Associations between low body mass index and mortality in patients with sepsis: A retrospective analysis of a cohort study in Japan

Sato, Tetsuya; Kudo, Daisuke; Kushimoto, Shigeki; Hasegawa, Masatsugu; Ito, Fumihito; Yamanouchi, Sathoshi; Honda, Hiroyuki; Andoh, Kohkichi; Furukawa, Hajime; Yamaguchi, Yasuo; Tsujimoto, Yuta; Okuyama, Manabu; Kobayashi, Masakazu

doi:10.1371/journal.pone.0252955

Cited by 15 publications

(12 citation statements)

References 32 publications

(39 reference statements)

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“…Several studies from East Asia have reported that patients with a low BMI had increased mortality, but no obesity paradox was reported (11)(12)(13)(14). They demonstrated that malnutrition, and not the obesity paradox, is critical to sepsis.…”

Section: Measurements and Resultsmentioning

confidence: 99%

“…In Western population-based studies, the obesity paradox has been widely evaluated, and it has been reported that obesity plays a protective role in sepsis (5–9, 26). However, it has not been fully evaluated in the Asian populations, and there are conflicting data on the relationship between obesity and sepsis outcomes (11–14, 27, 28). Most Asian studies on the effects of BMI on sepsis outcomes have focused on the underweight population (11–14).…”

Section: Discussionmentioning

confidence: 99%

“…However, it has not been fully evaluated in the Asian populations, and there are conflicting data on the relationship between obesity and sepsis outcomes (11–14, 27, 28). Most Asian studies on the effects of BMI on sepsis outcomes have focused on the underweight population (11–14). They suggested that a low BMI negatively affected sepsis outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Obesity Paradox and Functional Outcomes in Sepsis: A Multicenter Prospective Study

Yeo

Kim

Jang

et al. 2023

Critical Care Medicine

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OBJECTIVES: In Asian populations, the correlation between sepsis outcomes and body mass is unclear. A multicenter, prospective, observational study conducted between September 2019 and December 2020 evaluated obesity’s effects on sepsis outcomes in a national cohort. SETTING: Nineteen tertiary referral hospitals or university-affiliated hospitals in South Korea. PATIENTS: Adult patients with sepsis (n = 6,424) were classified into obese (n = 1,335) and nonobese groups (n = 5,089). MEASUREMENTS AND RESULTS: Obese and nonobese patients were propensity score-matched in a ratio of 1:1. Inhospital mortality was the primary outcome. After propensity score matching, the nonobese group had higher hospital mortality than the obese group (25.3% vs 36.7%; p < 0.001). The obese group had a higher home discharge rate (70.3% vs 65.2%; p < 0.001) and lower median Clinical Frailty Scale (CFS) (4 vs 5; p = 0.007) at discharge than the nonobese group, whereas the proportion of frail patients at discharge (CFS ≥ 5) was significantly higher in the nonobese group (48.7% vs 54.7%; p = 0.011). Patients were divided into four groups according to the World Health Organization body mass index (BMI) classification and performed additional analyses. The adjusted odds ratio of hospital mortality and frailty at discharge for underweight, overweight, and obese patients relative to normal BMI was 1.25 (p = 0.004), 0.58 (p < 0.001), and 0.70 (p = 0.047) and 1.53 (p < 0.001), 0.80 (p = 0.095), and 0.60 (p = 0.022), respectively. CONCLUSIONS: Obesity is associated with higher hospital survival and functional outcomes at discharge in Asian patients with sepsis.

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Section: Measurements and Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Obesity Paradox and Functional Outcomes in Sepsis: A Multicenter Prospective Study

Yeo

Kim

Jang

et al. 2023

Critical Care Medicine

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“…Previous studies had similarly concluded that a high BMI could reduce mortality in patients with septic shock. [35][36][37] This study also found that regardless of the pathogenic microorganism at the onset of the disease, patients with secondary pan-drug-resistant bacterial infection and hematogenous infection had increased difficulty in treatment and poor prognosis. The risk of death increased as the variety and quantity of antimicrobials for MDR organisms increased.…”

Section: Discussionmentioning

confidence: 65%

The mortality risk factor of severe community-acquired pneumonia (SCAP) patients with Sepsis: a retrospective study

