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

Thavamani, Aravind; Umapathi, Krishna Kishore; Sankararaman, Senthilkumar; Roy, Aparna

doi:10.1111/ijpo.12777

Cited by 3 publications

(1 citation statement)

References 36 publications

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“…Whether this counterintuitive epidemiological association between survival outcomes and traditional risk factors is a real phenomenon or the result of reverse causality or collider stratification bias remains unclear [ 8 ]. Nevertheless, this phenomenon has been repeatedly demonstrated in a variety of diseases, including stroke [ 9 ], peripheral arterial disease [ 10 ], acute coronary syndrome (ACS) [ 11 ], and sepsis [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of obesity on short-term mortality in patients with acute heart failure under different nutritional status

Liu

Qian

Li³

et al. 2023

BMC Cardiovasc Disord

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Background Increased body mass index (BMI) is associated with better survival in patients with acute heart failure (AHF), which is a paradoxical phenomenon. However, it is unclear whether different nutritional status affects this association. Methods 1325 patients with AHF from the Medical Information Mart for Intensive Care III database were retrospectively included. Nutritional status was assessed by serum albumin (SA) and prognostic nutritional index (PNI). Patients were divided into High-SA (≥ 3.5 g/dL) and Low-SA groups (< 3.5 g/dL), and they also were divided into High-PNI (≥ 38) and Low-PNI groups (< 38). Propensity-score matching (PSM) was used to control for the effect of baseline confounding factors, multifactor regression model was adopted to assess the association of nutritional status, BMI, and outcomes in AHF patients. Results Of the 1325 patients (mean age 72.4 ± 13.1 years), 52.1% (n = 690) were male, 13.1% (n = 173) died in hospital and 23.5% (n = 311) died within 90 days. Before PSM, after adjusting for potential confounders, in the High-SA population, compared with the under/normal BMI group, overweight and obesity were negatively correlated with 90-day mortality, with adjusted hazard ratios (HR) of 0.47, 95% confidence interval (CI) (0.30–0.74), P = 0.001; HR 0.45, 95%CI (0.28–0.72), P = 0.001, respectively. However, this correlation was much attenuated in the Low-SA group (overweight BMI: HR 1.06, 95%CI 0.75–1.50, P = 0.744; obese BMI: HR 0.86, 95%CI 0.59–1.24, P = 0.413). After PSM, those who were overweight or obese in the High-SA group had a 50–58% reduction in 90-day risk of death, while the protective effect disappeared in the Low-SA group (HR 1.09, 95% CI 0.70–1.71; HR 1.02, 95%CI 0.66 − 0.59). Similarly, results were similar in analyses using PNI as a nutritional assessment criterion. Conclusion Overweight or Obesity was associated with lower short-term mortality in well-nourished AHF patients, whereas this association was significantly attenuated or even disappeared in malnourished patients. Therefore, further research is needed for weight loss recommendations for malnourished obese patients with AHF.

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Section: Introductionmentioning

confidence: 99%

Effects of obesity on short-term mortality in patients with acute heart failure under different nutritional status

Liu

Qian

Li³

et al. 2023

BMC Cardiovasc Disord

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Differences by age in the obesity paradox in severe burns

Lin

Zheng

et al. 2022

Burns

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Obesity protects against sepsis-induced and norepinephrine-induced white adipose tissue browning

Davis

Lahni

et al. 2021

American Journal of Physiology-Endocrinology and Metabolism

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Sepsis is a dysregulated systemic response to infection and can lead to organ damage and death. Obesity is a significant problem worldwide and affects outcomes from sepsis. Our laboratory demonstrated that white adipose tissue (WAT) undergoes browning during sepsis, a process whereby WAT adopts a brown adipose tissue phenotype. However, this browning process was not observed in obese mice during sepsis. White adipose tissue browning is detrimental in patients with burn injury and cancer. We hypothesize that norepinephrine (NE) induces WAT browning in non-obese mice but not in obese mice similarly to sepsis-induced WAT browning. Six-week-old C57BL/6 male mice were randomized to a high-fat diet or normal diet. After 6-7 weeks of feeding, polymicrobial sepsis was induced by cecal ligation and puncture (CLP). Norepinephrine was administered intraperitoneally via osmotic minipumps for 18h or 72h (no CLP) at which time tissue and plasma were harvested. Controls were mice that underwent CLP (no NE) with 18h harvest. A separate group of mice underwent pretreatment with NE or vehicle infusion for 72h, CLP was performed and at 18h had tissue and plasma harvested. Sepsis resulted in significant weight loss in both non-obese and obese mice. NE treatment alone caused weight loss in obese mice. Septic non-obese mice had higher UCP1 expression compared to control and obese septic mice. NE treatment increased UCP1 expression in non-obese, but not obese mice. NE treated obese septic mice had lower lung MPO activity, ALT, AST, TNFa and IL-6 levels compared to NE treated non-obese septic mice. Obesity protects mice from septic-induced and NE-induced WAT browning.

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

Cited by 3 publications

References 36 publications

Effects of obesity on short-term mortality in patients with acute heart failure under different nutritional status

Effects of obesity on short-term mortality in patients with acute heart failure under different nutritional status

Differences by age in the obesity paradox in severe burns

Obesity protects against sepsis-induced and norepinephrine-induced white adipose tissue browning

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