Increased Body Mass Index and Adjusted Mortality in Intensive Care Unit Patients with Sepsis or Septic Shock

Abstract

Abstract Sepsis is life ‐ threatening organ dysfunction caused by a dysregulated host response to infection and is characterized by the presence of suspected or proven infection accompanied by an increase in sequential (sepsis ‐ related) organ failure assessment (SOFA) score of two points or more from baseline. Sepsis is one of the most common causes of death among hospitalized patients in the intensive care unit (ICU). It is particularly difficult to diagnose in this setting because of the multiple comorbidities and underlying diseases that these patients present. Over the past few decades, a growing body of evidence has investigated the values of different predictors of sepsis- related mortality. Previously, it was reported that old age, tachycardia, hypotension, elevated C-reactive protein (CRP) and lactate, thrombocytopenia, need of mechanical ventilation, high Acute Physiology, and Chronic Health Evaluation (APACHE) II, and high SOFA scores were variables associated with high mortality. Recently, a growing number of published studies have reported that obesity can be significantly correlate with mortality in the ICU setting. Body mass index (BMI) is one of the common clinical demographic characteristics and can be calculated from the ratio of body weight to squared height (kg/m2). Nevertheless, data are limited regarding the role of BMI in predicting short-term mortality among patients with sepsis. Therefore, we conducted the present prospective study in order to evaluate the effect of increased BMI on mortality in ICU patients with sepsis or septic shock. The present study included 45 adult patients (≥16 years old) who were admitted to the ICU and treated for sepsis, severe sepsis, or septic shock. The patients were divided into three groups based on their BMI. In the present study, the average age of the included patients ranged from 55-70 years old; while the majority of patients were males. Moreover, we found that patients with a BMI < 25kg/m2 were older than other groups of patients. On the other hand, patients with BMI > 30kg/m2 were more likely to have diabetes mellitus. Regarding the cause of admission, our analysis showed that patients with low BMI (< 25 kg/m2) were more likely to have chest infection; while patients with high BMI (>30 kg/m2) were more likely to have bed sores. In terms of vital signs of the included patients during the first day of admission, the present study shows that obese patients had significantly lower body temperature, heart rate, and respiratory rates; while they had significantly higher mean arterial blood pressure than patients in other BMI groups. Our analysis showed that the mortality rate was significantly lower in obese patients than other BMI groups (p =0.049). On the other hand, there were no significant associations between BMI and ICU length of stay, APACHE II Score, SOFA score, or rate of readmission. In concusion, Obesity is a potential predictive characteristics for mortality among septic patients admitted to ICU.