The obesity paradox in patients with severe soft tissue infections

Rios-Diaz, Arturo J.; Lin, E; Williams, Katherine V.; Jiang, Wei; Patel, Vihas; Shimizu, Naomi; Metcalfe, David; Olufajo, Olubode A.; Cooper, Zara; Havens, Joaquim M.; Salim, Ali; Askari, Reza

doi:10.1016/j.amjsurg.2016.05.006

Cited by 29 publications

(15 citation statements)

References 29 publications

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“…The inverse relationship between BMI and mortality may represent an unclear phenomenon known as the ‘obesity survival paradox’, which was reported with various chronic conditions 28-30. Recently, this phenomenon was studied in patients with NSTI, which revealed that obesity is independently associated with reduced mortality in this acute surgical population 31. Our data showed that climate factors were not associated with the severity of NSTI; nor did they predict mortality.…”

Section: Discussionmentioning

confidence: 52%

Effects of seasonal changes in temperature and humidity on incidence of necrotizing soft tissue infections in Halifax, Canada, 2001-2015

Fadel

Burke

Joukhadar

et al. 2019

SMJ

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Objectives: To explore weather seasonal variation in Necrotizing soft tissue infections (NSTI) in Halifax, Nova Scotia, Canada could be attributed to changes in environmental factors of temperature and humidity specifically. Methods: A retrospective chart review of NSTIs between 2001 and 2015. Regional temperature and humidity data were obtained from the Environment Canada Agency, Halifax, Canada. Chi-square was used for categorical variables and continuous data was used for correlation analyses. Logistic regression was performed to analyze mortality. Results: Of 170 NSTI patients identified, more presented from March to July, especially when the temperature was >10ºC. Higher incidence per 100,000 persons correlated with increased monthly temperatures ( p <0.01). Monthly NSTI incidence was inversely related to mean humidity ( p =0.005). Causative organism was associated with mean weekly temperature ( p <0.01) but not humidity ( p =0.66). Low body mass index, higher American Society of Anesthesiologists class, long intensive care unit stay, and shorter overall hospital stay were associated with mortality. No correlation was identified between temperature and humidity and mortality. Conclusion: This study demonstrates a tendency toward more frequent cases of NSTI with warmer, but less humid weather, without effect on severity or mortality.

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Section: Discussionmentioning

confidence: 52%

Effects of seasonal changes in temperature and humidity on incidence of necrotizing soft tissue infections in Halifax, Canada, 2001-2015

Fadel

Burke

Joukhadar

et al. 2019

SMJ

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“…This unexpected finding has led to the "obesity paradox" where obese patients have lower-than-expected mortality outcomes compared to similar patients who have lower BMIs. This finding can also be found in several different disease states including chronic kidney failure requiring hemodialysis, skin/soft tissue infections, and heart failure [12][13][14][15]. The effect of obesity on outcomes with sepsis is still unclear.…”

Section: Table 1: the World Health Organization Body Mass Indices Clamentioning

confidence: 90%

Sepsis Patients in Critical Care Units with Obesity: Is Obesity Protective?

Kalani¹,

Venigalla²,

Bailey

et al. 2020

Cureus

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“…While obesity is generally considered a risk factor for mortality and morbidity among trauma patients, there is growing evidence for a so‐called “obesity paradox.” Initially described in relation to cardiovascular and chronic kidney disease, it asserts that overweight patients are predicted to have a better outcome than patients with a normal body mass index (BMI) once ill . Multiple studies have also provided evidence for this paradox among surgical patients . One reason for the better outcome that is often discussed is the higher caloric reserves of obese patients during the catabolic status, which is often caused by severe illness …”

Section: Introductionmentioning

confidence: 99%

“…Initially described in relation to cardiovascular and chronic kidney disease, it asserts that overweight patients are predicted to have a better outcome than patients with a normal body mass index (BMI) once ill. 3,4 Multiple studies have also provided evidence for this paradox among surgical patients. [5][6][7] One reason for the better outcome that is often discussed is the higher caloric reserves of obese patients during the catabolic status, which is often caused by severe illness. 8 While age, burn severity, and presence of inhalation injury are commonly considered main risk factors for mortality in burned patients, the role of obesity is still controversially discussed.…”

Section: Introductionmentioning

confidence: 99%

Does obesity impact the outcome of severely burned patients?

Pauzenberger

Radtke

Ederer

et al. 2020

International Wound Journal

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Although obesity appears to be an important predictor of mortality and morbidity, little data about the impact of body mass index (BMI) on the outcome of severely burned patients are available. Patients admitted to the General Hospital Vienna between 1994 and 2014, who underwent surgery because of burn injuries, were enrolled in this study. BMI was used to divide patients into five groups: BMI 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and > 40. The groups were compared in terms of difference of mortality and morbidity. Of 460 patients, 34.3% (n = 158) died. Mortality rates were the lowest in patients with obesity class III and the highest in patients with BMI 35 to 39.9 (BMI 18.5‐24.9: 30.5%, BMI 25‐29.9: 31.5%, BMI 30‐34.9: 41.3%, BMI 35‐39.9: 55.5%, BMI > 40: 30%; P = .031). BMI was not found to be an independent risk factor when corrected with age, percent total body surface area burned, full‐thickness burns, and inhalation injury. No significant differences in length of stay, inhalation trauma, pneumonia, wound infection, sepsis, and invasive ventilation were observed. BMI as an independent risk factor for severely burned patients could not be confirmed via multivariate analysis.

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The obesity paradox in patients with severe soft tissue infections

Abstract: Obesity is independently associated with reduced inhospital mortality in patients with SSTI regardless of the obesity classification. This suggests that the obesity paradox exists in this acute surgical population.

Cited by 29 publications

References 29 publications

Effects of seasonal changes in temperature and humidity on incidence of necrotizing soft tissue infections in Halifax, Canada, 2001-2015

Effects of seasonal changes in temperature and humidity on incidence of necrotizing soft tissue infections in Halifax, Canada, 2001-2015

Sepsis Patients in Critical Care Units with Obesity: Is Obesity Protective?

Does obesity impact the outcome of severely burned patients?

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