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Research Snapshot Theater: Epidemiology - Outcomes, Adult I

Obesity Severity in ARDS: A Retrospective Analysis

Monday, March 23, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central - RST 01
  • CR

    Claudia Ramirez, MD

    New Jersey

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • SZ

    Sydney Zolezi, N/A

    DO, Pulmonary and Critical Care Fellow
    Jersey Shore university medical center, New Jersey

    Disclosure information not submitted.

  • MA

    Michael Adams, MD

    MD, Internal medicine resident
    Jersey shore university Medical Center

    Disclosure information not submitted.

  • AA

    Ahmad Abu Homoud, n/a

    MD
    Jersey Shore University Medical Center

    Disclosure information not submitted.

  • EC

    Eric Costanzo, MD

    DO, Pulmonary and Critical Care
    Shore Pulmonary

    Disclosure information not submitted.

  • PY

    Paul Yodice, MD, FCCM, FCCP

    MD, FCCP, FCCM, critical care medicine physician
    Hackensack Meridian Health

    Disclosure information not submitted.

Introduction: Although obesity is a known modifier of respiratory physiology, its impact on acute respiratory distress syndrome (ARDS) outcomes is still poorly understood. Recent evidence suggests obesity may have paradoxical protective effects in critical illness. The relationship between obesity severity, comorbidities, and ARDS outcomes remains unclear.


Methods: We conducted a retrospective study of adult patients diagnosed with ARDS from January 2020 to December 2023. The population was divided according to their BMI into: non-obese (BMI < 30), obesity Class I (BMI 30–34.9), Class II (35–39.9), and Class III (≥40). Demographics and outcomes were analyzed.


Results: 1873 patients with ARDS were included in the analysis, non-obese (n=949), obesity Class I (n=417), Class II (n=272), and Class III (n=235). Patients with Class III obesity were significantly younger (62 [53–72] years) compared to Class II (70 [62–77]), Class I (71 [61.5–79]), and the non-obese group (p < 0.001). Females predominated in all three obesity categories, whereas males predominated in the non-obese group (p < 0.001). There was no difference in ICU or hospital length of stay between groups (p=0.064). As compared to other groups, obesity Class I (41.7%) and Class III (30.6%) were more likely to have COVID-19. In contrast, sepsis and septic shock were found more frequently in patients classified as Class I and non-obese (p=0.002). When assessing other ICU admission diagnoses, such as aspiration pneumonia and bacterial pneumonia, there was no difference.

Comorbidities scores (≥9) analysed by Elixhauser Comorbidity Index were more frequent in patients with obesity Class I (27.1%) and Class III (26.0%). In terms of race, African American representation increased in obesity categories, whereas Caucasian predominated in non-obese group (p < 0.001). Compared with the other groups, obesity Class I had a higher 30-day readmission rate (p=0.027). In addition, obesity Class III patients had higher mortality rates than other groups (p=0.033).


Conclusions: ARDS outcomes are significantly influenced by obesity severity. Despite being younger and less often septic, patients with obesity class III had higher mortality rates, suggesting that traditional risk markers may underestimate severity in this population.