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Obesity and 1-year outcomes in older Americans with severe sepsis.
Crit Care Med. 2014 Aug; 42(8):1766-74.CC

Abstract

OBJECTIVES

Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index.

DESIGN

Observational cohort study.

SETTING

U.S. hospitals.

PATIENTS

We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64).

CONCLUSIONS

Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.

Authors+Show Affiliations

1Department of Medicine, University of Michigan, Ann Arbor, MI. 2Steindhart School of Culture, Education, and Human Development, New York University, New York, NY. 3Riverside Methodist Hospital, Columbus, OH. 4VA Center for Clinical Management Research, HSR&D Center for Excellence, Ann Arbor, MI. 5Institute for Social Research, Ann Arbor, MI.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

24717466

Citation

Prescott, Hallie C., et al. "Obesity and 1-year Outcomes in Older Americans With Severe Sepsis." Critical Care Medicine, vol. 42, no. 8, 2014, pp. 1766-74.
Prescott HC, Chang VW, O'Brien JM, et al. Obesity and 1-year outcomes in older Americans with severe sepsis. Crit Care Med. 2014;42(8):1766-74.
Prescott, H. C., Chang, V. W., O'Brien, J. M., Langa, K. M., & Iwashyna, T. J. (2014). Obesity and 1-year outcomes in older Americans with severe sepsis. Critical Care Medicine, 42(8), 1766-74. https://doi.org/10.1097/CCM.0000000000000336
Prescott HC, et al. Obesity and 1-year Outcomes in Older Americans With Severe Sepsis. Crit Care Med. 2014;42(8):1766-74. PubMed PMID: 24717466.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obesity and 1-year outcomes in older Americans with severe sepsis. AU - Prescott,Hallie C, AU - Chang,Virginia W, AU - O'Brien,James M,Jr AU - Langa,Kenneth M, AU - Iwashyna,Theodore J, PY - 2014/4/11/entrez PY - 2014/4/11/pubmed PY - 2016/4/14/medline SP - 1766 EP - 74 JF - Critical care medicine JO - Crit Care Med VL - 42 IS - 8 N2 - OBJECTIVES: Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index. DESIGN: Observational cohort study. SETTING: U.S. hospitals. PATIENTS: We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64). CONCLUSIONS: Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/24717466/Obesity_and_1_year_outcomes_in_older_Americans_with_severe_sepsis_ L2 - https://dx.doi.org/10.1097/CCM.0000000000000336 DB - PRIME DP - Unbound Medicine ER -