Impact of obesity on sepsis mortality: A systematic review

Trivedi, Vrinda; Bavishi, Chirag; Jean, Raymonde

doi:10.1016/j.jcrc.2014.12.007

Cited by 67 publications

(59 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With the increasing prevalence of obesity in the general population, higher numbers of obese patients are being hospitalized in ICUs with sepsis. Recent studies reveal around one‐third of the general ICU population are obese with similar figures applying for the ICU population with sepsis . In this cohort, 32% of cirrhotic patients with septic shock were obese.…”

Section: Discussionsupporting

confidence: 67%

“…In‐hospital mortality within our cohort was over 70% and much higher compared to the general ICU population with septic shock: Wurzinger et al reported in‐hospital mortality of 22.3% and Wacharasint et al reported 90‐day mortality of <50%. Our findings are however in keeping with the CANONIC study in acute‐on‐chronic liver failure patients (ACLF), where 90‐day mortality was as high as 80% in cirrhotic patients with over 3 organ failures, for which sepsis was recognized to be a common precipitating factor …”

Section: Discussionmentioning

confidence: 54%

“…Within the critically ill population, systematic reviews and meta‐analysis have revealed conflicting results as to whether obesity portends a negative or protective role towards mortality . Similarly, there is clinical equipoise regarding the impact of obesity in critically ill patients with sepsis . The impact of obesity in critically ill cirrhotic patients with sepsis has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study

Kok

Karvellas

Abraldes

et al. 2017

Liver International

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study

Kok

Karvellas

Abraldes

et al. 2017

Liver International

View full text Add to dashboard Cite

show abstract

“…Coined the “obesity paradox”, this clinical observation is only an association and several studies in this area have led to mixed results. A recent systematic review of relevant literature specific for sepsis (32) found that more studies have reported no association between sepsis mortality and obesity (33-35) or an increase in mortality in obese patients (36), than those that have reported decreased mortality with obesity (37-39). Thus the current data regarding whether or not obesity is protective during sepsis are inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Dietary Restriction Rescues Mice From Lethal Abdominal Sepsis and Endotoxemia and Reduces the Inflammatory/Coagulant Potential of Adipose Tissue

Starr

Steele

Cohen

et al. 2016

Critical Care Medicine

View full text Add to dashboard Cite

Objective Visceral adipose tissue is a major site for expression of pro-inflammatory and pro-coagulant genes during acute systemic inflammation. In this study, we tested whether loss of fat mass by dietary restriction (DR) would remove the major source of these factors resulting in improved tolerance to sepsis and endotoxemia. Design Prospective, laboratory controlled experiments. Setting Aging and Critical Care Research Laboratory in a university hospital. Subjects Middle-aged (12 month-old) male C57BL/6 mice. Interventions Mice were subjected to 40% DR for three weeks followed by induction of abdominal sepsis or endotoxemia by intraperitoneal injection with cecal slurry or lipopolysaccharide (LPS), respectively. Measurements and main results Compared to freely-fed mice, DR mice exhibited dramatically improved survival (80% vs 0% after sepsis, p<0.001;86% vs 12%after endotoxemia, p=0.013) and significantly reduced visceral fat-derived mRNA expression of interleukin-6 (IL-6), thrombospondin-1, plasminogen activator inhibitor-1, and tissue factor which positively correlated with fat mass. Plasma levels of IL-6 were significantly reduced by DR and correlated with adipose IL-6 mRNAlevels and fat mass (p<0.001, R2=0.64 and 0.89). In vitro culture of visceral fat explants from naïve DR mice showed significantly reduced IL-6 secretion compared to that from freely-fed mice in response to LPS. Analysis of major adipose immune cell populations by flow cytometry demonstrated that macrophages were the only cell population reduced by DR and that CD11c+/CD206+ (M2-type) and CD11c-/CD206- (double negative) macrophages, in addition to T cells, are the major immune cell populations that produce IL-6 in middle-age during systemic inflammation. Conclusions Short-term DR drastically improved the survival outcome of middle-aged mice during both polymicrobial sepsis and sterile endotoxemia. Improved survival was accompanied by a significantly attenuated inflammatory response in adipose tissue, which is likely due to alterations of both fat mass quantity and qualitative changes including a reduction in macrophage populations.

show abstract

“…Biomarkers in serum may be used to diagnose for patients with sepsis (5). Although numerous strategies have been explored for the treatment of sepsis, affected patients still have an increased risk of mortality (6,7). A previous study also demonstrated that a reduction of inflammatory factors significantly improved metabolic parameters that are beneficial for survival in septic rats (8).…”

Section: Introductionmentioning

confidence: 99%

Inflammatory cytokine expression in patients with sepsis at an intensive care unit

2018

View full text Add to dashboard Cite

Abstract. Sepsis is a systemic inflammatory response syndrome caused by infection of bacteria, fungi and/or viruses in clinical patients. It is known that inflammatory cytokine levels have an essential role in the progression of sepsis. The present study investigated the role of inflammatory markers in human peripheral blood mononuclear cells (hPBMCs) of patients with sepsis at an intensive care unit. In addition, the plasma levels of inflammatory cytokines were compared between sepsis patients and healthy individuals. The results demonstrated that the serum levels of interleukin-1, -17 and -6, as well as tumor necrosis factor-α, were upregulated in sepsis patients. The serum levels of high mobility group box 1 and C-reactive protein were increased in sepsis patients compared with those in healthy individuals. The expression levels of nuclear factor-κB-p65 and its inhibitor IκBα, as well as the ratio of CD25 + cells, and the levels of neutrophil gelatinase-associated lipocalin and peptidoglycan recognition protein were higher in hPBMCs in sepsis patients compared with those in healthy individuals. It was also indicated that balance of T helper type 1/2 cytokines was also disturbed in patients with sepsis compared with that in healthy individuals. In conclusion, these results indicated that inflammation is involved in the progression of sepsis by interfering with the expression of various molecules, suggesting a potential therapeutic strategy for the treatment of sepsis patients.

show abstract

Impact of obesity on sepsis mortality: A systematic review

Cited by 67 publications

References 61 publications

The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study

The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study

Short-Term Dietary Restriction Rescues Mice From Lethal Abdominal Sepsis and Endotoxemia and Reduces the Inflammatory/Coagulant Potential of Adipose Tissue

Inflammatory cytokine expression in patients with sepsis at an intensive care unit

Contact Info

Product

Resources

About