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The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study.
Liver Int. 2018 07; 38(7):1230-1241.LI

Abstract

BACKGROUND & AIMS

The prevalence of obesity in cirrhosis is rising. The impact of obesity in critically ill cirrhotic patients with sepsis/septic shock has not been evaluated. This study aimed to examine the relationship between obesity and mortality in cirrhotic patients admitted to the intensive care unit with septic shock.

METHODS

A retrospective cohort study of all cirrhotic patients with septic shock (n = 362) and a recorded body mass index (BMI) from an international, multicentre (CATSS) database (1996-2015) was performed. Patients were classified by BMI as per WHO categories. Primary outcome was in-hospital mortality. Multivariate logistic regression analyses were carried out to determine independent associations with outcome.

RESULTS

In this analysis, mean age was 56.4 years, and 62% were male. Median BMI was 26.3%, and 57.7% were overweight/obese. In-hospital mortality was 71%. Obese patients were more likely to have comorbidities of cardiac disease, lung disease and diabetes. Compared to survivors (n = 105), non-survivors (n = 257) had significantly higher MELD and APACHEII scores and higher requirements for renal replacement therapy and mechanical ventilation (P < .03 for all). Using multivariable logistic regression, increase in BMI (OR 1.07, P = .034), time delay to appropriate antimicrobials (OR 1.16 per hour, P = .003), APACHEII (OR 1.12 per unit, P = .008) and peak lactate (OR 1.15, P = .028) were independently associated with in-hospital mortality.

CONCLUSIONS

Septic shock in cirrhosis carries a high mortality. Increased BMI is common in critically ill cirrhotic patients and independently associated with increased in-hospital mortality.

Authors+Show Affiliations

Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada. Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada. Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.Institute for Liver and Digestive Health, University College London, London, UK.Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA.Royal Columbian Hospital, New Westminster, BC, Canada.Laurentian University, Sudbury, Ontario, Canada.Richmond General Hospital, Richmond, British Columbia, Canada.Brandon General Hospital, Brandon, Manitoba, Canada.Victoria General Hospital, Victoria, British Columbia, Canada.Section of Critical Care Medicine and Section of Infectious Disease, Health Sciences Center and St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29194916

Citation

Kok, Beverley, et al. "The Impact of Obesity in Cirrhotic Patients With Septic Shock: a Retrospective Cohort Study." Liver International : Official Journal of the International Association for the Study of the Liver, vol. 38, no. 7, 2018, pp. 1230-1241.
Kok B, Karvellas CJ, Abraldes JG, et al. The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study. Liver Int. 2018;38(7):1230-1241.
Kok, B., Karvellas, C. J., Abraldes, J. G., Jalan, R., Sundaram, V., Gurka, D., Keenan, S., Kumar, A., Martinka, G., Bookatz, B., Wood, G., & Kumar, A. (2018). The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study. Liver International : Official Journal of the International Association for the Study of the Liver, 38(7), 1230-1241. https://doi.org/10.1111/liv.13648
Kok B, et al. The Impact of Obesity in Cirrhotic Patients With Septic Shock: a Retrospective Cohort Study. Liver Int. 2018;38(7):1230-1241. PubMed PMID: 29194916.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study. AU - Kok,Beverley, AU - Karvellas,Constantine J, AU - Abraldes,Juan G, AU - Jalan,Rajiv, AU - Sundaram,Vinay, AU - Gurka,David, AU - Keenan,Sean, AU - Kumar,Aseem, AU - Martinka,Greg, AU - Bookatz,Brian, AU - Wood,Gordon, AU - Kumar,Anand, AU - ,, Y1 - 2017/12/18/ PY - 2017/05/31/received PY - 2017/11/17/accepted PY - 2017/12/2/pubmed PY - 2019/4/9/medline PY - 2017/12/2/entrez KW - cirrhosis KW - mortality KW - obesity KW - septic shock SP - 1230 EP - 1241 JF - Liver international : official journal of the International Association for the Study of the Liver JO - Liver Int VL - 38 IS - 7 N2 - BACKGROUND & AIMS: The prevalence of obesity in cirrhosis is rising. The impact of obesity in critically ill cirrhotic patients with sepsis/septic shock has not been evaluated. This study aimed to examine the relationship between obesity and mortality in cirrhotic patients admitted to the intensive care unit with septic shock. METHODS: A retrospective cohort study of all cirrhotic patients with septic shock (n = 362) and a recorded body mass index (BMI) from an international, multicentre (CATSS) database (1996-2015) was performed. Patients were classified by BMI as per WHO categories. Primary outcome was in-hospital mortality. Multivariate logistic regression analyses were carried out to determine independent associations with outcome. RESULTS: In this analysis, mean age was 56.4 years, and 62% were male. Median BMI was 26.3%, and 57.7% were overweight/obese. In-hospital mortality was 71%. Obese patients were more likely to have comorbidities of cardiac disease, lung disease and diabetes. Compared to survivors (n = 105), non-survivors (n = 257) had significantly higher MELD and APACHEII scores and higher requirements for renal replacement therapy and mechanical ventilation (P < .03 for all). Using multivariable logistic regression, increase in BMI (OR 1.07, P = .034), time delay to appropriate antimicrobials (OR 1.16 per hour, P = .003), APACHEII (OR 1.12 per unit, P = .008) and peak lactate (OR 1.15, P = .028) were independently associated with in-hospital mortality. CONCLUSIONS: Septic shock in cirrhosis carries a high mortality. Increased BMI is common in critically ill cirrhotic patients and independently associated with increased in-hospital mortality. SN - 1478-3231 UR - https://www.unboundmedicine.com/medline/citation/29194916/The_impact_of_obesity_in_cirrhotic_patients_with_septic_shock:_A_retrospective_cohort_study_ L2 - https://doi.org/10.1111/liv.13648 DB - PRIME DP - Unbound Medicine ER -