Effect of obesity on mortality among hospitalized paediatric patients with severe sepsis.
morbid obesity
mortality
nutritional status
obesity
obesity paradox
paediatric severe sepsis
septic shock
Journal
Pediatric obesity
ISSN: 2047-6310
Titre abrégé: Pediatr Obes
Pays: England
ID NLM: 101572033
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
03
10
2020
accepted:
25
01
2021
pubmed:
16
3
2021
medline:
23
11
2021
entrez:
15
3
2021
Statut:
ppublish
Résumé
Severe sepsis is one of the leading causes of mortality among children. Studies in adults have suggested a protective effect of obesity on mortality among patients hospitalized with sepsis. Paediatric studies evaluating similar relationship is lacking. We analysed non-overlapping years of the Kids Inpatient Database (KID) and National Inpatient Sample (NIS) database between 2003 and 2014 of all paediatric patients with severe sepsis (PSS) up to 20 years of age. PSS was defined using specific International Classification of Diseases (ICD) codes and modified Angus criteria. Using ICD-9 diagnosis codes, patients were divided into three mutually exclusive groups (obesity, morbid obesity and control groups), and these groups were compared for outcomes measures including in-hospital mortality and healthcare resource utilization using the length of stay and inflation-adjusted hospitalization charges. We analysed 109 026 hospitalizations due to PSS. The prevalence rate of obesity was 1.5% (n = 1643), and morbid obesity was 1.05% (n = 1147). Multivariate regression models showed obesity was associated with 63% (OR 0.37, CI: 0.29-0.47, p < 0.001) and 54% reduction in mortality among PSS patients and patients with septic shock respectively. Contrastingly, morbid obesity was not associated with mortality among PSS patients and but was associated with 1.37 times (CI: 1.06-1.78, p = 0.01) increased risk of mortality among paediatric patients with septic shock. Paediatric obesity is associated with reduced mortality among patients with PSS, with the exception of morbid obesity. Further prospective studies are needed to better understand the relationship between obesity and outcomes in PSS.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e12777Informations de copyright
© 2021 World Obesity Federation.
Références
Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe sepsis*. Pediatr Crit Care Med. 2013;14(7):686-693.
Jaramillo-Bustamante JC, Marin-Agudelo A, Fernandez-Laverde M, Bareno-Silva J. Epidemiology of sepsis in pediatric intensive care units: first Colombian multicenter study. Pediatr Crit Care Med. 2012;13(5):501-508.
Kutko MC, Calarco MP, Flaherty MB, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med. 2003;4(3):333-337.
Weiss SL, Parker B, Bullock ME, et al. Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice. Pediatr Crit Care Med. 2012;13(4):e219-e226.
Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2003;167(5):695-701.
Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity among Adults and Youth: United States, 2015-2016. NCHS Data Brief. 2017(288):1-8. https://www.cdc.gov/nchs/products/databriefs/db360.htm.
Kuperman EF, Showalter JW, Lehman EB, Leib AE, Kraschnewski JL. The impact of obesity on sepsis mortality: a retrospective review. BMC Infect Dis. 2013;13(1):377.
Kelsey MM, Zaepfel A, Bjornstad P, Nadeau KJ. Age-related consequences of childhood obesity. Gerontology. 2014;60(3):222-228.
Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clin Proc. 2017;92(2):251-265.
Gaulton TG, MacNabb CM, Mikkelsen ME, et al. A retrospective cohort study examining the association between body mass index and mortality in severe sepsis. Intern Emerg Med. 2015;10(4):471-479.
Singer K, Eng DS, Lumeng CN, Gebremariam A, Lee M. The relationship between body fat mass percentiles and inflammation in children. Obesity. 2014;22(5):1332-1336.
Schipper H, Nuboer R, Prop S, et al. Systemic inflammation in childhood obesity: circulating inflammatory mediators and activated CD14++ monocytes. Diabetologia. 2012;55(10):2800-2810.
Prescott HC, Chang VW, O'Brien JM Jr, Langa KM, Iwashyna TJ. Obesity and 1-year outcomes in older Americans with severe sepsis. Crit Care Med. 2014;42(8):1766-1774.
Wurzinger B, Dünser MW, Wohlmuth C, et al. The association between body-mass index and patient outcome in septic shock: a retrospective cohort study. Wien Klin Wochenschr. 2010;122(1-2):31-36.
Wang HE, Griffin R, Judd S, Shapiro NI, Safford MM. Obesity and risk of sepsis: a population-based cohort study. Obesity. 2013;21(12):E762-E769.
