Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition

Abstract

Septic shock is a frequent life-threatening condition and a leading cause of mortality in intensive care units (ICUs). Previous investigations have reported a potentially protective effect of obesity in septic shock patients. However, prior results have been inconsistent, focused on short-term in-hospital mortality and inadequately adjusted for confounders, and they have rarely applied the currently valid Sepsis-3 definition criteria for septic shock. This investigation examined the effect of obesity on 90-day mortality in patients with septic shock selected from a prospectively enrolled cohort of septic patients. A total of 352 patients who met the Sepsis-3 criteria for septic shock were enrolled in this study. Body-mass index (BMI) was used to divide the cohort into 24% obese (BMI ≥ 30 kg/m2) and 76% non-obese (BMI < 30 kg/m2) patients. Kaplan-Meier survival analysis revealed a significantly lower 90-day mortality (31% vs. 43%; p = 0.0436) in obese patients compared to non-obese patients. Additional analyses of baseline characteristics, disease severity, and microbiological findings outlined further statistically significant differences among the groups. Multivariate Cox regression analysis estimated a significant protective effect of obesity on 90-day mortality after adjustment for confounders. An understanding of the underlying physiologic mechanisms may improve therapeutic strategies and patient prognosis.

Effect of the Lymphocyte Activation Gene 3 Polymorphism rs951818 on Mortality and Disease Progression in Patients with Sepsis—A Prospective Genetic Association Study

“…For the purpose of the present study, we prospectively enrolled 707 consecutive patients with clinically defined sepsis from three surgical intensive care units (ICUs) at the University Medical Center Goettingen, Germany, since 2012. Our cohort of sepsis patients, or significant proportions of it, were previously studied in other published investigations for other clinical and experimental research questions by our study group [14][15][16]21,24,25,43]. Patient screening for sepsis and study recruitment was performed by study physicians on a daily basis using the currently valid international sepsis definitions and guidelines [1,[44][45][46].…”

“…Diagnostic procedures, pathogen characteristics and antibiotic treatment strategies are exogenous factors, for instance [10,11]. Endogenous factors include preexisting conditions and chronic diseases, host immune status, genetic predisposition, age, gender, and many more [12][13][14][15]. The exploration and investigation of the genetic determinants of sepsis as well as inflammatory conditions in general is a popular method, that could be extensively applied in the future [16][17][18][19][20].…”

Sepsis: Current Clinical Practices and New Perspectives: Introduction to the Special Issue

“…One population-based analysis of a Spanish hospital discharge database published in this Special Issue revealed that, even in the young study population (aged 20–44 years), the in-hospital sepsis mortality was 24% (2006–2015) and associated with age, comorbidity, and the extent of organ dysfunction [ 2 ]. One metabolic disease with a dramatically increasing prevalence in the first world is obesity, which was analyzed in regard to its impact on sepsis survival by Mewes et al [ 3 ]. Despite the negative long-term effects of obesity, such as the development of arterial hypertension, diabetes mellitus, etc., interestingly, there seems to be a protective effect of obesity on sepsis survival.…”

“…Despite the negative long-term effects of obesity, such as the development of arterial hypertension, diabetes mellitus, etc., interestingly, there seems to be a protective effect of obesity on sepsis survival. Obese patients (body mass index > 30 kg/m 2 ) showed decreased 90-day mortality in the Caucasian study group [ 3 ].…”

Obesity and cardiovascular disease

“…Z problematiky paradoxu obezity jsou zajímavé práce, které pro kazují nižší mortalitu obézních po sepsi (10). Je přitom známo, že po septických stavech a infekcích výrazně stoupá riziko kardiovaskulárních příhod obecně (11).…”