Observational, prospective, single-center study: Should body mass index be added to the scoring criteria of hepatic critically ill patients in the intensive care unit

Background: Obesity has recently become more prevalent, and thus the coexistence of liver cirrhosis with obesity has become very pervasive. The purpose of this study is to investigate the correlation between abnormal body mass index (BMI) (overweight and obese) and clinical outcomes in critically ill cirrhotic patients.Methods: This is a single-center, prospective observational study of cirrhotic patients admitted to the intensive care unit for either medical or surgical indications in the period from February 2018 to December 2020. Patients were categorized based on their body mass index and the reason for admission to the intensive care unit (ICU).Results: The current study enrolled 517 patients; 39.3% were overweight, and 19.5% were obese (85% were class 1 and 2). Surgical subgroup analysis revealed that the hospital stay was shorter in the obese than average weight patients (p-value= 0.039), and ICU stay was shorter in overweight patients than patients with average weight (p-value= 0.022). The incidence of acute kidney injury was shorter in the obese group than in overweight and average-weight patients (p-value= 0.045). The medical subgroup analysis revealed that the need for noninvasive ventilation was lower in the obese and overweight groups than in the normal group (p-value= 0.040).Conclusions: Despite having similar Child-Pugh (CP) and Sequential Organ Failure Assessment Score (SOFA) scores on admission, obese patients had better outcomes than non-obese patients, demonstrating the obesity paradox. Further research is required on BMI as a predictive score in a patient with critical cirrhosis as an indicator of obesity.