Underweight Is Associated With Mortality in Patients With Severe Sepsis and Septic Shock

Lee, SM; Kang, JW; Yh, Jo; Kim, K; Jh, Lee; Rim, KP

doi:10.1186/2197-425x-3-s1-a876

Cited by 6 publications

(8 citation statements)

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“…The present study revealed that being underweight was associated with better survival in patients with sepsis who had low mNUTRIC scores. Previous studies showed that being underweight may be a risk factor for patients with sepsis [18][19][20][21][22]24], while one study did not find a significant association between being underweight and outcomes in these patients [41]. Nevertheless, these studies did not consider the heterogeneity of patients with sepsis in the same BMI group.…”

Section: Discussionmentioning

confidence: 96%

“…Previous studies have reported that half of hospital in-patients have nutritional problems [14][15][16]. Malnutri-Nutrients 2021, 13, 1873 2 of 17 tion in patients with sepsis may increase the risk of mortality [17][18][19][20][21][22][23][24] and duration of ventilator dependence [25]. In these studies, body mass index (BMI), a simple variable calculated using the following formula: BMI = kg/m 2 (kg: a person's weight in kilograms; m 2 : person's height in meters squared), was commonly used to indicate the nutritional status of the general population.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Body Mass Index on the Survival of Patients with Sepsis with Different Modified NUTRIC Scores

et al. 2021

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Nutritional status affects the survival of patients with sepsis. This retrospective study analyzed the impact of body mass index (BMI) and modified nutrition risk in critically ill (mNUTRIC) scores on survival of these patients. Data of 1291 patients with sepsis admitted to the intensive care unit (ICU) were extracted. The outcomes were mortality, duration of stay, ICU stay, and survival curve for 90-day mortality. Logistic regression analysis was performed to examine the risk factors for mortality. Cytokine and biomarker levels were analyzed in 165 patients. The 90-day survival of underweight patients with low mNUTRIC scores was significantly better than that of normal-weight patients with low mNUTRIC scores (70.8% vs. 58.3%, respectively; p = 0.048). Regression model analysis revealed that underweight patients with low mNUTRIC scores had a lower risk of mortality (odds ratio = 0.557; p = 0.082). Moreover, normal-weight patients with low mNUTRIC scores had the lowest human leukocyte antigen DR (HLA-DR) level on days 1 (underweight vs. normal weight vs. overweight: 94.3 vs. 82.1 vs. 94.3, respectively; p = 0.007) and 3 (91.8 vs. 91.0 vs. 93.2, respectively; p = 0.047). Thus, being underweight may not always be harmful if patients have optimal clinical nutritional status. Additionally, HLA-DR levels were the lowest in patients with low survival.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Impact of Body Mass Index on the Survival of Patients with Sepsis with Different Modified NUTRIC Scores

et al. 2021

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“… 6 Being underweight was found to be one of the independent risk factors of mortality in a study on the correlation between surgical site infection and mortality. 10 Furthermore, Lee et al 11 also reported that being underweight was associated with mortality in patients with severe sepsis and septic shock. However, BMI has not been shown to be an independent factor for clinical outcomes by multivariable analyses.…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

Wang

et al. 2018

BMJ Open

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ObjectiveTo evaluate the impact of body mass index (BMI) on survival of a Chinese cohort of medical patients with sepsis.DesignA single-centre prospective cohort study conducted from May 2015 to April 2017.SettingA tertiary care university hospital in China.ParticipantsA total of 178 patients with sepsis admitted to the medical intensive care unit (ICU) were included.Main outcome measuresThe primary outcome was 90-day mortality while the secondary outcomes were in-hospital mortality, length of ICU stay and length of hospital stay.ResultsThe median age (IQR) was 78 (66–84) years old, and 77.0% patients were older than 65 years. The 90-day mortality was 47.2%. The in-hospital mortality was 41.6%, and the length of ICU stay and hospital stay were 12 (5–22) and 15 (9–28) days, respectively. Cox proportional hazard regression analysis identified that Sequential Organ Failure Assessment score (HR=1.229, p<0.001), Acute Physiology and Chronic Health Evaluation II score (HR=1.050, p<0.001) and BMI (HR=0.940, p=0.029) were all independently associated with the 90-day mortality. Patients were divided into four groups based on BMI (underweight 33 (18.5%), normal 98 (55.1%), overweight 36 (20.2%) and obese 11 (6.2%)). The 90-day mortality (66.7%, 48.0%, 36.1% and 18.2%, p=0.015) and in-hospital mortality (60.6%, 41.8%, 30.6% and 18.2%, p=0.027) were statistically different among the four groups. Differences in survival among the four groups were demonstrated by Kaplan-Meier survival analysis (p=0.008), with the underweight patients showing a lower survival rate.ConclusionsBMI was an independent factor associated with 90-day survival in a Chinese cohort of medical patients with sepsis, with patients having a lower BMI at a higher risk of death.

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“…We found that at the age of (65-80), the 30 The results of current studies on the impact of obesity on the prognosis of patients with sepsis are controversial [22]. Obesity is a high-risk factor for death in the general population [23]. The BMI remains a useful indicator of overall health because it is highly correlated with the body surface area, which is often used as a proxy for the classification of obesity.…”

Section: Sensitivity Analysesmentioning

confidence: 92%

Impact of obesity on short- and long-term mortality in patients with sepsis: A retrospective analysis of the large clinical database MIMIC-III

Wang¹,

Xia²,

Song³

et al. 2020

Preprint

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Background The purpose of our study was to explore the relationship between body weight and short- and long-term clinical outcomes in patients with sepsis. Methods We retrospectively analyzed 11,499 patients with sepsis at the Beth Israel Deaconess Medical Center (Boston, MA, USA) registered in the Medical Information Market Intensive Care (MIMIC-III) database from 2001 to 2012. Cox proportional hazards regression assessed the relationships between body mass index and 30-day and 1-year mortality. Results Patients were divided into four groups according to body mass index (underweight: 336 [6.0%]; normal weight: 1,752 [31.4%]; overweight: 1,563 [28.1%]; and obese: 1,920 [34.5%]), 30-day mortality (42.3%, 36.6%, 32.2%, and 29.6%; p<0.001), 1-year mortality, (64.6%, 56.8%, 52.5%, and 46.7%; p<0.001), and in-hospital mortality (35.4%, 34.3%, 31.6%, and 29.9%; p=0.018). In addition, obese patients had notably longer mechanical ventilation periods and intensive care unit and hospital lengths of stay. The Cox proportional hazards regression analysis confirmed that underweight patients had a 13% and 24% increased risk of death within 30 days and 1 year, respectively, compared with normal-weight patients. For overweight patients, these risks were 17% and 14% lower, respectively, than those reported for normal-weight patients. For obese patients, these risks were 22% and 21% lower than those observed in normal-weight patients. Conclusion This retrospective analysis showed that overweight or obese patients showed improved survival within 30 days and 1 year after admission to the intensive care unit.

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Underweight Is Associated With Mortality in Patients With Severe Sepsis and Septic Shock

Cited by 6 publications

References 1 publication

Impact of Body Mass Index on the Survival of Patients with Sepsis with Different Modified NUTRIC Scores

Impact of Body Mass Index on the Survival of Patients with Sepsis with Different Modified NUTRIC Scores

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

Impact of obesity on short- and long-term mortality in patients with sepsis: A retrospective analysis of the large clinical database MIMIC-III

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