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Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis.
Crit Care 2016; 20(1):181CC

Abstract

BACKGROUND

At least 25 % of adults admitted to intensive care units (ICU) in the United States have an overweight, obese or morbidly obese body mass index (BMI). The effect of BMI on adjusted mortality in adults requiring ICU treatment for sepsis is unclear. We performed a systematic review of adjusted all-cause mortality for underweight, overweight, obese and morbidly obese BMIs relative to normal BMI for adults admitted to the ICU with sepsis, severe sepsis, and septic shock.

METHOD

PubMed, the Cochrane Library, and EMBASE electronic databases were searched through November 18, 2015, without language restrictions. We included studies that reported multivariate regression analyses for all-cause mortality using standard BMI categories for adults admitted to the ICU for sepsis, severe sepsis, and septic shock. Articles were selected by consensus among multiple reviewers. Electronic database searches yielded 10,312 articles, of which six were eligible. Data were extracted by one reviewer and then reviewed by three independent reviewers. For the meta-analyses performed, the adjusted odds ratios (aOR) of mortality were combined using a random-effects model. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale for cohort studies.

RESULTS

Four retrospective (n = 6609 patients) and two prospective (n = 556) studies met inclusion criteria. Compared to normal BMI, across five studies each, overweight or obese BMIs reduced the adjusted odds ratio (95 % CI) of mortality [aOR] [0.83 (0.75, 0.91) p < 0.001 and 0.82 (0.67, 0.99) p = 0.04, respectively] with low or moderate heterogeneity (I(2) = 15.7 %, p = 0.31 and I(2) = 53.0 %, p = 0.07, respectively). Across three studies each, morbidly obese BMI and underweight BMI did not alter aOR [0.90 (0.59, 1.39), p = 0.64; I(2) = 43.3 %, p = 0.17; and 1.24 (0.79, 1.95), p = 0.35; I(2) = 15.6 %, p = 0.31 respectively]. Only one study clearly defined how and when height and weight measurements were calculated. Site of underlying infection and illness severity may have favored overweight and obese BMIs.

CONCLUSIONS

This is the first meta-analysis to show that overweight or obese BMIs reduce adjusted mortality in adults admitted to the ICU with sepsis, severe sepsis, or septic shock. More rigorous studies that address these limitations are needed to clarify the impact of BMI on sepsis ICU outcomes.

TRIAL REGISTRATION

PROSPERO International prospective register of systematic reviews 10.15124/ CRD42014010556 . Registered on July 11, 2014.

Authors+Show Affiliations

Critical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA. dominique.pepper@nih.gov.Critical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA.National Institutes of Health Library, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.Critical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA.Critical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA.Critical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Systematic Review

Language

eng

PubMed ID

27306751

Citation

Pepper, Dominique J., et al. "Increased Body Mass Index and Adjusted Mortality in ICU Patients With Sepsis or Septic Shock: a Systematic Review and Meta-analysis." Critical Care (London, England), vol. 20, no. 1, 2016, p. 181.
Pepper DJ, Sun J, Welsh J, et al. Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis. Crit Care. 2016;20(1):181.
Pepper, D. J., Sun, J., Welsh, J., Cui, X., Suffredini, A. F., & Eichacker, P. Q. (2016). Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis. Critical Care (London, England), 20(1), p. 181. doi:10.1186/s13054-016-1360-z.
Pepper DJ, et al. Increased Body Mass Index and Adjusted Mortality in ICU Patients With Sepsis or Septic Shock: a Systematic Review and Meta-analysis. Crit Care. 2016 06 15;20(1):181. PubMed PMID: 27306751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis. AU - Pepper,Dominique J, AU - Sun,Junfeng, AU - Welsh,Judith, AU - Cui,Xizhong, AU - Suffredini,Anthony F, AU - Eichacker,Peter Q, Y1 - 2016/06/15/ PY - 2016/03/23/received PY - 2016/05/27/accepted PY - 2016/6/17/entrez PY - 2016/6/17/pubmed PY - 2017/11/1/medline KW - Body mass index KW - Meta-analysis KW - Mortality KW - Obesity KW - Overweight KW - Sepsis SP - 181 EP - 181 JF - Critical care (London, England) JO - Crit Care VL - 20 IS - 1 N2 - BACKGROUND: At least 25 % of adults admitted to intensive care units (ICU) in the United States have an overweight, obese or morbidly obese body mass index (BMI). The effect of BMI on adjusted mortality in adults requiring ICU treatment for sepsis is unclear. We performed a systematic review of adjusted all-cause mortality for underweight, overweight, obese and morbidly obese BMIs relative to normal BMI for adults admitted to the ICU with sepsis, severe sepsis, and septic shock. METHOD: PubMed, the Cochrane Library, and EMBASE electronic databases were searched through November 18, 2015, without language restrictions. We included studies that reported multivariate regression analyses for all-cause mortality using standard BMI categories for adults admitted to the ICU for sepsis, severe sepsis, and septic shock. Articles were selected by consensus among multiple reviewers. Electronic database searches yielded 10,312 articles, of which six were eligible. Data were extracted by one reviewer and then reviewed by three independent reviewers. For the meta-analyses performed, the adjusted odds ratios (aOR) of mortality were combined using a random-effects model. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale for cohort studies. RESULTS: Four retrospective (n = 6609 patients) and two prospective (n = 556) studies met inclusion criteria. Compared to normal BMI, across five studies each, overweight or obese BMIs reduced the adjusted odds ratio (95 % CI) of mortality [aOR] [0.83 (0.75, 0.91) p < 0.001 and 0.82 (0.67, 0.99) p = 0.04, respectively] with low or moderate heterogeneity (I(2) = 15.7 %, p = 0.31 and I(2) = 53.0 %, p = 0.07, respectively). Across three studies each, morbidly obese BMI and underweight BMI did not alter aOR [0.90 (0.59, 1.39), p = 0.64; I(2) = 43.3 %, p = 0.17; and 1.24 (0.79, 1.95), p = 0.35; I(2) = 15.6 %, p = 0.31 respectively]. Only one study clearly defined how and when height and weight measurements were calculated. Site of underlying infection and illness severity may have favored overweight and obese BMIs. CONCLUSIONS: This is the first meta-analysis to show that overweight or obese BMIs reduce adjusted mortality in adults admitted to the ICU with sepsis, severe sepsis, or septic shock. More rigorous studies that address these limitations are needed to clarify the impact of BMI on sepsis ICU outcomes. TRIAL REGISTRATION: PROSPERO International prospective register of systematic reviews 10.15124/ CRD42014010556 . Registered on July 11, 2014. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/27306751/Increased_body_mass_index_and_adjusted_mortality_in_ICU_patients_with_sepsis_or_septic_shock:_a_systematic_review_and_meta_analysis_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1360-z DB - PRIME DP - Unbound Medicine ER -