P0577 - Childhood obesity: is it a heavy burden on hospital morbidity and mortality?

Background:
Respiratory pathology remains the leading diagnosis for pediatric hospitalization. Obesity has been reported to prolong hospital length-of-stay and need for / duration of mechanical ventilation. Paradoxically, in the setting of severe respiratory illness requiring intensive-care admission, overweight and obese intensive care patients have shown lower mortality rates. Ultimately, a full understanding of how childhood obesity relates to hospitalization outcomes is lacking.

Objective:
We hypothesized that obesity is a risk factor for more severe presentation as well as increased morbidity and mortality in pediatric patients hospitalized with acute respiratory illness.

Design:
We conducted a single-institution, retrospective cohort study at an urban general-hospital. Eligible patients aged 2-18 years were identified from admission logs; inclusion criteria included admitting diagnoses related to respiratory distress, infection or asthma; patients were excluded for septic shock, inborn-error of metabolism, chronic lung disease, home medications known to cause lactic acidosis (except bronchodilators), and patients transferred from outside facility. Obese patients were defined as those with body mass index in the 95th percentile or greater for age. Analyses of categorical and continuous variables were conducted using Fisher’s exact test and Student’s t-test, respectively.

Results:
A total of 231 patients were included in this study, 13% were obese (n=29). Between not-obese and obese cohorts, there was no significant difference in age, gender, or ethnicity. Furthermore, there was no relationship found between body mass index and lactate level (p= 0.75) or respiratory rate (p= 0.75), or level of hospital acuity on admission (p=0.5). In terms of hospital outcomes, there was no significant difference between non-obese and obese populations in regards to hospital length-of-stay (p= 0.18) or intensive-care length-of-stay (p= 0.91). There was one fatality in the non-obese cohort and none in the obese cohort (p= 1) (Table 1).

Conclusion:
Contradicting prior studies, we found that obesity did not predict higher acuity at presentation or hospital outcomes for children with respiratory symptoms. As the obesity survival paradox suggests possible implicit bias in patient triage and questions our current understanding of respiratory pathophysiology, so too do our results give rationale for further study into this paradox to fully understand the relationship between obesity and the morbidity and mortality of children with respiratory disease.