Does Obesity Protect Against Death in Sepsis? A Retrospective Cohort Study of 55,038 Adult Patients
Does Obesity Protect Against Death in Sepsis? A Retrospective Cohort Study of 55,038 Adult Patients
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DOI：
10.1097/ccm.0000000000003692
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发表时间：
2019-05-01
影响因子：
8.8
通讯作者：
Kadri, Sameer S.
中科院分区：
文献类型：
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作者：
Pepper, Dominique J.;Demirkale, Cumhur Y.;Kadri, Sameer S.
目的：观察性研究表明肥胖与脓毒症的存活率有关，但这些研究规模较小，未能调整关键的混杂因素，在不一致的时间点测量体重指数，和/或使用管理数据来定义脓毒症。使用详细的临床数据评估体重指数和脓毒症死亡率之间的关系，以进行病例检测和风险调整。设计：对一个大型临床数据仓库进行回顾性队列分析。地点：美国的139家医院。患者：符合脓毒症-3标准的成人败血症住院患者。暴露量：体重指数6类：体重不足(BMI=18.5~24.9 kg/m2)、正常体重(BMI=18.5~24.9 kg/m2)、超重(BMI=25.029.9 kg/m2)、肥胖I类(BMI=30.0~34.9 kg/m2)、肥胖II类(BMI=35.0~39.9 kg/m2)、肥胖III类(BMI=40 kg/m2)。测量：多变量Logistic回归和广义估计方程来估计体重指数类别对短期死亡率(住院死亡或出院到临终关怀)的影响，调整了患者、感染和医院水平的因素。敏感性分析在年龄、性别、Elixhauser共病指数、序贯器官衰竭评估四分位数、菌血症和ICU入院的亚组中进行。主要结果：从2009年到2015年，我们确定了55,038名患有脓毒症的成年人和可评估的身体质量指数：6%的体重不足，33%的正常体重，28%的超重和33%的肥胖。粗死亡率与体重指数类别成反比：体重不足(31%)、正常体重(24%)、超重(19%)、I级肥胖(16%)、II级肥胖(16%)和III级肥胖(14%)。与正常体重相比，调整后的死亡优势比(95%CI)分别为1.62(1.50~1.74)、0.73(0.70~0.77)、0.61(0.570.66)、0.61(0.55~0.67)、0.65(0.59~0.71)。结论：在临床明确的成人脓毒症患者中，与正常体重指数患者相比，高体重指数患者的短期死亡率较低，而低体重指数患者的短期死亡率较高。了解肥胖如何改善脓毒症的存活率将为预后和治疗策略提供信息。
Objectives: Observational studies suggest obesity is associated with sepsis survival, but these studies are small, fail to adjust for key confounders, measure body mass index at inconsistent time points, and/ or use administrative data to define sepsis. To -estimate the relationship between body mass index and sepsis mortality using detailed clinical data for case detection and risk adjustment. Design: Retrospective cohort analysis of a large clinical data repository. Setting: One- hundred thirty- nine hospitals in the United States. Patients: Adult inpatients with sepsis meeting Sepsis- 3 criteria. Exposure: Body mass index in six categories: underweight (body mass index < 18.5 kg/m2), normal weight (body mass index = 18.5- 24.9 kg/m2), overweight (body mass index = 25.029.9 kg/m2), obese class I (body mass index = 30.0- 34.9 kg/m2), obese class II (body mass index = 35.0- 39.9 kg/m2), and obese class III (body mass index = 40 kg/m2). Measurements: Multivariate logistic regression with generalized estimating equations to estimate the effect of body mass index category on short- term mortality (in- hospital death or discharge to hospice) adjusting for patient, infection, and hospital- level factors. Sensitivity analyses were conducted in subgroups of age, gender, Elixhauser comorbidity index, Sequential Organ Failure Assessment quartiles, bacteremic sepsis, and ICU admission. Main Results: From 2009 to 2015, we identified 55,038 adults with sepsis and assessable body mass index measurements: 6% underweight, 33% normal weight, 28% overweight, and 33% obese. Crude mortality was inversely proportional to body mass index category: underweight (31%), normal weight (24%), overweight (19%), obese class I (16%), obese class II (16%), and obese class III (14%). Compared with normal weight, the adjusted odds ratio (95% CI) of mortality was 1.62 (1.50- 1.74) for underweight, 0.73 (0.70- 0.77) for overweight, 0.61 (0.570.66) for obese class I, 0.61 (0.55- 0.67) for obese class II, and 0.65 (0.59- 0.71) for obese class III. Results were consistent in sensitivity analyses. Conclusions: In adults with clinically defined sepsis, we demonstrate lower short- term mortality in patients with higher body mass indices compared with those with normal body mass indices (both unadjusted and adjusted analyses) and higher short- term mortality in those with low body mass indices. Understanding how obesityimproves survival in sepsis would inform prognostic and therapeutic strategies.