Zusammenfassung
HINTERGRUND: Es bestehen keine Daten über die Assoziation zwischen dem Body Mass Index (BMI) bzw. BMI Kategorien und der Mortalität von septischen Schock-patienten. METHODEN: Die Datenbank einer interdisziplinären Intensivstation wurde retrospektiv nach erwachsenen Patienten mit septischem Schock durchsucht. Von allen Patienten wurde der BMI, demographische, klinische und laborchemische Parameter gemeinsam mit Outcomevariabeln dokumentiert. Die Studienpatienten wurden wie folgt anhand des BMI kategorisiert: BMI < 18,5 kg/m2, Untergewicht; BMI 18,5–24,9 kg/m2, Normalgewicht; BMI 25–29,9 kg/m2, Übergewicht; BMI > 30 kg/m2, Fettleibigkeit. Bivariate und multivariate logistische Regressionsmodelle wurden verwendet, um den Zusammenhang zwischen dem BMI und Outcome-variabeln zu untersuchen. RESULTATE: 301 septische Schockpatienten wurden identifiziert. Der BMI war bivariat mit der Mortalität auf der Intensivstation assoziiert (OR, 0,91; 95% CI, 0,86–0,98; p = 0,007). Es gab keine signifikante Assoziation zwischen dem BMI und der Mortalität auf der Intensivstation. Allerdings waren höhere BMI Werte trendmässig mit einer niedrigeren Intensivstations-mortalität assoziiert (OR, 0,93; 95% CI, 0,86–1,01; p = 0,09). Während übergewichtige (OR, 0,43; 95% CI, 0,19–0,98; p = 0,04) und fettleibige (OR, 0,28; 95% CI, 0,08–0,93; p = 0,04) Patienten ein unabhängig niedrigeres Risiko auf der Intensivstation zu versterben hatten als normalgewichtige Patienten, gab es keinen Unterschied im Sterberisiko zwischen normal- und untergewichtigen Patienten (p = 0,22). Ein hoher BMI war unabhängig mit einer geringen Häufigkeit eines akutem Deliriums (p = 0,04) und einer geringeren Intensivwieder-aufnahmerate (p = 0,001), aber mit mehr Harnwegsinfektionen (p = 0,02) assoziiert. SCHLUSSFOLGERUNG: Bis zu einem BMI von 50 kg/m2 scheint keine Assoziation zwischen BMI und schlechterem Überleben auf der Intensivstation oder im Krankenhaus bei septischen Schockpatienten zu bestehen. Im Gegenteil, hohe BMI Werte könnten sogar das Risiko am septischen Schock zu versterben reduzieren.
Summary
BACKGROUND: It is unknown whether body-mass index (BMI) and commonly defined BMI categories are associated with mortality in patients with septic shock. METHODS: The database of a multidisciplinary intensive care unit (ICU) was retrospectively screened for adult patients with septic shock. BMI, demographic, clinical and laboratory variables together with outcome measures were collected in all patients. Subjects were categorized as follows: underweight, BMI < 18.5; normal weight, BMI 18.5–24.9; overweight, BMI 25–29.9; obesity, BMI ≥ 30. Bivariate and multivariate logistic regression models were used to evaluate the association between BMI and outcome parameters. RESULTS: In total, 301 patients with septic shock were identified. BMI was bivariately associated with ICU mortality (OR 0.91; 95% CI 0.86–0.98; P = 0.007). There was no significant association between BMI and ICU mortality in the multivariate model but an increasing BMI tended to be associated with lower ICU mortality (OR 0.93; 95% CI 0.86–1.01; P = 0.09). Although overweight (OR 0.43; 95% CI 0.19–0.98; P = 0.04) and obese (OR 0.28; 95% CI 0.08–0.93; P = 0.04) patients had an independently lower risk of ICU death than those with normal weight, there was no difference in the risk of ICU death between normal weight and underweight patients (P = 0.22). A high BMI was independently associated with a lower frequency of acute delirium (P = 0.04) and a lower need for ICU re-admission (P = 0.001) but with a higher rate of ICU-acquired urinary tract infections (P = 0.02). CONCLUSIONS: BMI up to 50 does not appear to be associated with worse ICU and hospital mortality in patients with septic shock. In contrast, a high BMI may reduce the risk of death from septic shock.
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Wurzinger, B., Dünser, M., Wohlmuth, C. et al. The association between body-mass index and patient outcome in septic shock: a retrospective cohort study. Wien Klin Wochenschr 122, 31–36 (2010). https://doi.org/10.1007/s00508-009-1241-4
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DOI: https://doi.org/10.1007/s00508-009-1241-4