Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study

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dc.contributor.author Arabi, Yaseen M
dc.contributor.author Dara, Saqib I
dc.contributor.author Tamim, Hani M
dc.contributor.author Rishu, Asgar H
dc.contributor.author Bouchama, Abderrezak
dc.contributor.author Khedr, Mohammad K
dc.contributor.author Feinstein, Daniel
dc.contributor.author Parrillo, Joseph E
dc.contributor.author Wood, Kenneth E
dc.contributor.author Keenan, Sean P
dc.contributor.author Zanotti, Sergio
dc.contributor.author Martinka, Greg
dc.contributor.author Kumar, Aseem
dc.contributor.author Kumar, Anand
dc.contributor.author The Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
dc.date.accessioned 2013-05-22T15:06:16Z
dc.date.available 2013-05-22T15:06:16Z
dc.date.issued 2013-04-17
dc.identifier.citation Critical Care. 2013 Apr 17;17(2):R72
dc.identifier.uri http://hdl.handle.net/1993/20957
dc.description.abstract Abstract Introduction Data are sparse as to whether obesity influences the risk of death in critically ill patients with septic shock. We sought to examine the possible impact of obesity, as assessed by body mass index (BMI), on hospital mortality in septic shock patients. Methods We performed a nested cohort study within a retrospective database of patients with septic shock conducted in 28 medical centers in Canada, United States and Saudi Arabia between 1996 and 2008. Patients were classified according to the World Health Organization criteria for BMI. Multivariate logistic regression analysis was performed to evaluate the association between obesity and hospital mortality. Results Of the 8,670 patients with septic shock, 2,882 (33.2%) had height and weight data recorded at ICU admission and constituted the study group. Obese patients were more likely to have skin and soft tissue infections and less likely to have pneumonia with predominantly Gram-positive microorganisms. Crystalloid and colloid resuscitation fluids in the first six hours were given at significantly lower volumes per kg in the obese and very obese patients compared to underweight and normal weight patients (for crystalloids: 55.0 ± 40.1 ml/kg for underweight, 43.2 ± 33.4 for normal BMI, 37.1 ± 30.8 for obese and 27.7 ± 22.0 for very obese). Antimicrobial doses per kg were also different among BMI groups. Crude analysis showed that obese and very obese patients had lower hospital mortality compared to normal weight patients (odds ratio (OR) 0.80, 95% confidence interval (CI) 0.66 to 0.97 for obese and OR 0.61, 95% CI 0.44 to 0.85 for very obese patients). After adjusting for baseline characteristics and sepsis interventions, the association became non-significant (OR 0.80, 95% CI 0.62 to 1.02 for obese and OR 0.69, 95% CI 0.45 to 1.04 for very obese). Conclusions The obesity paradox (lower mortality in the obese) documented in other populations is also observed in septic shock. This may be related in part to differences in patient characteristics. However, the true paradox may lie in the variations in the sepsis interventions, such as the administration of resuscitation fluids and antimicrobial therapy. Considering the obesity epidemic and its impact on critical care, further studies are warranted to examine whether a weight-based approach to common therapeutic interventions in septic shock influences outcome.
dc.title Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study
dc.type Journal Article
dc.language.rfc3066 en
dc.description.version Peer Reviewed
dc.rights.holder Yaseen M Arabi et al.; licensee BioMed Central Ltd.
dc.date.updated 2013-05-22T15:06:17Z
dc.identifier.doi http://dx.doi.org/10.1186/cc12680

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