Obesity and Mortality, Length of Stay and Hospital Cost among Patients with Sepsis: A Nationwide Inpatient Retrospective Cohort Study

Abstract

ObjectivesThe objective of this study was to examine the association between obesity and all-cause mortality, length of stay and hospital cost among patients with sepsis 20 years of age or older.Materials and MethodsIt was a retrospective cohort study. The dataset was the Nationwide Inpatient Sample 2011, the largest publicly available all-payer inpatient care database in the United States. Hospitalizations of sepsis patients 20 years of age or older were included. All 25 primary and secondary diagnosis fields were screened to identify patients with sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Obesity was the exposure of interest. It was one of the 29 standardized Elixhauser comorbidity measures and readily available in the dataset as a dichotomized variable. The outcome measures were all-cause in-hospital death, length of stay and hospital cost.ResultsAfter weighting, our sample projected to a population size of 1,763,000, providing an approximation for the number of hospital discharges of all sepsis patients 20 years of age or older in the US in 2011. The overall all-cause mortality rate was 14.8%, the median hospital length of stay was 7 days and the median hospital cost was $15,917. After adjustment, the all-cause mortality was lower (adjusted OR = 0.84; 95% CI = 0.81 to 0.88); the average hospital length of stay was longer (adjusted difference = 0.65 day; 95% CI = 0.44 to 0.86) and the hospital cost per stay was higher (adjusted difference = $2,927; 95% CI = $1,606 to $4,247) for obese sepsis patients as compared to non-obese ones.ConclusionWith this large and nationally representative sample of over 1,000 hospitals in the US, we found that obesity was significantly associated with a 16% decrease in the odds of dying among hospitalized sepsis patients; however it was also associated with greater duration and cost of hospitalization.

Impact of Obesity in Patients with Candida Bloodstream Infections: A Retrospective Cohort Study

“…In a second study, higher BMI was associated with increased risk of all-cause mortality and organ failure in patients with gramnegative bloodstream infections [22]. Finally, in obese patients with sepsis, all-cause mortality was lower, length of stay was longer, and hospital costs were higher than in non-obese patients [23]. Taken together, these results lend support to the findings of increased mortality and length of stay in obese patients with Candida bloodstream infections that were found in this study.…”

“…Although limited information is available on the impact of obesity in candidemia, several studies have been published related to the effect of obesity in other infectious diseases with mixed results [21][22][23]. In one study, obesity was associated with decreased 30-day mortality in pneumonia, but had no impact on mortality in urinary tract infections, skin infections, or bloodstream infections [21].…”

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

“…Although only 32% were admitted to the ICU, obesity had a 6.4 adjusted OR of increasing risk of mortality . In the latest retrospective study by Nguyen et al who utilized the NHANES database examining nearly four hundred thousand patients from the USA with sepsis, obesity (BMI ≥ 30) was significantly associated with 16% decreased odds of in‐hospital mortality, with the association remaining significant for the septic shock subcategory. Only 6% of this cohort had liver disease, however, and overall mortality rate was low at 14.3%.…”

Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study

“…This approach was found to combine maximal sensitivity and specificity for identification of sepsis in administrative data in a chartbased validation study, as compared with other ICDbased algorithms [31], has comparable sensitivity to sepsis identified in electronic medical records [32], and has been used in contemporary studies of sepsis in administrative data to align ICD-based algorithms with the framework of Sepsis-3 [32,33]. The abovementioned "explicit" code for septic shock has been used to describe septic shock in the present study [34,35]. ICU admissions were identified based on unit-specific revenue codes for an intensive care unit or a coronary care unit.…”