10.3 days vs 9.3 ± 9.7 days, P = .02), had longer ICU length of stay (10.8 ± 12.1 days vs 13.7 ± 11.7 days, P = .03), and had longer hospitalization (18.2 ± 14.6 days vs 22.2 ± 16.5 days, P = .02). Mortality adjusted by severity and potential confounders identified that obesity was not significantly associated with ICU mortality (hazard ratio, 1.1; 95% CI, 0.69-1.75; P = .68).

Conclusions:  In our cohort, patients who were obese and infected with A(H1N1) did not have increased mortality. However, there was an association between obesity and higher ICU resource consumption.

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