Abstract
BackgroundRecent sepsis guidelines have focused on the early identification and risk stratification of patients on presentation. Obesity is associated with alterations in multiple inflammatory regulators similar to changes seen in sepsis, suggesting a potential interaction between the presence of obesity and the severity of illness in sepsis.MethodsWe performed a retrospective chart review of patients admitted with a primary billing diagnosis of sepsis at a single United States university hospital from 2007 to 2010. Seven hundred and ninety-two charts were identified meeting inclusion criteria. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2. The data recorded included age, race, sex, vital signs, laboratory values, length of stay, comorbidities, weight, height, and survival to discharge. A modified APACHE II score was calculated to estimate disease severity. The primary outcome variable was inpatient mortality.ResultsSurvivors had higher average BMI than nonsurvivors (27.6 vs. 26.3 kg/m2, p = 0.03) in unadjusted analysis. Severity of illness and comorbid conditions including cancer were similar across BMI categories. Increased incidence of diabetes mellitus type 2 was associated with increasing BMI (p < 0.01) and was associated with decreased mortality, with an odds ratio of 0.53 compared with nondiabetic patients. After adjusting for age, gender, race, severity of illness, length of stay, and comorbid conditions, the trend of decreased mortality for increased BMI was no longer statistically significant, however diabetes continued to be strongly protective (odds ratio 0.52, p = 0.03).ConclusionsThis retrospective analysis suggests obesity may be protective against mortality in septic inpatients. The protective effect of obesity may be dependent on diabetes, possibly through an unidentified hormonal intermediary. Further prospective studies are necessary to elaborate the specific mechanism of this protective effect.
Highlights
Recent sepsis guidelines have focused on the early identification and risk stratification of patients on presentation
These findings suggest a potential correlation between sepsis mortality and obesity, and previous investigators have noted obese patients have impaired immune responses to viral and bacterial pathogens [18]
Obesity, including morbid obesity, was protective for inpatient sepsis mortality within this cohort, but the protection appears to have been due to the presence of comorbid insulin resistance and diabetes
Summary
Recent sepsis guidelines have focused on the early identification and risk stratification of patients on presentation. Recent investigations into the alterations in response to sepsis in these animal models have focused on hormonal mediators, including leptin and adiponectin [11,12,13] Serum levels of these hormones are altered in obese humans [14,15]. Alterations in serum leptin [16] and adiponectin [17] have correlated with human survival in sepsis, these relationships are complex and the investigations have been small These findings suggest a potential correlation between sepsis mortality and obesity, and previous investigators have noted obese patients have impaired immune responses to viral and bacterial pathogens [18]
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