Increased body mass index linked to greater short- and long-term survival in sepsis patients: A retrospective analysis of a large clinical database

Li, Shuhe; Hu, Xiaoguang; Xu, Jinghong; Huang, Feng; Guo, Zilu; Li, Tong; Lui, Ka Yin; Cao, Lu; Zhu, Yueyong; Yao, Jiyou; Lin, Xiaobin; Guan, Xiangdong; Cai, Changjie

doi:10.1016/j.ijid.2019.07.018

Cited by 38 publications

(40 citation statements)

References 36 publications

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“…Our findings are consistent with previous studies showing a protective impact of obesity on mortality in critically ill patients [20,21,[30][31][32]. However, the physiologic mechanisms behind these associations remain unclear.…”

Section: Discussionsupporting

confidence: 92%

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Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition

Mewes

Böhnke

Alexander

et al. 2019

JCM

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Septic shock is a frequent life-threatening condition and a leading cause of mortality in intensive care units (ICUs). Previous investigations have reported a potentially protective effect of obesity in septic shock patients. However, prior results have been inconsistent, focused on short-term in-hospital mortality and inadequately adjusted for confounders, and they have rarely applied the currently valid Sepsis-3 definition criteria for septic shock. This investigation examined the effect of obesity on 90-day mortality in patients with septic shock selected from a prospectively enrolled cohort of septic patients. A total of 352 patients who met the Sepsis-3 criteria for septic shock were enrolled in this study. Body-mass index (BMI) was used to divide the cohort into 24% obese (BMI ≥ 30 kg/m2) and 76% non-obese (BMI < 30 kg/m2) patients. Kaplan-Meier survival analysis revealed a significantly lower 90-day mortality (31% vs. 43%; p = 0.0436) in obese patients compared to non-obese patients. Additional analyses of baseline characteristics, disease severity, and microbiological findings outlined further statistically significant differences among the groups. Multivariate Cox regression analysis estimated a significant protective effect of obesity on 90-day mortality after adjustment for confounders. An understanding of the underlying physiologic mechanisms may improve therapeutic strategies and patient prognosis.

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Section: Discussionsupporting

confidence: 92%

“…Despite predominantly negative associations, previous studies have also suggested obesity as a possible protective factor in sepsis and septic shock [20,21]. Biologically active and hormone secreting adipose tissue leads to alterations at both the cellular and the systemic level [22].…”

Section: Introductionmentioning

confidence: 99%

Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition

Mewes

Böhnke

Alexander

et al. 2019

JCM

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“…However, we still cannot determine whether the interventions that patients have received before ICU admission may affect BMI, such as intravenous infusions. Compared with the inclusion criteria by ICD-9 code in the previous study [ 40 ], we used the sepsis-3 diagnostic criteria to enroll the study population. Moreover, our study took into account the effect of comorbidities, and, to our knowledge, this is the first time a U-shaped relationship between BMI and 28-day mortality has been found.…”

Section: Discussionmentioning

confidence: 99%

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

Lin

et al. 2020

BioMed Research International

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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.

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“…Second, we retrospectively identified the septic patient dataset for developing SMRS from a single-center and excluded some patients due to missing data. A few of the variables were also excluded for the same reason, but previous research has shown that they might be associated with septic patients' mortality (e.g., BMI, albumin) (37,38). Third, in accordance with other severity scores, the timing of variable measurement was determined.…”

Section: Limitationsmentioning

confidence: 99%

Development and Validation of a Sepsis Mortality Risk Score for Sepsis-3 Patients in Intensive Care Unit

Zhang

Cui

et al. 2021

Front. Med.

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Background: Many severity scores are widely used for clinical outcome prediction for critically ill patients in the intensive care unit (ICU). However, for patients identified by sepsis-3 criteria, none of these have been developed. This study aimed to develop and validate a risk stratification score for mortality prediction in sepsis-3 patients.Methods: In this retrospective cohort study, we employed the Medical Information Mart for Intensive Care III (MIMIC III) database for model development and the eICU database for external validation. We identified septic patients by sepsis-3 criteria on day 1 of ICU entry. The Least Absolute Shrinkage and Selection Operator (LASSO) technique was performed to select predictive variables. We also developed a sepsis mortality prediction model and associated risk stratification score. We then compared model discrimination and calibration with other traditional severity scores.Results: For model development, we enrolled a total of 5,443 patients fulfilling the sepsis-3 criteria. The 30-day mortality was 16.7%. With 5,658 septic patients in the validation set, there were 1,135 deaths (mortality 20.1%). The score had good discrimination in development and validation sets (area under curve: 0.789 and 0.765). In the validation set, the calibration slope was 0.862, and the Brier value was 0.140. In the development dataset, the score divided patients according to mortality risk of low (3.2%), moderate (12.4%), high (30.7%), and very high (68.1%). The corresponding mortality in the validation dataset was 2.8, 10.5, 21.1, and 51.2%. As shown by the decision curve analysis, the score always had a positive net benefit.Conclusion: We observed moderate discrimination and calibration for the score termed Sepsis Mortality Risk Score (SMRS), allowing stratification of patients according to mortality risk. However, we still require further modification and external validation.

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Increased body mass index linked to greater short- and long-term survival in sepsis patients: A retrospective analysis of a large clinical database

Cited by 38 publications

References 36 publications

Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition

Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition

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

Development and Validation of a Sepsis Mortality Risk Score for Sepsis-3 Patients in Intensive Care Unit

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