Abstract
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.
Highlights
A worldwide increasing incidence of sepsis and septic shock has had a noticeable and challenging effect on the everyday routine in intensive care units (ICUs) [1]
A total of 352 adult Caucasian patients met the criteria for septic shock and were enrolled in the study
The average Sequential Organ Failure Assessment (SOFA) score on the day of enrolment was significantly higher in obese patients compared to that in the non-obese patients (11.9 ± 3.7 vs. 11.0 ± 3.7; p = 0.023; Table 1); there were no significant differences found for the APACHE II scores or baseline procalcitonin levels (n = 197)
Summary
A worldwide increasing incidence of sepsis and septic shock has had a noticeable and challenging effect on the everyday routine in intensive care units (ICUs) [1]. Despite strong efforts in early diagnosis and adequate treatment, the mortality of patients in septic shock still remains in excess of 40% [2,3,4]. We argue that a more adequate categorization of obese versus non-obese patients in septic shock would lead to an improvement of intensive care support. Patients in septic shock present a “clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain a mean arterial pressure (MAP) ≥ 65 mmHg and having a serum lactate level. Arterial hypotension and vital organs suffering from hypoperfusion are the consequence [7]. In many cases, these symptoms result in multiple organ failure or death
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