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체질량지수에 따른 중증 패혈증 및 패혈성 쇼크 환자의 예후

Body Mass Index and Outcomes in Patients with Severe Sepsis or Septic Shock

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Background: The aim of this study was to investigate the association between body mass index (BMI) and survival in patients with severe sepsis or septic shock. Methods: We analyzed the sepsis registry of patients presenting to the emergency department (ED) of a tertiary urban hospital and meeting the criteria for severe sepsis or septic shock from August 2008 to March 2012. We categorized patients into the underweight group (BMI < 18.5 kg/m2), the normal weight group (18.5 ≤ BMI < 25 kg/m2) and the obese group (BMI ≥ 25 kg/m2). Then, we analyzed the registry to evaluate the relation between obesity and in-hospital mortality. Results: A total of 770 adult patients with severe sepsis and septic shock were analyzed. In-hospital mortality rate of the underweight group (n = 86), the normal weight group (n = 489) and the obese group (n = 195) was 22.1%, 15.3% and 16.4%, respectively. In a multivariate regression analysis, the underweight group had a significant association with in-hospital mortality compared with the normal weight group (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.68-1.87; p = 0.028). The obese group showed no significant difference in mortality (OR, 2.04; 95% CI, 1.08-3.86; p = 0.65). Conclusions: The underweight patients showed significantly higher mortality than the normal weight patients with severe sepsis and septic shock.

Abstract

Background: The aim of this study was to investigate the association between body mass index (BMI) and survival in patients with severe sepsis or septic shock. Methods: We analyzed the sepsis registry of patients presenting to the emergency department (ED) of a tertiary urban hospital and meeting the criteria for severe sepsis or septic shock from August 2008 to March 2012. We categorized patients into the underweight group (BMI < 18.5 kg/m2), the normal weight group (18.5 ≤ BMI < 25 kg/m2) and the obese group (BMI ≥ 25 kg/m2). Then, we analyzed the registry to evaluate the relation between obesity and in-hospital mortality. Results: A total of 770 adult patients with severe sepsis and septic shock were analyzed. In-hospital mortality rate of the underweight group (n = 86), the normal weight group (n = 489) and the obese group (n = 195) was 22.1%, 15.3% and 16.4%, respectively. In a multivariate regression analysis, the underweight group had a significant association with in-hospital mortality compared with the normal weight group (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.68-1.87; p = 0.028). The obese group showed no significant difference in mortality (OR, 2.04; 95% CI, 1.08-3.86; p = 0.65). Conclusions: The underweight patients showed significantly higher mortality than the normal weight patients with severe sepsis and septic shock.

참고문헌 (32)

  1. Flegal KM, "Prevalence and trends in obesity among US adults, 1999-2008", JAMA, 303, pp.235~241 (2010)
  2. Zheng W, "Association between body-mass index and risk of death in more than 1 million Asians", N Engl J Med, 364, pp.719~729 (2011)
  3. Whitlock G, "Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies", Lancet, 373, pp.1083~1096 (2009)
  4. Must A, "The disease burden associated with overweight and obesity", JAMA, 282, pp.1523~1529 (1999)
  5. O'Brien JM Jr., "Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury", Ann Intern Med, 140, pp.338~345 (2004)
  6. Goulenok C, "Influence of overweight on ICU mortality: a prospective study", Chest, 125, pp.1441~1445 (2004)
  7. Arabi YM, "Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study", Crit Care, 17, pp.R72~ (2013)
  8. Akinnusi ME, "Effect of obesity on intensive care morbidity and mortality: a meta-analysis", Crit Care Med, 36, pp.151~158 (2008)
  9. O'Brien JM Jr, "Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury", Crit Care Med, 34, pp.738~744 (2006)
  10. Garrouste-Orgeas M, "Body mass index. An additional prognostic factor in ICU patients", Intensive Care Med, 30, pp.437~443 (2004)
  11. Sakr Y, "Obesity is associated with increased morbidity but not mortality in critically ill patients", Intensive Care Med, 34, pp.1999~2009 (2008)
  12. Bone RC, "Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP", SCCM Consensus Conference Committee. American College of Chest Physicians, Chest, pp.1992, 101[DOI]
  13. Low S, "Rationale for redefining obesity in Asians", Ann Acad Med Singapore, 38, pp.66~69 (2009)
  14. Sung HH, "Impact of body mass index in Korean patients with renal cell carcinoma", Cancer Causes Control, 23, pp.505~511 (2012)
  15. Rivers E, "Early goal-directed therapy in the treatment of severe sepsis and septic shock", N Engl J Med, 345, pp.1368~1377 (2001)
  16. Dellinger RP, "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008", Crit Care Med, 36, pp.296~327 (2008)
  17. Jeon K, "Improvements in compliance with resuscitation bundles and achievement of end points after an educational program on the management of severe sepsis and septic shock", Shock, 37, pp.463~467 (2012)
  18. Ferreira FL, "Serial evaluation of the SOFA score to predict outcome in critically ill patients", JAMA, 286, pp.1754~1758 (2001)
  19. Neville AL, "Obesity is an independent risk factor of mortality in severely injured blunt trauma patients", Arch Surg, 139, pp.983~987 (2004)
  20. Morris AE, "The association between body mass index and clinical outcomes in acute lung injury", Chest, 131, pp.342~348 (2007)
  21. Ray DE, "The effect of body mass index on patient outcomes in a medical ICU", Chest, 127, pp.2125~2131 (2005)
  22. Tremblay A, "Impact of body mass index on outcomes following critical care", Chest, 123, pp.1202~1207 (2003)
  23. Bercault N, "Obesity-related excess mortality rate in an adult intensive care unit: A risk-adjusted matched cohort study", Crit Care Med, 32, pp.998~1003 (2004)
  24. Peake SL, "The effect of obesity on 12-month survival following admission to intensive care: a prospective study", Crit Care Med, 34, pp.2929~2939 (2006)
  25. El-Solh A, "Morbid obesity in the medical ICU", Chest, 120, pp.1989~1997 (2001)
  26. Hogue CW Jr., "The impact of obesity on outcomes after critical illness: a meta-analysis", Intensive Care Med, 35, pp.1152~1170 (2009)
  27. Wurzinger B, "The association between body-mass index and patient outcome in septic shock: a retrospective cohort study", Wien Klin Wochenschr, 122, pp.31~36 (2010)
  28. Jee SH, "Body-mass index and mortality in Korean men and women", N Engl J Med, 355, pp.779~787 (2006)
  29. Vachharajani V, "Influence of obesity on sepsis", Pathophysiology, 15, pp.123~134 (2008)
  30. Vachharajani V, "Obesity exacerbates sepsis-induced inflammation and microvascular dysfunction in mouse brain", Microcirculation, 12, pp.183~194 (2005)
  31. Vachharajani V, "Obesity and sepsis", J Intensive Care Med, 21, pp.287~295 (2006)
  32. Kang MJ, "Factors influencing compliance with early resuscitation bundle in the management of severe sepsis and septic shock", Shock, 38, pp.474~479 (2012)

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