Einfluss von Adipositas auf den Krankheitsverlauf sowie die 28- und 90- Tage Mortalität von Patienten mit Sepsis und septischem Schock

Abstract

Sepsis, septic shock, and obesity remain subjects of significant interest in medical research and science. These diseases have a substantial impact on daily medical practices worldwide. Sepsis, a life-threatening condition, ranks among the leading causes of global mortality and has a hospital mortality rate of 25-30% in Germany. The mortality risk is described to further escalate to approximately 60% in patients experiencing septic shock. Despite extensive research efforts, this medical condition is still not fully understood and has undergone frequent changes in definitions and guidelines over the years. Moreover, obesity has an increasing public attention due to the rising incidence of cases and its association with comorbidities such as arterial hypertension and diabetes mellitus. Previous studies have suggested a protective effect of obesity in patients with sepsis and septic shock. However, these investigations mainly focused on short-term hospital mortality and did not adhere to the internationally recognized sepsis-3 consensus definitions of sepsis and septic shock. The present study aimed to examine the impact of obesity on 28- and 90-day mortality rates in a large cohort of prospectively enrolled patients with sepsis and septic shock. The study included a total of 686 septic patients from four intensive care units at the University Medical Center Göttingen, with 352 patients meeting the criteria for septic shock. The participants were divided into two cohorts based on their body mass index: obese (BMI > 30 kg/m²) and non-obese (BMI < 30 kg/m²). Clinical data and laboratory parameters were documented for each patient over a maximum duration of 28 days. Survival rates were assessed at both 28- and 90-days in order to assess mortality rates for the respective observation periods. The findings revealed that obese patients in septic shock exhibited significantly higher 28- and 90-day survival rates compared to non-obese patients (28-day survival: obese: 83%, non-obese: 69%, p = 0.0159; 90-day survival: obese: 69%, non-obese: 57%, p = 0.0436). Multivariate Cox regression analysis revieled a significant protective effect of obesity on 28- and 90-day mortality rate of patients with septic shock after adjustment for confounders. Although obese patients with sepsis also demonstrated improved outcomes in terms of 28- and 90-day mortality, the differences compared to non-obese patients were not statistically significant (28-day survival: obese: 85%, non-obese: 78%, p = 0.0539; 90-day survival: obese: 73%, non-obese: 68%, p = 0.1671). This study underscores the prognostic significance of obesity in relation to 28- and 90-day mortality rates in patients with septic shock according to the sepsis-3 definitions. The presence of obesity should be considered in risk stratification for patients diagnosed with septic shock. Understanding the underlying biological mechanisms and the protective effects of obesity in sepsis and septic shock patients holds promise for improving therapeutic approaches and predicting adverse clinical outcomes.