Key result
Underweight is linked to ~57% higher ICU mortality in sepsis, whereas obesity predicts lower risk.
Why the study?
Higher survival had previously been shown for overweight septic patients compared with normal or underweight patients, prompting investigation into the management and outcome of septic ICU patients across different BMI categories.
Does BMI category (underweight, overweight, obesity) affect ICU mortality in septic ICU patients compared to normal weight?
Cohort (n=16,612)
Yes
Does BMI category (underweight, overweight, obesity) affect ICU mortality in septic ICU patients compared to normal weight?
Odds Ratio: 1.57 (95% CI 1.16–2.12)
Absolute Event Rate: 14% vs 11%
p-value: p=0.003
In septic ICU patients, being underweight is associated with increased mortality, whereas obesity is associated with lower mortality, supporting the obesity paradox.
Supports obesity paradox in septic ICU patients; observational data leaves open causal inference and practice change.
BACKGROUND: Higher survival has been shown for overweight septic patients compared with normal or underweight patients in the past. This study aimed at investigating the management and outcome of septic ICU patients in different body mass index (BMI) categories in a large multicenter database. METHODS: ). Data were adjusted for patient level characteristics (model 2) as well as management strategies (model 3). RESULTS: Management strategies were similar across BMI categories. Underweight patients evidenced higher rates of ICU mortality. This finding persisted after adjusting in model 2 (aOR 1.54, 95% CI 1.15-2.06; p = 0.004) and model 3 (aOR 1.57, 95%CI 1.16-2.12; p = 0.003). No differences were found regarding ICU mortality between normal and overweight patients (aOR 0.93, 95%CI 0.81-1.06; p = 0.29). Obese patients evidenced a lower risk of ICU mortality compared to normal weight, a finding which persisted across all models (model 2: aOR 0.83, 95%CI 0.69-0.99; p = 0.04; model 3: aOR 0.82, 95%CI 0.68-0.98; p = 0.03). The protective effect of obesity and the negative effect of underweight were significant in individuals > 65 years only. CONCLUSION: In this cohort, underweight was associated with a worse outcome, whereas obese patients evidenced lower mortality. Our analysis thus supports the thesis of the obesity paradox.
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Danninger et al. (2021) conducted a cohort in Sepsis (n=16,612). Underweight (BMI < 18.5 kg/m2) vs. Normal weight (BMI 18.5 to < 25 kg/m2) was evaluated on ICU mortality (aOR 1.57, 95% CI 1.16-2.12, p=0.003). Underweight was associated with a significantly higher risk of ICU mortality compared to normal weight (aOR 1.57), whereas obesity was associated with a lower mortality risk (aOR 0.82) in septic patients.
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