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Being short may be mortality risk factor in critically ill patients

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Shorter critical care patients have an increased mortality risk compared to others being treated in intensive care settings, according to researchers.

A study of more than 400,000 critically ill adults in the UK, published in Intensive Care Medicine, shows that being shorter is associated with increased hospital mortality.

“Short stature may be a risk factor for mortality in critically ill patients”

Study authors

Although previous research has examined associations between height and disease-specific and all-cause mortality, this study is the first to investigate potential links between height and critical illness.

The study authors noted that many critical care interventions are set by default to accommodate a typical male patient with height of 174cm – corresponding to an ideal body weight of 70 kg.

For example, ventilators may have default settings for tidal volume too large for female and shorter male patients, the researchers highlighted.

Furthermore, the study authors said that patient size was not consistently measured in adult intensive care units and not all ICU therapies can be customised for patients of different sizes.

They studied patients admitted to 210 ICUs in the UK participating in the Intensive Care National Audit and Research Centre’s Case Mix Programme Database from 1 April 2009 to 31 March 2015.

The primary outcome was hospital mortality, adjusted for age, ethnicity, comorbid disease, severity of illness, socioeconomic status and body mass index.

Data were organised by sex, and computer modelling was used to assess the association between height and mortality. The cohort included 233,308 men and 184,070 women, with overall hospital mortality of 22.5% and 20.6%, respectively.

Just under half, 44.5% of patients had their height actually measured and clinicians estimated the height in the remaining patients.

Hospital mortality fell with increasing height – predicted mortality decreased from 24.1% to 17.1% for women and from 29.2% to 21.0% for men across the range of heights, from shortest to tallest.

Similar associations were observed between height and ICU mortality, according to the researchers writing in the journal Intensive Care Medicine.

Height was also statistically significantly associated with some secondary outcomes including discharge home, with lower likelihood of discharge among patients at extremes of height.

However, there was no difference in observed outcomes among patients who received mechanical ventilation, a commonly used ICU therapy that is most safely delivered when customised to height.

The authors said: “Although size-based treatment is a well-accepted principle in paediatric patients and offers theoretical benefits in adults, its use and implementation has not been widely studied.

They said: “In a cohort of more than 400,000 critically ill adults admitted to 210 intensive care units in the United Kingdom, decreasing height was associated with increases in hospital mortality across the full range studied.”

As a result, the researchers said: “Short stature may be a risk factor for mortality in critically ill patients.

“Further work is needed to determine which unmeasured patient characteristics and processes of care may contribute to the increased risk observed,” they added.

Predicted in-hospital mortality (%) for patients of different heights by gender:

Height (cm)140150160170180190200

Women

24.1

22.1

20.5

19.8

18.9

18.0

17.1

Men

29.2

26.9

24.5

22.7

22.2

21.6

21.0

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