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Obese patients more likely to survive sepsis

Patients with greater BMIs experienced lower one-year mortality compared with non-obese patients

Obese patients are more likely to survive sepsis, according to researchers from the University of Michigan Health System. The findings, published in the Critical Care Medicine, raise interesting questions about how obesity impacts the body's response to infection.

"Physicians expect obese patients to do poorly and this belief can affect the care and counselling they provide to patients and their families," said lead author Dr Hallie C Prescott, a pulmonary and critical care medicine clinical lecturer at the U-M Health System. "Our study indicates obese sepsis patients actually have lower mortality and similar functional outcomes as normal weight patients."

The focus of the study was to investigate the association of BMI to survival, health care use and functional deficiencies following a severe sepsis hospitalisation.

The authors note that incidence of sepsis has doubled in the past 15 years leading to an increased focus on research and Medicare spending. Severe sepsis causes a million hospitalisations yearly among Medicare beneficiaries, costing more than US$16 billion annually. Half of patients hospitalised with severe sepsis die within a year.

In the study, they analysed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.

Using Medicare claims, they identified severe sepsis hospitalisations and measured inpatient healthcare facility use and calculated total and itemised Medicare spending in the year following hospital discharge. Using the National Death Index, they determined mortality. In addition, pre- and postmorbid functional status was obtained from survey data.

They found that patients with greater BMIs experienced lower one-year mortality compared with non-obese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality.

Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p<0.01 for both comparisons), but average daily utilization (p=0.44) and Medicare spending were similar (p=0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by BMI category (p=0.64).

"Obese patients who survive their sepsis hospitalisation use more health care resources and require more Medicare spending, but this apparent increase in resource use is a result of living longer, not increased use per day alive," said senior author, Dr Theodore Iwashyna, assistant professor of internal medicine at the U-M Health System.

Authors note there are many health benefits to maintaining a normal weight, but the findings suggest that excess weight may cause the body to respond differently to critical illness. A better understanding of this difference may help health care providers improve care for all patients with sepsis and other critical illnesses.

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