OBESITY PARADOX? IMPROVED IN-HOSPITAL MORTALITY IN PATIENTS ADMITTED FOR SEPSIS VS SEPTIC SHOCK: A PROPENSITY SCORE MATCH ANALYSIS

Abstract

SESSION TITLE: Tuesday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: To determine the relationship between obesity and the rate of hospital readmission within 30 days, mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with sepsis and septic shock. METHODS: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Adults (≥ 18 years) with a principal diagnosis of sepsis and septic shock and a secondary diagnosis of obesity were identified using ICD-9 codes as described in the literature (2). The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders (3). Independent risk factors for readmission were identified using Cox’s proportional hazards model (4). RESULTS: In total, 1,924,860 admissions with sepsis and 430,180 septic shock admissions were identified, of which 15.23% and 15.37% of patients were obese, respectively. After PS matching with similar demographic and clinical characteristics, 370,655 obese patients with sepsis were paired with 370,655 non-obese patients with sepsis. Similarly, 370,655 obese patients with septic shock were paired with 370,655 non-obese patients with septic shock. Among obese patients with sepsis, in-hospital morality (OR 0.723, CI 0.649-0.805, p<0.001) was lower in comparison to non-obese patients with sepsis. However, medical comorbidities were higher among obese patients with sepsis, including atrial fibrillation (Afib), acute respiratory failure (ARF), and acute kidney injury (AKI). Similarly, the in-hospital morality among obese patients with septic shock (OR 0.723, CI 0.649-0.805, p <0.001) was lower in comparison to non-obese patients with septic shock. However, medical comorbidities were higher, including Afib, ARF, and AKI. Obese patients admitted with sepsis had a longer mean LOS (8.0 days vs 7.7 days, p <0.001) and a higher mean total hospital cost ($20,155 vs $19,151, p <0.02) when compared to the non-obese patients admitted with sepsis. For septic shock, obese patients had similar mean LOS (p <0.20), mean total hospital charge p <0.4), and mean total hospital cost p <0.08) as the non-obese patients. CONCLUSIONS: In this study, the reduced in-hospital mortality in obese patients with sepsis and septic shock support the “obesity paradox”. CLINICAL IMPLICATIONS: Obese patients have improved in-hospital mortality rates when compared to non-obese patients presenting with sepsis and septic shock. Additional research is needed to elucidate the physiological rationale for improved survival in obese patients presenting with sepsis and septic shock. DISCLOSURES: No relevant relationships by Kam Sing Ho, source=Web Response no disclosure on file for James Salonia; No relevant relationships by Jacqueline Sheehan, source=Web Response No relevant relationships by Lingling Wu, source=Web Response