Abstract
ObjectivesThe objective of this study was to examine the association between obesity and all-cause mortality, length of stay and hospital cost among patients with sepsis 20 years of age or older.Materials and MethodsIt was a retrospective cohort study. The dataset was the Nationwide Inpatient Sample 2011, the largest publicly available all-payer inpatient care database in the United States. Hospitalizations of sepsis patients 20 years of age or older were included. All 25 primary and secondary diagnosis fields were screened to identify patients with sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Obesity was the exposure of interest. It was one of the 29 standardized Elixhauser comorbidity measures and readily available in the dataset as a dichotomized variable. The outcome measures were all-cause in-hospital death, length of stay and hospital cost.ResultsAfter weighting, our sample projected to a population size of 1,763,000, providing an approximation for the number of hospital discharges of all sepsis patients 20 years of age or older in the US in 2011. The overall all-cause mortality rate was 14.8%, the median hospital length of stay was 7 days and the median hospital cost was $15,917. After adjustment, the all-cause mortality was lower (adjusted OR = 0.84; 95% CI = 0.81 to 0.88); the average hospital length of stay was longer (adjusted difference = 0.65 day; 95% CI = 0.44 to 0.86) and the hospital cost per stay was higher (adjusted difference = $2,927; 95% CI = $1,606 to $4,247) for obese sepsis patients as compared to non-obese ones.ConclusionWith this large and nationally representative sample of over 1,000 hospitals in the US, we found that obesity was significantly associated with a 16% decrease in the odds of dying among hospitalized sepsis patients; however it was also associated with greater duration and cost of hospitalization.
Highlights
Sepsis is defined as a systemic inflammatory response syndrome (SIRS) plus a documented or suspected infection; severe sepsis is sepsis plus organ dysfunction; septic shock is sepsis plus refractory hypotension or hyperlactatemia [1]
Our sample projected to a population size of 1,763,000, providing an approximation for the number of hospital discharges of all sepsis patients 20 years of age or older in the United States (US) in 2011
With this large and nationally representative sample of over 1,000 hospitals in the US, we found that obesity was significantly associated with a 16% decrease in the odds of dying among hospitalized sepsis patients; it was associated with greater duration and cost of hospitalization
Summary
Sepsis is defined as a systemic inflammatory response syndrome (SIRS) plus a documented or suspected infection; severe sepsis is sepsis plus organ dysfunction; septic shock is sepsis plus refractory hypotension or hyperlactatemia [1]. The Centers for Disease Control and Prevention (CDC) reported that hospitalizations with sepsis in the United States (US) rapidly rose from 621,000 in 2000 to 1,141,000 in 2008 [2]. Sepsis mortality was estimated to be 20–30% [4,5]. The World Health Organization (WHO) reported that 11% of adults aged 20 and over (i.e. 500 million) were obese worldwide in 2008 [7]. Data from the National Health and Nutrition Examination Surveys (NHANES) showed that 35.7% of adults in the US were obese in 2009– 2010 [8]. According to a study on the Framingham Cohort, the duration lived with obesity was significantly associated with the risk of all-cause, cardiovascular and cancer mortality with a clear dose-response pattern [9]. Similar results were observed in other large cohort studies [10,11,12]
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