The Association Between Obesity and ICU Duration in Pediatric Critical Asthma.

OBJECTIVE

To evaluate the association between obesity and ICU length of stay (LOS) in children with critical asthma and assess whether socioeconomic factors modify this relationship.

DESIGN

A multicenter retrospective cohort study using the Virtual PICU Systems (VPS) database of children 2-19 years old admitted to ICUs with asthma between 2010 and 2020. Patients were classified by body mass index (BMI) percentile. Children with chronic medical conditions and those missing relevant data were excluded. Multivariable Cox and logistic regression models were performed and adjusted for confounders.

SETTING

All PICUs in the VPS database.

PATIENTS: A total of 16,412 children from 53 centers with available data to assign BMI, race, and insurance type were included.

INTERVENTIONS: None.

MEASUREMENTS: The primary outcome was hazard of ICU discharge among survivors, with ICU LOS as the time-to-event variable. Secondary outcomes included the use of invasive or noninvasive mechanical ventilation (NIV) within the first hour of ICU admission and after the first hour.

MAIN

RESULTS

Obesity was associated with a lower hazard of ICU discharge among survivors (hazard ratio [HR] 0.87 [95% CI, 0.83-0.91]), consistent with longer ICU LOS. Obesity was associated with higher odds of MV in the first hour (odds ratio [OR] 1.24 [95% CI, 1.12-1.39]) and after the first hour (OR 1.63 [95% CI, 1.39-1.92]). These associations remained after adjustment for age, sex, race, insurance type, pneumonia diagnosis, transfer status, and overall severity of illness (Pediatric Risk of Mortality III). Among Black children, obesity was not associated with longer ICU LOS (HR 0.95 [95% CI, 0.89-1.03], p = 0.22). Otherwise, race and insurance type did not significantly modify these associations.

CONCLUSIONS

Obesity is independently associated with longer ICU stays and increased respiratory support in children with critical asthma. These findings are predominantly consistent across racial and socioeconomic groups.