Wang S, Liu X, Chen Q, Liu C, Huang C, Fang X. The role of increased body mass index in outcomes of sepsis: a systematic review and meta-analysis. BMC Anesthesiol. 2017;17(1):118.
Maley N, Gebremariam A, Odetola F, Singer K. Influence of obesity diagnosis with organ dysfunction, mortality, and resource use among children hospitalized with infection in the United States. J Intensive Care Med. 2017;32(5):339-345.
Gaulton TG, Weiner MG, Morales KH, Gaieski DF, Mehta J, Lautenbach E. The effect of obesity on clinical outcomes in presumed sepsis: a retrospective cohort study. Intern Emerg Med. 2014;9(2):213-221.
Arabi YM, Dara SI, Tamim HM, et al. Clinical characteristics, sepsis interventions and outcomes in the patients with obesity with septic shock: an international multicenter cohort study. Crit Care. 2013;17(2):R72.
Sakr Y, Elia C, Mascia L, et al. Being overweight or obese is associated with decreased mortality in critically ill patients: a retrospective analysis of a large regional Italian multicenter cohort. J Crit Care. 2012;27(6):714-721.
Okubo Y, Nochioka K, Testa MA. The impact of pediatric obesity on hospitalized children with lower respiratory tract infections in the United States. Clin Respir J. 2018;12(4):1479-1484.
Li NY, Kalagara S, Hersey A, Eltorai AEM, Daniels AH, Cruz AI Jr. Impact of obesity on operative treatment and inpatient outcomes of paediatric limb fractures. Bone Joint J. 2019;101B(4):491-496.
Okubo Y, Nochioka K, Hataya H, Sakakibara H, Terakawa T, Testa M. Burden of obesity on pediatric inpatients with acute asthma exacerbation in the United States. J Allergy Clin Immunol Pract. 2016;4(6):1227-1231.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-1310.
Ross PA, Newth CJ, Leung D, Wetzel RC, Obesity KRG. Mortality risk in critically ill children. Pediatrics. 2016;137(3):e20152035.
Ross PA, Klein MJ, Nguyen T, et al. Body habitus and risk of mortality in pediatric sepsis and septic shock: a retrospective cohort study. J Pediatr. 2019;210:178-183.
Taylor SP, Karvetski C, Templin M, Herlihy JD, Taylor B. Do-not-resuscitate status explains the obesity paradox in patients with severe sepsis. Critical care: the other half of the ICU-update in management of non-pulmonary critical care. 2017:A7152-A7152. https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A7152.
Pepper DJ, Demirkale CY, Sun J, et al. Does obesity protect against death in sepsis? A retrospective cohort study of 55,038 adult patients. Crit Care Med. 2019;47(5):643-650.
Zhi G, Xin W, Ying W, Guohong X, Shuying L. “Obesity paradox” in acute respiratory distress syndrome: Asystematic review and meta-analysis. PLoS One. 2016;11(9):e0163677.
Oesch L, Tatlisumak T, Arnold M, Sarikaya H. Obesity paradox in stroke - myth or reality? A systematic review. PLoS One. 2017;12(3):e0171334.
Kalantar-Zadeh K, Rhee CM, Chou J, et al. The obesity paradox in kidney disease: how to reconcile it with obesity management. Kidney Int Rep. 2017;2(2):271-281.
Kalani C, Venigalla T, Bailey J, Udeani G, Surani S. Sepsis patients in critical care units with obesity: is obesity protective? Cureus. 2020;12(2):e6929.
Robinson MK, Mogensen KM, Casey JD, et al. The relationship among obesity, nutritional status, and mortality in the critically ill. Crit Care Med. 2015;43(1):87-100.
Wacharasint P, Boyd JH, Russell JA, Walley KR. One size does not fit all in severe infection: obesity alters outcome, susceptibility, treatment, and inflammatory response. Crit Care. 2013;17(3):R122.
Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly patients with obesity. Chest. 1996;109(1):144-151.
Kress JP, Pohlman AS, Alverdy J, Hall JB. The impact of morbid obesity on oxygen cost of breathing (V O 2RESP) at rest. Am J Respir Crit Care Med. 1999;160(3):883-886.
Flegal KM, Ioannidis JP. The obesity paradox: a misleading term that should be abandoned. Obesity. 2018;26(4):629-630.
Banack H, Stokes A. The ‘obesity paradox’ may not be a paradox at all. Int J Obes (Lond). 2017;41(8):1162-1163.