The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis

Author:

Lebovitz Shalom12,Rozen Guy34,Abu Ghosh Zahi12,Korem Maya25ORCID,Elinav Hila25,Zayyad Hiba6,Carasso Shemy7,Planer David12,Amir Offer12,Elbaz-Greener Gabby12ORCID

Affiliation:

1. Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel

2. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel

3. Cardiovascular Center, Tufts Medical Center, Boston, MA 02111, USA

4. Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA

5. Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 9112001, Israel

6. Infectious Diseases Unit, The Baruch Padeh Medical Center Poriya, Tiberias 1528001, Israel

7. The Jerusalem Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel

Abstract

Background: The association between Body Mass Index (BMI) and clinical outcomes following sepsis continues to be debated. We aimed to investigate the relationship between BMI and in-hospital clinical course and mortality in patients hospitalized with bacteremic sepsis using real-world data. Methods: A sampled cohort of patients hospitalized with bacteremic sepsis between October 2015 and December 2016 was identified in the National Inpatient Sample (NIS) database. In-hospital mortality and length of stay were defined as the relevant outcomes. Patients were divided into 6 BMI (kg/m2) subgroups; (1) underweight ≤ 19, (2) normal-weight 20–25, (3) over-weight 26–30, (4) obese I 31–35, (5) obese II 36–39, and (6) obese stage III ≥ 40. A multivariable logistic regression model was used to find predictors of mortality, and a linear regression model was used to find predictors of an extended length of stay (LOS). Results: An estimated total of 90,760 hospitalizations for bacteremic sepsis across the U.S. were analyzed. The data showed a reverse-J-shaped relationship between BMI and study population outcomes, with the underweight patients (BMI ≤ 19 kg/m2) suffering from higher mortality and longer LOS as did the normal-weight patients (BMI 20–25 kg/m2) when compared to the higher BMI groups. The seemingly protective effect of a higher BMI diminished in the highest BMI group (BMI ≥ 40 kg/m2). In the multivariable regression model, BMI subgroups of ≤19 kg/m2 and ≥40 kg/m2 were found to be independent predictors of mortality. Conclusions: A reverse-J-shaped relationship between BMI and mortality was documented, confirming the “obesity paradox” in the real-world setting in patients hospitalized for sepsis and bacteremia.

Publisher

MDPI AG

Subject

General Medicine

Reference26 articles.

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3. WHO/Europe (2022, April 22). Nutrition—Body Mass Index—BMI. Available online: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi.

4. Body Mass Index and Infectious Disease Mortality in Midlife in a Cohort of 2.3 Million Adolescents;Twig;Int. J. Obes.,2017

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