Geng

Jin

2022

Preprint

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ObjectivesSepsis is one of the most common comorbidities in severe community-acquired pneumonia (SCAP) patients. We aimed to investigate the characteristics and mortality risk factors of SCAP patients hospitalized with Sepsis.DesignA retrospective, single-centre study.SettingThis study was conducted at a tertiary hospital in Southern China.ParticipantsA total of 119 patients with SCAP, aged 17 years or older, were treated in the Integrated intensive care unit from 1 January 2018 to 30 December 2020.Interventionsnone.Outcome180-day mortality was the primary outcome.Results119 patients were divided into the survivors (83 patients,69.75%), and the non-survivors (36 patients,30.25%). There are more pronounced inflammatory responses and respiratory problems at the beginning of the disease in non-survivors, requiring stronger respiratory and circulatory support. The CURB-65 score was a better predictor of mortality than the PSI and APACHE2 scores, AUCs of CURB-65: OR 0.744, p<0.005. For the entire treatment cycle, the non-survivors had a longer duration of persistent fever, required continuous and repeated airway intervention, and a longer duration of Vasopressor support (P<0.001). SCAP with bacterial infection as the onset, or secondary bacterial infection had a poor prognosis (P=0.018). The non-survivors had more use of different types of antimicrobials (P<0.05), because of Multidrug-resistant (MDR) organisms. And have faced more antifungal treatment failures (P=0.006). The mortality risk factors were comorbid with a duration of Vasopressors support, duration of persistent fever, age, numbers of antimicrobials for MDR organisms, CURB-65 score and duration of Neuromuscular Blocking Agents (NMBAs) (OR=1.234, OR=1.158, OR=1.084, OR=6.484, OR=3.386, OR=1.505, p<0.005, respectively).ConclusionDynamic monitoring of the duration of patients’ abnormal indicators can help predict the prognosis. Age≥65.5 years, fever duration ≥9.5 days, number of antimicrobials for MDR organisms ≥2 types, longer NMBAs and Vasopressors use, and higher CURB-65 score were mortality risk factors in SCAP-Sepsis patients.strengths and limitations of this studyWe evaluated dynamic monitoring of the duration of patients’ abnormal indicators can help predict the prognosis. To the best of our knowledge, a very few studies had done a dynamic monitoring of the duration of patients’ abnormal indicators in the field of SCAP with Sepsis. The retrospective nature of the study was a limitation, statistical data including respiratory support in later treatment, can be further quantified.

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“…[11,27] Conversely, several reports have shown that a low BMI is associated with increased mortality in patients with sepsis. [28,29] Patients with a low BMI have less adipose tissue, [13] which is involved in immunologic functions and thermogenesis. [14,15] Therefore, patients with a low BMI may have weak immunity and low thermogenetic capacity.…”

Section: Discussionmentioning

confidence: 99%

Association between low body temperature on admission and in-hospital mortality according to body mass index categories of patients with sepsis

2022

Self Cite

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Hypothermia has been shown to be associated with a high mortality rate among patients with sepsis. However, the relationship between hypothermia and body mass index (BMI) with respect to mortality remains to be elucidated. We conducted this study to assess the association between hypothermia and survival outcomes of patients with sepsis according to BMI categories. This secondary analysis of a prospective cohort study enrolled 1184 patients (aged ≥ 16 years) with sepsis hospitalized in 59 intensive care units in Japan. Patients were divided into 3 BMI categories (<18.5 [low], 18.5-24.9 [normal], >24.9 [high] kg/m 2 ) and 2 body temperature (36 °C and ≥ 36 °C) groups. The primary outcome was in-hospital mortality rate. Associations between hypothermia and BMI categories with respect to in-hospital mortality were evaluated using multivariate logistic regression analysis. Of the 1089 patients, 223, 612, and 254 had low, normal, and high BMI values, respectively. Patients with body temperature < 36 °C (hypothermia) had a higher in-hospital mortality rate than that had by those without hypothermia in the normal BMI group (25/63, 39.7% vs. 107/549, 19.5%); however, this was not true for patients in the low or high BMI groups. A significant interaction was observed between hypothermia and normal BMI for in-hospital mortality (odds ratio, 1.56; 95% confidence interval, 1.00-3.41; P value for interaction = .04); however, such an interaction was not found between hypothermia and low or high BMIs. Patients with sepsis and hypothermia in the normal BMI subgroup may have a higher mortality risk than that of those in the low or high BMI subgroups and, therefore, require more attention.

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Associations between low body mass index and mortality in patients with sepsis: A retrospective analysis of a cohort study in Japan

Cited by 15 publications

References 32 publications

Obesity Paradox and Functional Outcomes in Sepsis: A Multicenter Prospective Study

Obesity Paradox and Functional Outcomes in Sepsis: A Multicenter Prospective Study

The mortality risk factor of severe community-acquired pneumonia (SCAP) patients with Sepsis: a retrospective study

Association between low body temperature on admission and in-hospital mortality according to body mass index categories of patients with sepsis

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