Obesity survival paradox in patients hospitalized with community-acquired pneumonia. Assessing sex-differences in a population-based cohort study

Miguel‐Díez, Javier de; Jiménez‐García, Rodrigo; Hernández‐Barrera, Valentín; Miguel‐Yanes, José M. de; Carabantes-Alarcón, David; Zamorano-León, José J.; López‐de‐Andrés, Ana

doi:10.1016/j.ejim.2022.01.027

Cited by 9 publications

(7 citation statements)

References 47 publications

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“…The studies examining the impact of obesity reported conflicting and inconsistent results; while some have identified an increased mortality risk in obese patients, including H1N1 influenza and severe COVID-19 [ 8 , 42 , 43 , 44 ], others have shown a mortality benefit in obese patients with CAP, known as the “obesity paradox” [ 9 , 10 , 11 , 13 , 14 , 45 ]. Studies reporting the obesity paradox could be confounded by selection bias and reverse causation, such as smoking, higher rates of comorbidities, weight loss due to chronic diseases, or increased infection susceptibility in obese patients, as previously reviewed [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the studies reported conflicting and inconsistent results [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ], and did not include nonalcoholic fatty liver disease (NAFLD) as a potentially important variable. NAFLD is closely related with metabolic syndrome and is the most common chronic liver disease, affecting about 25% of the Western population [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Nonalcoholic Fatty Liver Disease on Severe Community-Acquired Pneumonia Outcomes

Gjurašin

Jeličić

Kutleša

et al. 2022

Life

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Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality, while nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. NAFLD is associated with systemic changes in immune response, possibly linked to CAP severity. However, the impact of NAFLD on CAP outcomes has not been determined. The aim of this study was to evaluate clinical course, complications and outcomes of severe CAP requiring ICU treatment in patients with NAFLD in the pre-COVID-19 era. A retrospective cohort study included 138 consecutively hospitalized adult patients with severe CAP admitted to the ICU during a 4-year period: 80 patients with NAFLD and 58 controls. Patients with NAFLD more frequently presented with ARDS (68.7% vs. 43.1%), and required invasive mechanical ventilation (86.2% vs. 63.8%), respiratory ECMO (50% vs. 24.1%), and continuous renal replacement therapy (62.5% vs. 29.3%). Mortality was significantly higher in the NAFLD group (50% vs. 20.7%), and the time from hospital admission to death was significantly shorter. In survival analysis, NAFLD (HR 2.21, 95%CI 1.03–5.06) was associated with mortality independently of other components of metabolic syndrome. In conclusion, our study identified NAFLD as an independent predictor of mortality in patients with severe CAP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Impact of Nonalcoholic Fatty Liver Disease on Severe Community-Acquired Pneumonia Outcomes

Gjurašin

Jeličić

Kutleša

et al. 2022

Life

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“…Nie et al [ 10 ] and Hespanhol et al [ 11 ] found that the risk of pneumonia mortality decreased in obese people in comparison with normal weight population. Similarly, de Miguel-Diez et al [ 12 ] found that the risk of in-hospital mortality decreased in the obese and morbidly obese patients with CAP in comparison to the non-obese patients. Several research studies reported that, among patients with pneumonia, obese individuals had a considerably lower 30-day mortality than normal weight counterparts [ 13 – 17 ], indicating that obesity protects against death from CAP.…”

Section: Obesity Paradox In Lung Diseasesmentioning

confidence: 91%

“…The role of gender in the obesity paradox of lung diseases is still inconsistent. Several independent studies showed that obesity protected both men and women from pneumonia and CAP [ 9 , 12 , 156 , 157 ], whereas the studies conducted by Kornum et al [ 155 ] and Phung et al [ 158 ] showed the obesity-reduced risk of pneumonia among women, not men, which is also observed in the patients with lung cancer [ 159 ]. In COPD patients, significant correlation between obesity and COPD was only found in males [ 160 ], which could be involved with less rapid decline of FEV 1 in male patients with higher BMI [ 161 ].…”

Section: Discrepancy Of Obesity Paradox In Lung Diseasesmentioning

confidence: 99%

Obesity Paradox in Lung Diseases: What Explains It?

