Body Habitus and Risk of Mortality in Pediatric Sepsis and Septic Shock: A Retrospective Cohort Study

Ross, Patrick; Klein, Margaret J.; Nguyen, Tuan Anh; Leung, Denis H. Y.; Khemani, Robinder G.; Newth, Christopher J L; Bhalla, Anoopindar

doi:10.1016/j.jpeds.2019.03.027

Cited by 14 publications

(16 citation statements)

References 32 publications

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“…Indeed, a plethora of observational studies supporting the obesity paradox present significant limitations, such as their retrospective design, the heterogeneous study populations, the lack of adjustment for important confounding factors (severity of disease, preexisting illness and comorbidities, recent weight loss due to chronic disease, and the effects of treatment to outcome), the inherent limitations of measures of adiposity, and the presence of selection bias [17]. Moreover, in contrast to studies on adult populations, increased severity of sepsis and organ damage has been observed in pediatric patients with obesity compared to children of normal weight [86,87]. However, some studies on pediatric patients do not have a sufficient sample size to explore the independent association of obesity with adverse outcomes in ARDS and sepsis.…”

Section: Does Sars-cov-2 Infection Challenge the "Obesity Paradox" Observed In Ards?mentioning

confidence: 99%

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

et al. 2021

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Purpose of Review A growing body of evidence suggests that obesity and increased visceral adiposity are strongly and independently linked to adverse outcomes and death due to COVID-19. This review summarizes current epidemiologic data, highlights pathogenetic mechanisms on the association between excess body weight and COVID-19, compares data from previous pandemics, discusses why COVID-19 challenges the “obesity paradox,” and presents implications in prevention and treatment as well as future perspectives. Recent Findings Data from meta-analyses based on recent observational studies have indicated that obesity increases the risks of infection from SARS-CoV-2, severe infection and hospitalization, admission to the ICU and need of invasive mechanical ventilation (IMV), and the risk of mortality, particularly in severe obesity. The risks of IMV and mortality associated with obesity are accentuated in younger individuals (age ≤ 50 years old). The meta-inflammation in obesity intersects with and exacerbates underlying pathogenetic mechanisms in COVID-19 through the following mechanisms and factors: (i) impaired innate and adaptive immune responses; (ii) chronic inflammation and oxidative stress; (iii) endothelial dysfunction, hypercoagulability, and aberrant activation of the complement; (iv) overactivation of the renin–angiotensin–aldosterone system; (v) overexpression of the angiotensin-converting enzyme 2 receptor in the adipose tissue; (vi) associated cardiometabolic comorbidities; (vii) vitamin D deficiency; (viii) gut dysbiosis; and (ix) mechanical and psychological issues. Summary Mechanistic and large epidemiologic studies using big data sources with omics data exploring genetic determinants of risk and disease severity as well as large randomized controlled trials (RCTs) are necessary to shed light on the pathways connecting chronic subclinical inflammation/meta-inflammation with adverse COVID-19 outcomes and establish the ideal preventive and therapeutic approaches for patients with obesity.

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Section: Does Sars-cov-2 Infection Challenge the "Obesity Paradox" Observed In Ards?mentioning

confidence: 99%

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

et al. 2021

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“…25 Another retrospective cohort from the same investigators showed no association between obesity status and mortality in children with severe sepsis. 26 However, they found that both overweight and obesity had higher association in receiving mechanical ventilation, and longer intensive care unit stay. 26 T respiratory distress syndrome, stroke, chronic renal disease, heart failure, chronic obstructive pulmonary disease, cirrhosis and metastatic malignancy.…”

Section: Discussionmentioning

confidence: 97%

“…26 However, they found that both overweight and obesity had higher association in receiving mechanical ventilation, and longer intensive care unit stay. 26 T respiratory distress syndrome, stroke, chronic renal disease, heart failure, chronic obstructive pulmonary disease, cirrhosis and metastatic malignancy. [29][30][31] These relate to the results of our study, in which we reported a 63% reduction in the odds of in-hospital mortality for patients with obesity compared to control population (Table 4).…”

Section: Discussionmentioning

confidence: 97%

“…Another retrospective cohort from the same investigators showed no association between obesity status and mortality in children with severe sepsis 26 . However, they found that both overweight and obesity had higher association in receiving mechanical ventilation, and longer intensive care unit stay 26 …”

