Obesity Does Not Increase Risk for Mortality in Severe Sepsis Trauma Patients

Abstract

Introduction The prevalence of obesity in the United States is up to 40% in adults. Obese patients with severe sepsis have a lower mortality rate compared with normal body mass index (BMI) patients. We hypothesized that trauma patients with severe sepsis and obese BMI will have a decreased mortality risk in comparison with normal BMI patients. Methods The Trauma Quality Improvement Program (2017) was queried for adult trauma patients with documented BMI and severe sepsis. Patients were grouped based on BMI: non-obese trauma patients (nOTP) BMI <30 kg/m2 and obese trauma patients (OTP) ≥30 kg/m2. A multivariable logistic regression model was used for analysis of mortality. Results From 1246 trauma patients with severe sepsis, 566 (42.4%) were nOTP and 680 (57.6%) were OTP. OTP had increased length of stay (LOS) (19 vs 21 days, P < .001), intensive care unit (ICU) LOS (13 vs 18 days, P < .001) and ventilator days (10 vs 11 days, P < .001). After adjusting for covariates, when compared to normal BMI patients, patients who were overweight (OR 1.11 CI .875-1.41 P = .390), obese (OR .797 CI .59-1.06 P = .126), severely obese (OR .926 CI .63-1.36 P = .696) and morbidly obese (OR 1.448 CI 1.01-2.07 P = .04) all had a similar associated risk for mortality compared to patients with normal BMI. Conclusion In adult trauma patients with severe sepsis, this national analysis demonstrated OTP had increased LOS, ICU LOS, and ventilator days compared to nOTP. However, patients with increasing degrees of obesity had similar associated risk of mortality compared to trauma patients with severe sepsis and a normal BMI.

Association of obesity and mortality in sepsis patients: A meta-analysis from observational evidence

“…A total of 3865 records were identified via a systematic search of databases published before March 28, 2023, and screened for inclusion based on eligibility criteria. After reviewing the titles and abstracts, 12 studies [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ] were selected for inclusion in this study. Specifically, these studies reported on the association between obesity and sepsis prognosis, with 8 [ 14 , [16] , [17] , [18] , [19] , [20] , [21] , 23 ] of them focusing on overweight patients and 6 [ 14 , 16 , 18 , 20 , 21 , 35 ] of them restricting the analysis to patients with low weight.…”

“…This meta-analysis comprised 12 studies [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ] encompassing data from multiple countries or regions with a total of 521,207 individuals, and two of which were prospective cohort studies. The follow-up time varied across the studies.…”

“…Active monitoring of suspected risk factors for sepsis was essential to prevent and treat sepsis. Recent studies have shown that obesity, body weight, and Body Mass Index (BMI) were important factors related to sepsis [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ].…”

“…Previous studies [ 24 ] have found that obesity is a risk factor for increased sepsis mortality. In addition, in six studies [ 15 , 17 , 19 , 20 , 22 , 25 ], obesity was not associated with sepsis mortality. However, these were contradictions in their conclusions.…”

Letter re: Letter to the Editor: Obesity Does Not Increase Risk for Mortality in Severe Sepsis Trauma Patients

“…We read with great interest the study by Tay-Lasso et al regarding the impact of obese body habitus on outcomes in trauma patients with severe sepsis. 1 This study offers impactful findings with a thoughtful discussion of the potential influence of these findings. We commend the authors’ contributions through their excellent efforts in exploring a crucial topic in trauma research.…”