Association between Body Mass Index and Short‐Term Clinical Outcomes in Critically Ill Patients with Sepsis: A Real‐World Study

Abstract

Background. Obesity is now recognized as one of the major public health threats, especially for patients with a critical illness. However, studies regarding whether and how body mass index (BMI) affects clinical outcomes in patients with sepsis are still scarce and controversial. The aim of our study was to determine the effect of BMI on critically ill patients with sepsis. Materials and Methods. We performed this study using data from the Medical Information Center for Intensive Care III database. A multivariate Cox regression model was used to assess the independent association of BMI with the primary outcome. Results. A total of 7,967 patients were enrolled in this study. Firstly, we found that the 28-day mortality was reduced by 22% ( HR = 0.78 , 95% CI 0.69–0.88) and 13% ( HR = 0.87 , 95% CI 0.78–0.98) for obese and overweight compared to normal weight, respectively. Subsequently, a U-shaped association of BMI with 28-day mortality was observed in sepsis patients, with the lowest 28-day mortality at the BMI range of 30–40 kg/m2. Finally, significant interactions were observed only for sex ( P = 0.0071 ). Male patients with a BMI of 25-30 kg/m2 ( HR = 0.74 , 95% CI 0.63–0.86) and 30-40 kg/m2 ( HR = 0.63 , 95% CI 0.53–0.76) had a significantly lower risk of 28-day mortality. Conclusions. A U-shaped association of BMI with 28-day mortality in critically ill sepsis patients was found, with the lowest 28-day mortality at a BMI range of 30–40 kg/m2. Notably, male patients were protected by a higher BMI more effectively than female patients as males had a significantly lower mortality risk.

Early supplemental parenteral nutrition is associated with reduced mortality in critically ill surgical patients with high nutritional risk

“…Recently, the NUTRIC and APACHE scores have been reported as good scoring systems that reflect the severity of illness affecting the patients' metabolism, which finally results in malnutrition. Additionally, some studies have shown the association of low BMI with unfavorable outcomes in critically ill patients [23]. In contrast, previous studies presented that the patients with higher BMI showed better outcome in ICU care, which is called "Obesity Paradox" [24e27].…”

Association of obesity and mortality in sepsis patients: A meta-analysis from observational evidence

“…A total of 3865 records were identified via a systematic search of databases published before March 28, 2023, and screened for inclusion based on eligibility criteria. After reviewing the titles and abstracts, 12 studies [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ] were selected for inclusion in this study. Specifically, these studies reported on the association between obesity and sepsis prognosis, with 8 [ 14 , [16] , [17] , [18] , [19] , [20] , [21] , 23 ] of them focusing on overweight patients and 6 [ 14 , 16 , 18 , 20 , 21 , 35 ] of them restricting the analysis to patients with low weight.…”

“…This meta-analysis comprised 12 studies [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ] encompassing data from multiple countries or regions with a total of 521,207 individuals, and two of which were prospective cohort studies. The follow-up time varied across the studies.…”

“…Active monitoring of suspected risk factors for sepsis was essential to prevent and treat sepsis. Recent studies have shown that obesity, body weight, and Body Mass Index (BMI) were important factors related to sepsis [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ].…”

Association of Diabetes and Admission Blood Glucose Levels with Short-Term Outcomes in Patients with Critical Illnesses

“…Data were extracted using structured query language (SQL), the website and code to generate support for MIMIC-III documentation are released publicly. [22][23][24]…”