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Bai L, Huang J, Wang D, Zhu D, Zhao Q, Li T, Zhou X, Xu Y. Association of body mass index with mortality of sepsis or septic shock: an updated meta-analysis. J Intensive Care 2023; 11:27. [PMID: 37400897 DOI: 10.1186/s40560-023-00677-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The effects of body mass index (BMI) on mortality of sepsis remain unknown, since previous meta-analyses have reported conflicting results. Several observational studies published recently have provided new evidence. Thus, we performed this updated meta-analysis. METHODS PubMed, Embase, Web of Science, and Cochran Library were searched for articles published before February 10, 2023. Observational studies that assessed the association of BMIs with mortality of sepsis patients aged > 18 years were selected. We excluded studies of which data were unavailable for quantitative synthesis. Odds ratios (OR) with 95% confidence interval (CI) were the effect measure, which were combined using fixed-effect or random-effect models. The Newcastle-Ottawa Scale was applied for quality assessment. Subgroups analyses were conducted according to potential confounders. RESULTS Fifteen studies (105,159 patients) were included in the overall analysis, which indicated that overweight and obese BMIs were associated with lower mortality (OR: 0.79, 95% CI 0.70-0.88 and OR: 0.74, 95% CI 0.67-0.82, respectively). The association was not significant in patients aged ≤ 50 years (OR: 0.89, 95% CI 0.68-1.14 and OR: 0.77, 95% CI 0.50-1.18, respectively). In addition, the relationship between morbidly obesity and mortality was not significant (OR: 0.91, 95% CI 0.62-1.32). CONCLUSIONS Overweight and obese BMIs (25.0-39.9 kg/m2) are associated with reduced mortality of patients with sepsis or septic shock, although such survival advantage was not found in all crowds. Trial registration The protocol of this study was registered in PROSPERO (registration number CRD42023399559).
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Affiliation(s)
- Le Bai
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Jingyi Huang
- Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Dan Wang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Dongwei Zhu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Qi Zhao
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Tingyuan Li
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Xianmei Zhou
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China.
- Department of Respiratory Medicine, Jiangsu Province Hospital of Chinese Medicine, 155 Hanzhong Road, Nanjing, 210029, Jiangsu Province, People's Republic of China.
| | - Yong Xu
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, 210029, Jiangsu Province, People's Republic of China.
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Murphy DL, Johnson NJ, Hall MK, Kim ML, Shapiro NI, Henning DJ. Predicting Prolonged Intensive Care Unit Stay Among Patients With Sepsis-Induced Hypotension. Am J Crit Care 2019; 28:e1-e7. [PMID: 31676528 DOI: 10.4037/ajcc2019931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sepsis risk stratification tools typically predict mortality, although stays in the intensive care unit (ICU) of 24 hours or longer may be more clinically relevant for emergency department disposition. OBJECTIVE To explore predictors of ICU stay of 24 hours or longer among infected, hypotensive emergency department patients. METHODS A secondary analysis of 2 prospective, observational studies of adult patients with severe sepsis or an infection with a systolic blood pressure less than 90 mm Hg in 3 urban, academic emergency departments was performed. Patients with hypotension and infection were included. Patients with emergency department intubation, vasopressor administration, and/or death were excluded. The primary outcome was ICU stay of 24 hours or longer or death in less than 24 hours. Multivariable logistic regression was used to predict ICU stay of 24 hours or longer. RESULTS Of 233 patients, 108 (46.4%) had ICU stays of 24 hours or longer. History of heart failure (odds ratio, 3.6; 95% CI, 1.5-8.3), bicarbonate level less than 20 mEq/L (odds ratio, 2.0; 95% CI, 1.1-3.8), respiratory rate greater than 20/min (odds ratio, 2.0; 95% CI, 1.1-3.7), and creatinine level greater than 2.0 mg/dL (odds ratio, 3.6; 95% CI, 1.9-6.7) were independent predictors of ICU stay of 24 hours or longer (area under curve, 0.74). The presence of 1 of these factors predicted ICU stay of 24 hours or longer (area under curve, 0.74) with 82.4% sensitivity and 49.6% specificity. CONCLUSIONS These exploratory results show that heart failure, bicarbonate level of less than 20 mEq/L, tachypnea, or creatinine level greater than 2.0 mg/dL increases the likelihood of an ICU stay of 24 hours or longer among infected, hypotensive emergency department patients.
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Affiliation(s)
- David L. Murphy
- David L. Murphy, M. Kennedy Hall, Mitchell L. Kim, and Daniel J. Henning are emergency medicine physicians, and Nicholas J. Johnson is an emergency medicine and critical care physician in the Department of Emergency Medicine, University of Washington, Seattle, Washington. Nathan I. Shapiro is an emergency medicine physician in the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nicholas J. Johnson
- David L. Murphy, M. Kennedy Hall, Mitchell L. Kim, and Daniel J. Henning are emergency medicine physicians, and Nicholas J. Johnson is an emergency medicine and critical care physician in the Department of Emergency Medicine, University of Washington, Seattle, Washington. Nathan I. Shapiro is an emergency medicine physician in the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - M. Kennedy Hall
- David L. Murphy, M. Kennedy Hall, Mitchell L. Kim, and Daniel J. Henning are emergency medicine physicians, and Nicholas J. Johnson is an emergency medicine and critical care physician in the Department of Emergency Medicine, University of Washington, Seattle, Washington. Nathan I. Shapiro is an emergency medicine physician in the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mitchell L. Kim
- David L. Murphy, M. Kennedy Hall, Mitchell L. Kim, and Daniel J. Henning are emergency medicine physicians, and Nicholas J. Johnson is an emergency medicine and critical care physician in the Department of Emergency Medicine, University of Washington, Seattle, Washington. Nathan I. Shapiro is an emergency medicine physician in the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nathan I. Shapiro
- David L. Murphy, M. Kennedy Hall, Mitchell L. Kim, and Daniel J. Henning are emergency medicine physicians, and Nicholas J. Johnson is an emergency medicine and critical care physician in the Department of Emergency Medicine, University of Washington, Seattle, Washington. Nathan I. Shapiro is an emergency medicine physician in the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Daniel J. Henning
- David L. Murphy, M. Kennedy Hall, Mitchell L. Kim, and Daniel J. Henning are emergency medicine physicians, and Nicholas J. Johnson is an emergency medicine and critical care physician in the Department of Emergency Medicine, University of Washington, Seattle, Washington. Nathan I. Shapiro is an emergency medicine physician in the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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