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Critical Care |

Obese Patients Have Decreased Mortality and Express a Lower Inflammatory Cytokine Profile During Septic Shock

Petch Wacharasint*, MD; John Boyd, MD; James Russell, MD; Keith Walley, MD
Author and Funding Information

Critical Care Research Laboratories, Institute for Heart + Lung Health, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada


Chest. 2012;142(4_MeetingAbstracts):411A. doi:10.1378/chest.1389940
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Abstract

SESSION TYPE: Sepsis/Shock Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Obesity is a major health problem and a risk factor contributing to the overall burden of disease worldwide. However an “obesity paradox” phenomenon has been reported in septic shock patients where obese patients appear to be protected. The cause of this phenomenon is unknown. We hypothesized that obese patients with septic shock would have decreased mortality and this would correspond to their inflammatory cytokine profile during septic shock.

METHODS: We conducted a retrospective analysis using the VASST (Vasopressin in Septic Shock Trial) cohort. According to WHO criteria, 245 septic shock patients were classified as obese (BMI >30 kg/m2) and 250 were classified as normal BMI (18.5-24.99 kg/m2) and were included in the analysis. Primary outcome was 28-day survival and secondary outcomes were days alive and free of organ dysfunctions. We measured serum pro-inflammatory cytokines (Interleukin-6 (IL-6), IL-8, IL-1β, interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and monocyte chemotactic protein-1 (MCP-1) levels at baseline and at 24 hours in a convenience sample of 123 obese patients and 117 normal BMI patients.

RESULTS: There were no differences in APACHE II score between the two patient groups. Obese patients had significantly lower 28-day mortality (HR 0.68, 95% CI 0.50-0.93, p=0.015) and more days alive and free of hepatic (27 days vs. 21 days, p=0.012) and coagulation (28 days vs. 20 days, p<0.0001) dysfunction than patients with normal BMI. Obese patients had lower levels of serum IL-6, IL-8, and MCP-1 at baseline (p=0.017, <0.0001 and 0.04, respectively) and at 24 hours (p<0.0001, 0.002 and 0.012, respectively) during septic shock compared to normal BMI patients.

CONCLUSIONS: Surprisingly, obese patients having septic shock had decreased mortality and this was associated with a lower inflammatory cytokine response than normal BMI patients. Thus the “obesity paradox” may be partly explained by a blunted pro-inflammatory cytokine response in obese patients.

CLINICAL IMPLICATIONS: Obese patients having septic shock had decreased mortality and may be partly explained by a blunted pro-inflammatory cytokine response.

DISCLOSURE: The following authors have nothing to disclose: Petch Wacharasint, John Boyd, James Russell, Keith Walley

No Product/Research Disclosure Information

Critical Care Research Laboratories, Institute for Heart + Lung Health, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada

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