Impact of body mass index on survival of medical patients with sepsis: a prospective cohort study in a university hospital in China

Zhou, Qingtao; Wang, Meng; Li, Shuo; Zhang, Jing; Ma, Qingbian; Ding, Yanling; Ge, Hua; Shen, Ning; Zheng, Yaan; Sun, Yongchang

doi:10.1136/bmjopen-2018-021979

Cited by 25 publications

(36 citation statements)

References 36 publications

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“…It is may be related to a worsened nutritional status of patients with COVID-19 from the ICU or geriatric ward. A similar phenomenon was also observed by other previous studies; for example, patients with BMI < 20 had greater 60-day mortality in the ICU setting (47); lower BMI was associated with a higher risk of death for patients with sepsis (48); patients who are underweight have a higher mortality rate in the pediatric ICU (49). Hence, patients with COVID-19 from the ICU or geriatric ward may need to maintain BMI within the normal range.…”

Section: Discussionsupporting

confidence: 83%

Body mass index associated with severity and mortality of patients with coronavirus disease 2019: A systematic review and meta-analysis

Fang

Zhou

et al. 2020

Preprint

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Background As an important indicator to measure obesity or underweight, body mass index (BMI) can be used to assess the potential risk for various diseases. The present study systematically examined the relationship between BMI and severity and mortality of patients with coronavirus disease 2019 (COVID-19). Methods We systematically searched PubMed, Embase, Cochrane, and China National Knowledge Infrastructure (CNKI) for studies published as of September 3, 2020 and extracted the relevant data of research endpoints in each study. Results This study included 16 studies with 6087 patients. This study observed a significant increase in BMI on admission in patients with severe COVID-19 compared with those with non-severe COVID-19 (Mean difference [MD] = 1.95, 95% confidence interval [CI], 1.52 − 2.37, I2 = 33%, P < 0.00001). A significant increase in BMI on admission was observed in patients who died from COVID-19 compared with (MD = 3.01, 95% CI: 1.83 to 4.19, I2 = 0%, P < 0.00001). In the intensive care unit (ICU) or geriatric ward, the study observed a significant decrease in BMI in the non-survivor group compared with the survivor group (MD = -1.61, 95% CI: -3.07 to -0.16, I2 = 72%, P = 0.03). Conclusions Higher BMI on admission is associated with severity and mortality of patients with COVID-19, but lower BMI is associated with mortality of patients with COVID-19 in the ICU or geriatric ward. Thus, we strongly recommend that clinicians should closely monitor the BMI of patients with COVID-19, especially those from the ICU or geriatric ward.

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Section: Discussionsupporting

confidence: 83%

Body mass index associated with severity and mortality of patients with coronavirus disease 2019: A systematic review and meta-analysis

Fang

Zhou

et al. 2020

Preprint

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“…Over the years, whether BMI was associated with altered mortality of patients with severe sepsis has been rarely reported in Asian population; we only found one single-center study with a small sample size (sepsis n = 178) conducted in a Chinese population. In the Chinese study, patients with a BMI < 18.5 had the highest 90-day mortality (66.7%) compared to the other subgroups with BMI ≥ 18.5 (18.2–48.0%) 7 . In accordance with these findings, the present study that enrolled 2175 patients with severe sepsis in total verified the increased mortality in patients with a BMI < 18.5.…”

Section: Discussionmentioning

confidence: 86%

“…By contrast, patients with a low BMI significantly increased blood IL-6 levels compared to those with a high BMI in North America 3 . However, studies regarding BMI in sepsis in Asian populations are limited; after the publication of the systematic review, a single-center study of sepsis with a small sample size in China reported that patients with a low BMI had increased mortality 7 . Non-obese patients were more common in Asian countries than in Europe and North America 8 – 10 .…”

Section: Introductionmentioning

confidence: 99%

Association between low body mass index and increased 28-day mortality of severe sepsis in Japanese cohorts