Yao¹,

Zeng²,

Wang³

et al. 2023

Obes Facts

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Background: Obesity is a globally increasing health problem that impacts multiple organ systems and a potentially modifiable risk factor for many diseases. Obesity has a significant impact on lung function and is strongly linked to the pathophysiology that contributes to lung diseases. On the other hand, reports have emerged that obesity is associated with a better prognosis than for normal weight individuals in some lung diseases, including pneumonia, acute lung injury/acute respiratory distress syndrome, chronic obstructive pulmonary disease, and lung cancer. The lesser mortality and better prognosis in patients with obesity is known as obesity paradox. While obesity paradox is both recognized and disputed in epidemiological studies, recent research has suggested possible mechanisms. Summary: In this review, we attempted to explain and summarize these factors and mechanisms, including immune response, pulmonary fibrosis, lung function, microbiota, fat and muscle reserves, which are significantly altered by obesity and may contribute to the obesity paradox in lung diseases. We also discuss contrary literature that attributes the “obesity paradox” to confounding. Key Messages: The review will illustrate the possible role of obesity in the prognosis or course of lung diseases, leading to a better understanding of the obesity paradox and provide hints for further basic and clinical research in lung diseases.

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“…Although studies of prognosis in CAP have consistently used BMI to define obesity, the cut-off points to classify patients have varied ( Table 2 ) [ 14 , 15 , 16 , 29 , 31 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. Most published studies have found increased BMI to be significantly associated with increased survival in patients with CAP [ 14 , 15 , 16 , 44 , 47 , 48 , 49 , 50 , 52 ]. A cohort study documented that obesity was associated with decreased 30-day mortality in 7449 hospitalized patients with CAP.…”

Section: Effect Of Malnutrition On Clinical Outcomes In Capmentioning

confidence: 99%

Effect of Undernutrition and Obesity on Clinical Outcomes in Adults with Community-Acquired Pneumonia

2022

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Malnutrition comprises two groups of conditions: undernutrition and overweight or obesity. It has been associated with a high risk of contracting infectious diseases and with elevated mortality rates. Community-acquired pneumonia (CAP) is one of the most common infectious diseases worldwide and its prognosis is affected by a large number of recognizable risk factors. This narrative review updates the information on the impact of malnutrition, including both undernutrition and obesity, on the risk and prognosis of adults with CAP. Studies of CAP that have evaluated undernutrition have applied a variety of definitions when assessing the nutritional status of patients. Undernutrition has been associated with unfavorable clinical outcomes, such as prolonged hospital stay, need for intensive care unit admission, and mortality; in contrast, most published studies have found that increased body mass index is significantly associated with higher survival in patients with CAP. However, some authors have presented divergent results, mainly in relation to the etiology of CAP (bacterial versus viral). Influenza infection, caused by influenza A (H1N1) pdm09, has been associated with worse prognosis in obese patients. The current data underscore the need for larger studies to examine the physiological mechanisms that explain the differential impact of malnutrition on outcomes. Achieving a better understanding may help to guide the design of new interventions to improve prognosis.

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Obesity survival paradox in patients hospitalized with community-acquired pneumonia. Assessing sex-differences in a population-based cohort study

Cited by 9 publications

References 47 publications

The Impact of Nonalcoholic Fatty Liver Disease on Severe Community-Acquired Pneumonia Outcomes

The Impact of Nonalcoholic Fatty Liver Disease on Severe Community-Acquired Pneumonia Outcomes

Obesity Paradox in Lung Diseases: What Explains It?

Effect of Undernutrition and Obesity on Clinical Outcomes in Adults with Community-Acquired Pneumonia

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