The impact of obesity on sepsis mortality: a retrospective review

BMC Infectious Diseases

Jennifer L Kraschnewski¹  Amy E Leib¹  Erik B Lehman¹  John W Showalter²  Ethan F Kuperman³ 

[1] Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, PO Box 850, Hershey, PA 17033-0850, USA;University of Mississippi Medical College, Oxford, MS, USA;University of Iowa Hospitals and Clinics, Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA

关键词: Body mass index;    Inpatients;    Diabetes mellitus;    Mortality;    Sepsis;    Obesity;   

Others  :  1146100
DOI  :  10.1186/1471-2334-13-377

 received in 2012-07-20, accepted in 2013-07-17,  发布年份 2013

【 摘 要 】

Background

Recent sepsis guidelines have focused on the early identification and risk stratification of patients on presentation. Obesity is associated with alterations in multiple inflammatory regulators similar to changes seen in sepsis, suggesting a potential interaction between the presence of obesity and the severity of illness in sepsis.

Methods

We performed a retrospective chart review of patients admitted with a primary billing diagnosis of sepsis at a single United States university hospital from 2007 to 2010. Seven hundred and ninety-two charts were identified meeting inclusion criteria. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m². The data recorded included age, race, sex, vital signs, laboratory values, length of stay, comorbidities, weight, height, and survival to discharge. A modified APACHE II score was calculated to estimate disease severity. The primary outcome variable was inpatient mortality.

Results

Survivors had higher average BMI than nonsurvivors (27.6 vs. 26.3 kg/m2, p = 0.03) in unadjusted analysis. Severity of illness and comorbid conditions including cancer were similar across BMI categories. Increased incidence of diabetes mellitus type 2 was associated with increasing BMI (p < 0.01) and was associated with decreased mortality, with an odds ratio of 0.53 compared with nondiabetic patients. After adjusting for age, gender, race, severity of illness, length of stay, and comorbid conditions, the trend of decreased mortality for increased BMI was no longer statistically significant, however diabetes continued to be strongly protective (odds ratio 0.52, p = 0.03).

Conclusions

This retrospective analysis suggests obesity may be protective against mortality in septic inpatients. The protective effect of obesity may be dependent on diabetes, possibly through an unidentified hormonal intermediary. Further prospective studies are necessary to elaborate the specific mechanism of this protective effect.

【 授权许可】

   
2013 Kuperman et al.; licensee BioMed Central Ltd.

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