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Obesity and Mortality in Severe Sepsis and Septic Shock: No "Paradox" FREE TO VIEW

Jeffrey Fried, MD; Samantha Sobelman, BS; George Villatoro, BS; Jonathan Grotts, MA; Tyler Paras; Daniel Meller, BS
Author and Funding Information

Santa Barbara Cottage Hospital, Santa Barbara, CA; Westmont College, Santa Barbara, CA; University of California at Santa Barbara, Santa Barbara, CA

Chest. 2015;148(4_MeetingAbstracts):298A. doi:10.1378/chest.2265770
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SESSION TITLE: Hot Topics in Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 25, 2015 at 04:30 PM - 05:30 PM

PURPOSE: Studies examining the relationship between obesity and mortality in sepsis demonstrate conflicting results. Some show an “obesity paradox”, where obesity correlated with decreased mortality in sepsis, while others show no such benefit. Many of these studies were drawn from large databases based on coding, and self-reported measurements of height(ht)and weight (wt)were sometimes used. We sought to determine the prevalence of obesity, the frequency of actual ht and wt measurement, and mortality in patients (pts) with severe sepsis (SS) and septic shock (SShock) admitted to our ICUs.

METHODS: All pts admitted from our ED directly to our adult 20 bed MICU and 20 bed SICU with SS and SShock between 01/01/2011 and 07/19/2014 were prospectively identified by our IRB approved Santa Barbara Cottage Hospital Sepsis Registry. The Registry includes demographic and clinical data, including APACHE II scores. All recorded hts and wts on admission are noted to be either measured or estimated. We retrospectively reviewed this info on all pts. BMI was calculated by standard formula. WHO classification of BMI was used: Underwt (<18.5), Normal (18.5-24.9), Overwt (25-29.9), Obese (30-34.9), Severely obese ( >35). For analysis, Normal + overweight patients were grouped into Group N, and Obese + severely obese into Group O. Data were tested for statistical significance using t-test or chi-square test with yates correction based on data distribution. A logistic regression model with BMI and APACHE II scores was used for risk-adjustment.

RESULTS: There were 1054 pts included. Mean age: 62.5. Mean APACHE II:19.8. Mean BMI: 26.6: Underwt 7%, Normal 34%, Overwt 34%, Obese 15%, Severely Obese 10%. 26% had diabetes mellitus (DM), and 46% SShock. Overall mortality was 15%. Hts and wts were actually measured in 26% and 97% respectively. Distribution of wt classes by BMI was the same in the pts whose hts were measured vs estimated. Group O vs N were younger, (58.5 vs 63.7, p<0.001), and had more DM (38.3% vs 22.4% p<0.001) and hypertension (44.7% vs 37.4%, p=0.042). Risk adjusted mortality, ICU and hospital LOS were not significantly different between groups.

CONCLUSIONS: A minority of pts have hts that were measured, versus estimated. We found no paradoxic relationship between obesity and hospital mortality in our severe sepsis and septic shock patients.

CLINICAL IMPLICATIONS: Actual measurement of height and weight should be mandatory and standardized. There was no relationship between obesity and mortality in severe sepsis and septic shock.

DISCLOSURE: The following authors have nothing to disclose: Jeffrey Fried, Daniel Meller, Tyler Paras, Samantha Sobelman, George Villatoro, Jonathan Grotts

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