IN-HOSPITAL OUTCOMES IN PATIENTS WITH OBESITY AND ACUTE ASTHMA EXACERBATION

Abstract

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: According to United States national surveys, prevalence of obesity is 42.4% and asthma is 7.7%. Obesity is a known risk factor and disease modifier of asthma. The purpose of this study is to evaluate the effect of obesity on in-hospital mortality, intubation rates, and length of stay in hospitalized patients with acute asthma exacerbation. METHODS: We performed a retrospective study by utilizing the 2016 National inpatient sample database, which comprises data on 20% of hospital discharges for that year. We included patients aged 18 or older who were admitted to the hospital with a principal diagnosis of acute asthma exacerbation or acute hypoxic respiratory failure with a secondary diagnosis of asthma in the study. Obesity was defined as Body Mass Index of 30 or greater. Diagnosis data was obtained by utilizing ICD 10 CM codes. The sample size was adjusted to the weights provided. A multivariate logistic regression model was used to analyze the effect of obesity on mortality and intubation rate. Linear regression was used to analyze the effect of obesity on length of stay. All outcomes were adjusted to age, sex, race, insurance status, Charlson Comorbidity Index, hospital location and characteristics. RESULTS: A total of 135,710 patients were included in the study, of which 34,845 patients met criteria for having acute asthma exacerbation with obesity (AOE). Mean age was 50.1 years (SD 14.9) and 81.01% of patients were female. A total of 10.04% (350) died and 5.4 % intubated in the AOE group. Adjusted Odds Ratio for mortality 0.74 (CI 0.54-0.99, p = 0.045), and intubation 0.8 (CI 0.71-0.91, p = 0.01). Mean length of stay was 4.07 for the AOE group and 3.4 for acute asthma exacerbation without obesity. Adjusted length of stay was a 0.56-day longer in the obese group. CONCLUSIONS: Obese patients with an acute asthma exacerbation were found to have 26% lower odds of in-hospital death and 20% lower intubation rate compared with non-obese patients in a large nationally representative sample. A longer length of stay, however, was found in the obese group compared to the non-obese group. Female gender, 81% of obese asthma patients in cohort, may be one contributing factor to the lower adjusted mortality and intubation rates. CLINICAL IMPLICATIONS: To our knowledge, there are no studies that looked at in-hospital outcomes in patients with acute asthma exacerbation and obesity. This paradox of obesity being beneficial was reported in patients with stroke, myocardial infarction, heart failure, sepsis, renal disease, and requirement of intensive care admission. Future studies looking for pathophysiological mechanisms of obesity reducing acute asthma exacerbation inpatient mortality might help to improve outcomes in acute asthma. DISCLOSURES: No relevant relationships by aniesh bobba, source=Web Response No relevant relationships by karthik Gangu, source=Web Response No relevant relationships by Zachary Holliday, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by Esha Sharma, source=Web Response