The association between body mass index and outcomes in patients with sepsis and acute respiratory failure

Edna Juarez MD, Hawa Edriss MD, Michelle Lear BS, Asley Sanchez BS, Shengping Yang PhD, Kenneth Nugent MD

ABSTRACT

Background: Patients with increased body mass indices (BMIs) often present practical problems during their management for acute medical disorders in intensive care units. Some studies suggested obese patients have longer ICU stays but lower in-hospital mortality rates. This study considers the effect of BMI on outcomes in patients with sepsis and respiratory failure.

Methods: The electronic medical records of patients hospitalized between 2010 and 2016 with sepsis who required mechanical ventilation were reviewed to collect demographic characteristics, clinical information including BMI subcategory, management requirements, and outcomes, such as mortality, ICU length of stay (LOS), and hospital LOS.

Results: This study included 312 adult patients. The mean age was 59.1 ± 16.3 years; 57.4% were men. The mean BMI was 29.3 ± 10.7 kg/m². The median APACHE II score was 14, 46.2 % of the patients had pulmonary infections, and 34.9% had extrapulmonary infections. The overall mortality was 42.6%. The mean LOS was 12.4 ± 11.8 days in the ICU and 16.6 ± 13.6 days in the hospital. The mortality rates were 38.5% in underweight patients (BMI <18.5kg/m²), 51.1% in normal weight patients (BMI 18.5–24.9 kg/m²), 38.5% in overweight patients (BMI 25–29.9 kg/m²), and 40.2% in obese patients (BMI >30 kg/m²). Body mass index did not have an independent effect on mortality after adjusting for age, gender, and APACHE II scores; however, overweight patients required more mechanical ventilation days and had an increased LOS in the ICU and the hospital.

Conclusions: This study demonstrates that patients with sepsis requiring mechanical ventilation have a high mortality rate and that BMI did not have an effect on mortality. A prospective study which considers differences in clinical characteristics, management requirements, complications, and inflammatory parameters in different BMI subcategories is needed. Overweight patients had an increased ICU and hospital LOS.

Keywords: body mass index, obesity, sepsis, acute respiratory failure, outcomes

Article citation: Juarez E, Edriss H, Lear M, Sanchez A, Yang S, Nugent K. The association between body mass index and outcomes in patient with sepsis and acute respiratory failure. The Southwest Respiratory and Critical Care Chronicles 2019;7(31):13–23.
From: Department of Internal Medicine (EJ, ML, AS, KN), Texas Tech University Health Sciences Center, Lubbock, TX; Saint Joseph Hospital/Pulmonary Associates (HE), Lexington, KY; Pennington Biomedical Research Center (SY), Baton Rouge, LA
Submitted: 10/1/2019
Accepted: 10/20/2019
Reviewer: Jeff Dennis PhD
Conflicts of interest: none
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.