The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis
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:...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/11/3848 |
| _version_ | 1797597236111081472 |
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| author | Shalom Lebovitz Guy Rozen Zahi Abu Ghosh Maya Korem Hila Elinav Hiba Zayyad Shemy Carasso David Planer Offer Amir Gabby Elbaz-Greener |
| author_facet | Shalom Lebovitz Guy Rozen Zahi Abu Ghosh Maya Korem Hila Elinav Hiba Zayyad Shemy Carasso David Planer Offer Amir Gabby Elbaz-Greener |
| author_sort | Shalom Lebovitz |
| collection | DOAJ |
| description | 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/m<sup>2</sup>) 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/m<sup>2</sup>) suffering from higher mortality and longer LOS as did the normal-weight patients (BMI 20–25 kg/m<sup>2</sup>) when compared to the higher BMI groups. The seemingly protective effect of a higher BMI diminished in the highest BMI group (BMI ≥ 40 kg/m<sup>2</sup>). In the multivariable regression model, BMI subgroups of ≤19 kg/m<sup>2</sup> and ≥40 kg/m<sup>2</sup> 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. |
| first_indexed | 2024-03-11T03:03:49Z |
| format | Article |
| id | doaj.art-9977ba7249e046a4aa910c88089e7ea3 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T03:03:49Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-9977ba7249e046a4aa910c88089e7ea32023-11-18T08:07:15ZengMDPI AGJournal of Clinical Medicine2077-03832023-06-011211384810.3390/jcm12113848The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic SepsisShalom Lebovitz0Guy Rozen1Zahi Abu Ghosh2Maya Korem3Hila Elinav4Hiba Zayyad5Shemy Carasso6David Planer7Offer Amir8Gabby Elbaz-Greener9Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, IsraelCardiovascular Center, Tufts Medical Center, Boston, MA 02111, USADepartment of Cardiology, Hadassah Medical Center, Jerusalem 9112001, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, IsraelInfectious Diseases Unit, The Baruch Padeh Medical Center Poriya, Tiberias 1528001, IsraelThe Jerusalem Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, IsraelDepartment of Cardiology, Hadassah Medical Center, Jerusalem 9112001, IsraelDepartment of Cardiology, Hadassah Medical Center, Jerusalem 9112001, IsraelDepartment of Cardiology, Hadassah Medical Center, Jerusalem 9112001, IsraelBackground: 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/m<sup>2</sup>) 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/m<sup>2</sup>) suffering from higher mortality and longer LOS as did the normal-weight patients (BMI 20–25 kg/m<sup>2</sup>) when compared to the higher BMI groups. The seemingly protective effect of a higher BMI diminished in the highest BMI group (BMI ≥ 40 kg/m<sup>2</sup>). In the multivariable regression model, BMI subgroups of ≤19 kg/m<sup>2</sup> and ≥40 kg/m<sup>2</sup> 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.https://www.mdpi.com/2077-0383/12/11/3848BMIsepsisbacteremiabacteremic sepsisBMI mortalityobesity paradox |
| spellingShingle | Shalom Lebovitz Guy Rozen Zahi Abu Ghosh Maya Korem Hila Elinav Hiba Zayyad Shemy Carasso David Planer Offer Amir Gabby Elbaz-Greener The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis Journal of Clinical Medicine BMI sepsis bacteremia bacteremic sepsis BMI mortality obesity paradox |
| title | The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis |
| title_full | The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis |
| title_fullStr | The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis |
| title_full_unstemmed | The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis |
| title_short | The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis |
| title_sort | relationship between body mass index and in hospital mortality in bacteremic sepsis |
| topic | BMI sepsis bacteremia bacteremic sepsis BMI mortality obesity paradox |
| url | https://www.mdpi.com/2077-0383/12/11/3848 |
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