Section: Discussionmentioning

confidence: 97%

“…In a study conducted by Ross and colleagues across multiple paediatric intensive care units in the U.S. studying the effect of obesity on mortality in critically ill children, age >15 years was associated with increased mortality in children with obesity 25 . Another retrospective cohort from the same investigators showed no association between obesity status and mortality in children with severe sepsis 26 . However, they found that both overweight and obesity had higher association in receiving mechanical ventilation, and longer intensive care unit stay 26 …”

Section: Discussionmentioning

confidence: 98%

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Effect of obesity on mortality among hospitalized paediatric patients with severe sepsis

et al. 2021

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Summary Introduction Severe sepsis is one of the leading causes of mortality among children. Studies in adults have suggested a protective effect of obesity on mortality among patients hospitalized with sepsis. Paediatric studies evaluating similar relationship is lacking. Methods We analysed non‐overlapping years of the Kids Inpatient Database (KID) and National Inpatient Sample (NIS) database between 2003 and 2014 of all paediatric patients with severe sepsis (PSS) up to 20 years of age. PSS was defined using specific International Classification of Diseases (ICD) codes and modified Angus criteria. Using ICD‐9 diagnosis codes, patients were divided into three mutually exclusive groups (obesity, morbid obesity and control groups), and these groups were compared for outcomes measures including in‐hospital mortality and healthcare resource utilization using the length of stay and inflation‐adjusted hospitalization charges. Results We analysed 109 026 hospitalizations due to PSS. The prevalence rate of obesity was 1.5% (n = 1643), and morbid obesity was 1.05% (n = 1147). Multivariate regression models showed obesity was associated with 63% (OR 0.37, CI: 0.29–0.47, p < 0.001) and 54% reduction in mortality among PSS patients and patients with septic shock respectively. Contrastingly, morbid obesity was not associated with mortality among PSS patients and but was associated with 1.37 times (CI: 1.06–1.78, p = 0.01) increased risk of mortality among paediatric patients with septic shock. Conclusions Paediatric obesity is associated with reduced mortality among patients with PSS, with the exception of morbid obesity. Further prospective studies are needed to better understand the relationship between obesity and outcomes in PSS.

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Admission factors associated with nutritional status deterioration and prolonged pediatric intensive care unit stay in critically ill children: PICU‐ScREEN multicenter study

Ventura

Oliveira

Silveira

et al. 2021

J Parenter Enteral Nutr

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Background Early identification of patients in the pediatric intensive care unit (PICU) at risk of nutritional status (NS) deterioration and poor outcomes is desirable. We aimed to identify factors associated with NS deterioration and prolonged PICU stay. Methods Prospective cohort study in eight Brazilian PICUs with children <18 years with a PICU stay >72h. We used multivariable logistic regression to identify the clinical, laboratory, and nutrition variables at admission that were associated with outcomes. NS deterioration was defined as the reduction in weight‐for‐age, body mass index–for‐age or mid‐upper arm circumference–for‐age z‐score ≥1 during PICU stay. Prolonged PICU stay was defined as ≥13 days. Results We enrolled 363 eligible patients, median age 11.3 months (interquartile range:3.1–45.6) and 46% had at least one complex chronic condition (CCC). NS deterioration was observed in 23% of participants and was associated with CCC (odds ratio [OR]:2.71; 95% confidence interval [CI]:1.44–5.09), after adjusting for severity risk score, leukocyte count, obesity, and PICU site. Prolonged PICU stay was associated with age <2 years (OR:1.95; 95%CI:1.03–3.66), fluid overload (>10%) over the first 72h (OR:2.66; 95%CI:1.50–4.73), and hypoalbuminemia (<3.0 g/dL) (OR:2.05; 95%CI:1.12–3.76), after adjusting for CCC, severity risk score, undernutrition, early nutrition therapy, and PICU site. Conclusions CCC at admission was associated with NS deterioration. Age <2 years, fluid overload, and hypoalbuminemia at PICU admission were associated with prolonged PICU stay. These factors must be further evaluated as part of an admission nutrition screening tool for critically ill children.

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Body Habitus and Risk of Mortality in Pediatric Sepsis and Septic Shock: A Retrospective Cohort Study

Cited by 14 publications

References 32 publications

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

Effect of obesity on mortality among hospitalized paediatric patients with severe sepsis

Admission factors associated with nutritional status deterioration and prolonged pediatric intensive care unit stay in critically ill children: PICU‐ScREEN multicenter study

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