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Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study.
Crit Care. 2013 Apr 17; 17(2):R72.CC

Abstract

INTRODUCTION

Data are sparse as to whether obesity influences the risk of death in critically ill patients with septic shock. We sought to examine the possible impact of obesity, as assessed by body mass index (BMI), on hospital mortality in septic shock patients.

METHODS

We performed a nested cohort study within a retrospective database of patients with septic shock conducted in 28 medical centers in Canada, United States and Saudi Arabia between 1996 and 2008. Patients were classified according to the World Health Organization criteria for BMI. Multivariate logistic regression analysis was performed to evaluate the association between obesity and hospital mortality.

RESULTS

Of the 8,670 patients with septic shock, 2,882 (33.2%) had height and weight data recorded at ICU admission and constituted the study group. Obese patients were more likely to have skin and soft tissue infections and less likely to have pneumonia with predominantly Gram-positive microorganisms. Crystalloid and colloid resuscitation fluids in the first six hours were given at significantly lower volumes per kg in the obese and very obese patients compared to underweight and normal weight patients (for crystalloids: 55.0 ± 40.1 ml/kg for underweight, 43.2 ± 33.4 for normal BMI, 37.1 ± 30.8 for obese and 27.7 ± 22.0 for very obese). Antimicrobial doses per kg were also different among BMI groups. Crude analysis showed that obese and very obese patients had lower hospital mortality compared to normal weight patients (odds ratio (OR) 0.80, 95% confidence interval (CI) 0.66 to 0.97 for obese and OR 0.61, 95% CI 0.44 to 0.85 for very obese patients). After adjusting for baseline characteristics and sepsis interventions, the association became non-significant (OR 0.80, 95% CI 0.62 to 1.02 for obese and OR 0.69, 95% CI 0.45 to 1.04 for very obese).

CONCLUSIONS

The obesity paradox (lower mortality in the obese) documented in other populations is also observed in septic shock. This may be related in part to differences in patient characteristics. However, the true paradox may lie in the variations in the sepsis interventions, such as the administration of resuscitation fluids and antimicrobial therapy. Considering the obesity epidemic and its impact on critical care, further studies are warranted to examine whether a weight-based approach to common therapeutic interventions in septic shock influences outcome.

Authors

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Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23594407

Citation

Arabi, Yaseen M., et al. "Clinical Characteristics, Sepsis Interventions and Outcomes in the Obese Patients With Septic Shock: an International Multicenter Cohort Study." Critical Care (London, England), vol. 17, no. 2, 2013, pp. R72.
Arabi YM, Dara SI, Tamim HM, et al. Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. Crit Care. 2013;17(2):R72.
Arabi, Y. M., Dara, S. I., Tamim, H. M., Rishu, A. H., Bouchama, A., Khedr, M. K., Feinstein, D., Parrillo, J. E., Wood, K. E., Keenan, S. P., Zanotti, S., Martinka, G., Kumar, A., & Kumar, A. (2013). Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. Critical Care (London, England), 17(2), R72. https://doi.org/10.1186/cc12680
Arabi YM, et al. Clinical Characteristics, Sepsis Interventions and Outcomes in the Obese Patients With Septic Shock: an International Multicenter Cohort Study. Crit Care. 2013 Apr 17;17(2):R72. PubMed PMID: 23594407.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. AU - Arabi,Yaseen M, AU - Dara,Saqib I, AU - Tamim,Hani M, AU - Rishu,Asgar H, AU - Bouchama,Abderrezak, AU - Khedr,Mohammad K, AU - Feinstein,Daniel, AU - Parrillo,Joseph E, AU - Wood,Kenneth E, AU - Keenan,Sean P, AU - Zanotti,Sergio, AU - Martinka,Greg, AU - Kumar,Aseem, AU - Kumar,Anand, AU - ,, Y1 - 2013/04/17/ PY - 2012/11/21/received PY - 2013/04/16/accepted PY - 2013/4/19/entrez PY - 2013/4/19/pubmed PY - 2015/4/22/medline SP - R72 EP - R72 JF - Critical care (London, England) JO - Crit Care VL - 17 IS - 2 N2 - INTRODUCTION: Data are sparse as to whether obesity influences the risk of death in critically ill patients with septic shock. We sought to examine the possible impact of obesity, as assessed by body mass index (BMI), on hospital mortality in septic shock patients. METHODS: We performed a nested cohort study within a retrospective database of patients with septic shock conducted in 28 medical centers in Canada, United States and Saudi Arabia between 1996 and 2008. Patients were classified according to the World Health Organization criteria for BMI. Multivariate logistic regression analysis was performed to evaluate the association between obesity and hospital mortality. RESULTS: Of the 8,670 patients with septic shock, 2,882 (33.2%) had height and weight data recorded at ICU admission and constituted the study group. Obese patients were more likely to have skin and soft tissue infections and less likely to have pneumonia with predominantly Gram-positive microorganisms. Crystalloid and colloid resuscitation fluids in the first six hours were given at significantly lower volumes per kg in the obese and very obese patients compared to underweight and normal weight patients (for crystalloids: 55.0 ± 40.1 ml/kg for underweight, 43.2 ± 33.4 for normal BMI, 37.1 ± 30.8 for obese and 27.7 ± 22.0 for very obese). Antimicrobial doses per kg were also different among BMI groups. Crude analysis showed that obese and very obese patients had lower hospital mortality compared to normal weight patients (odds ratio (OR) 0.80, 95% confidence interval (CI) 0.66 to 0.97 for obese and OR 0.61, 95% CI 0.44 to 0.85 for very obese patients). After adjusting for baseline characteristics and sepsis interventions, the association became non-significant (OR 0.80, 95% CI 0.62 to 1.02 for obese and OR 0.69, 95% CI 0.45 to 1.04 for very obese). CONCLUSIONS: The obesity paradox (lower mortality in the obese) documented in other populations is also observed in septic shock. This may be related in part to differences in patient characteristics. However, the true paradox may lie in the variations in the sepsis interventions, such as the administration of resuscitation fluids and antimicrobial therapy. Considering the obesity epidemic and its impact on critical care, further studies are warranted to examine whether a weight-based approach to common therapeutic interventions in septic shock influences outcome. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/23594407/Clinical_characteristics_sepsis_interventions_and_outcomes_in_the_obese_patients_with_septic_shock:_an_international_multicenter_cohort_study_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc12680 DB - PRIME DP - Unbound Medicine ER -