Oami

Karasawa

Shimada

et al. 2021

Sci Rep

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Current research regarding the association between body mass index (BMI) and altered clinical outcomes of sepsis in Asian populations is insufficient. We investigated the association between BMI and clinical outcomes using two Japanese cohorts of severe sepsis (derivation cohort, Chiba University Hospital, n = 614; validation cohort, multicenter cohort, n = 1561). Participants were categorized into the underweight (BMI < 18.5) and non-underweight (BMI ≥ 18.5) groups. The primary outcome was 28-day mortality. Univariate analysis of the derivation cohort indicated increased 28-day mortality trend in the underweight group compared to the non-underweight group (underweight 24.4% [20/82 cases] vs. non-underweight 16.0% [85/532 cases]; p = 0.060). In the primary analysis, multivariate analysis adjusted for baseline imbalance revealed that patients in the underweight group had a significantly increased 28-day mortality compared to those in the non-underweight group (p = 0.031, adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.06–3.46). In a repeated analysis using a multicenter validation cohort (underweight n = 343, non-underweight n = 1218), patients in the underweight group had a significantly increased 28-day mortality compared to those in the non-underweight group (p = 0.045, OR 1.40, 95% CI 1.00–1.97). In conclusion, patients with a BMI < 18.5 had a significantly increased 28-day mortality compared to those with a BMI ≥ 18.5 in Japanese cohorts with severe sepsis.

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“…A systematic review from 2017 found markedly reduced mortality from sepsis among overweight and obese patients compared with those of normal weight [18]. Other hospital-based studies have reported similar findings [12][13][14][15], including a recent study of approximately 55,000 patients from 139 hospitals in the United States [17].…”

Section: Discussionmentioning

confidence: 87%

“…Traditional observational studies of general populations have found body mass index (BMI) to be positively associated with risk of BSI or sepsis [7][8][9][10], and above-normal BMI to be associated with BSI or sepsis mortality [7,9,11]. However, studies restricted to patients with BSI or sepsis have observed a considerable reduced mortality risk with increasing BMI [12][13][14][15][16][17], including a systematic review from 2017 [18]. It has therefore been advocated that one should study in what way obesity is protective for sepsis mortality, and that this may help inform new therapeutic strategies [17,18].…”

Section: Introductionmentioning

confidence: 99%

Body mass index and risk of dying from a bloodstream infection: A Mendelian randomization study

et al. 2020

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Background In observational studies of the general population, higher body mass index (BMI) has been associated with increased incidence of and mortality from bloodstream infection (BSI) and sepsis. On the other hand, higher BMI has been observed to be apparently protective among patients with infection and sepsis. We aimed to evaluate the causal association of BMI with risk of and mortality from BSI. Methods and findings We used a population-based cohort in Norway followed from 1995 to 2017 (the Trøndelag Health Study [HUNT]), and carried out linear and nonlinear Mendelian randomization analyses. Among 55,908 participants, the mean age at enrollment was 48.3 years, 26,324 (47.1%) were men, and mean BMI was 26.3 kg/m2. During a median 21 years of follow-up, 2,547 (4.6%) participants experienced a BSI, and 451 (0.8%) died from BSI. Compared with a genetically predicted BMI of 25 kg/m2, a genetically predicted BMI of 30 kg/m2 was associated with a hazard ratio for BSI incidence of 1.78 (95% CI: 1.40 to 2.27; p < 0.001) and for BSI mortality of 2.56 (95% CI: 1.31 to 4.99; p = 0.006) in the general population, and a hazard ratio for BSI mortality of 2.34 (95% CI: 1.11 to 4.94; p = 0.025) in an inverse-probability-weighted analysis of patients with BSI. Limitations of this study include a risk of pleiotropic effects that may affect causal inference, and that only participants of European ancestry were considered. Conclusions Supportive of a causal relationship, genetically predicted BMI was positively associated with BSI incidence and mortality in this cohort. Our findings contradict the “obesity paradox,” where previous traditional epidemiological studies have found increased BMI to be apparently protective in terms of mortality for patients with BSI or sepsis.

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Impact of body mass index on survival of medical patients with sepsis: a prospective cohort study in a university hospital in China

Cited by 25 publications

References 36 publications

Body mass index associated with severity and mortality of patients with coronavirus disease 2019: A systematic review and meta-analysis

Body mass index associated with severity and mortality of patients with coronavirus disease 2019: A systematic review and meta-analysis

Association between low body mass index and increased 28-day mortality of severe sepsis in Japanese cohorts

Body mass index and risk of dying from a bloodstream infection: A Mendelian randomization study

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