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Intensive care
Research
Impact of body mass index on survival of medical patients with sepsis: a prospective cohort study in a university hospital in China
  1. Qingtao Zhou1,
  2. Meng Wang1,
  3. Shuo Li2,
  4. Jing Zhang1,
  5. Qingbian Ma2,
  6. Yanling Ding1,
  7. Hongxia Ge2,
  8. Ning Shen1,
  9. Yaan Zheng2,
  10. Yongchang Sun1
  1. 1 Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
  2. 2 Emergency Department, Peking University Third Hospital, Beijing, China
  1. Correspondence to Dr Yongchang Sun; suny{at}bjmu.edu.cn

Abstract

Objective To evaluate the impact of body mass index (BMI) on survival of a Chinese cohort of medical patients with sepsis.

Design A single-centre prospective cohort study conducted from May 2015 to April 2017.

Setting A tertiary care university hospital in China.

Participants A total of 178 patients with sepsis admitted to the medical intensive care unit (ICU) were included.

Main outcome measures The primary outcome was 90-day mortality while the secondary outcomes were in-hospital mortality, length of ICU stay and length of hospital stay.

Results The median age (IQR) was 78 (66–84) years old, and 77.0% patients were older than 65 years. The 90-day mortality was 47.2%. The in-hospital mortality was 41.6%, and the length of ICU stay and hospital stay were 12 (5–22) and 15 (9–28) days, respectively. Cox proportional hazard regression analysis identified that Sequential Organ Failure Assessment score (HR=1.229, p<0.001), Acute Physiology and Chronic Health Evaluation II score (HR=1.050, p<0.001) and BMI (HR=0.940, p=0.029) were all independently associated with the 90-day mortality. Patients were divided into four groups based on BMI (underweight 33 (18.5%), normal 98 (55.1%), overweight 36 (20.2%) and obese 11 (6.2%)). The 90-day mortality (66.7%, 48.0%, 36.1% and 18.2%, p=0.015) and in-hospital mortality (60.6%, 41.8%, 30.6% and 18.2%, p=0.027) were statistically different among the four groups. Differences in survival among the four groups were demonstrated by Kaplan-Meier survival analysis (p=0.008), with the underweight patients showing a lower survival rate.

Conclusions BMI was an independent factor associated with 90-day survival in a Chinese cohort of medical patients with sepsis, with patients having a lower BMI at a higher risk of death.

  • infectious diseases
  • thoracic medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-021979

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    Footnotes

    • Contributors QTZ, YCS, YAZ: designed the study. QTZ, YCS, NS, YAZ, QBM: coordinated the study. MW, JZ, YLD, SL, HXG: were responsible for patient screening, enrollment and follow-up. QTZ, MW, YCS: analysed the data. QTZ: drafted the manuscript. YCS: critically revised the manuscript. All authors had full access to all study data, read and approved the final version of the manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study protocol was approved (approval number M2015021) by the ethics committee of Peking University Third Hospital, Beijing, China.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The authors declare that all data supporting the findings of this study are available within the article.