ABSTRACT
OBJECTIVE: The objective of this study was to assess the existence of the obesity paradox in patients with COVID-19 admitted to the intensive care unit. METHODS: This was a multicentric retrospective cohort study including individuals aged 18 years or older admitted to the intensive care unit with SARS-CoV-2. Data were obtained from electronic medical records. The primary outcome was in-hospital mortality. Multiple logistic regression and restricted cubic splines analyses were conducted to assess the association between BMI and mortality. RESULTS: From March 2020 to December 2021, 977 patients met the inclusion criteria, and 868 were included in the analysis. Obesity was identified in 382 patients (44%). Patients with obesity more often underwent prone positioning (42% vs. 28%; p < 0.001), although they used less vasoactive medications (57% vs. 68%; p < 0.001). The overall in-hospital mortality was 48%, with 44% observed in the subgroup of individuals with obesity and 50% in those without obesity (p = 0.06). Patients with BMI < 25 kg/m2 had the highest mortality. CONCLUSIONS: Obesity was not associated with higher mortality rates in critically ill patients with COVID-19. Moreover, patients with BMI < 25 kg/m2 had a higher mortality rate compared with those in higher BMI categories.
ABSTRACT
BACKGROUND: Prolonged donor hepatectomy time may be implicated in early and late complications of liver transplantation. AIM: To evaluate the impact of donor hepatectomy time on outcomes of liver transplant recipients, mainly early allograft dysfunction. METHODS: This multicenter retrospective study included brain-dead donors and adult liver graft recipients. Donor-recipient matching was obtained through a crossover list. Clinical and laboratory data were recorded for both donors and recipients. Donor hepatectomy, cold ischemia, and warm ischemia times were recorded. Primary outcome was early allograft dysfunction. Secondary outcomes included need for retransplantation, length of intensive care unit and hospital stay, and patient and graft survival at 12 months. RESULTS: From January 2019 to December 2021, a total of 243 patients underwent a liver transplant from a brain-dead donor. Of these, 57 (25%) developed early allograft dysfunction. The median donor hepatectomy time was 29 (23-40) min. Patients with early allograft dysfunction had a median hepatectomy time of 25 (22-38) min, whereas those without it had a median time of 30 (24-40) min (P = 0.126). CONCLUSION: Donor hepatectomy time was not associated with early allograft dysfunction, graft survival, or patient survival following liver transplantation.
