LB037 - SEPSIS AND THE OBESITY PARADOX: A COMPARATIVE EVALUATION OF NORMAL VS. OVERWEIGHT/OBESE PATIENTS

LB037

SEPSIS AND THE OBESITY PARADOX: A COMPARATIVE EVALUATION OF NORMAL VS. OVERWEIGHT/OBESE PATIENTS

K. Aydin^1,*, S. TEMEL²

¹Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Cukurova University, Adana, ²Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri, Türkiye

Rationale: The association between higher body mass index (BMI) and improved survival in critical illness, known as the "obesity paradox," remains controversial in sepsis. This study aims to evaluate whether overweight and obese patients with sepsis have different clinical characteristics and mortality outcomes compared to patients with normal BMI. 

Methods: This retrospective study included 404 adult patients diagnosed with sepsis and admitted to the intensive care unit (ICU). Patients were divided into two groups based on the BMI (kg/m²): group 1(18.5≤BMI<25 kg/m²) and group 2 (25≤BMI<40 kg/m²). Demographic characteristics, comorbidities, severity scores, and clinical outcomes were analyzed. Continuous variables were reported as medians with interquartile ranges (25th–75th percentiles),while categorical variables were presented as frequencies and percentages. Group comparisons were performed using the Mann–Whitney U test for continuous variables and the chi-square or Fisher’s exact test for categorical variables, depending on distribution. Variables that demonstrated statistical significance in the univariate analysis were subsequently entered into a multivariable logistic regression model to identify independent associations between BMI category and clinical outcomes. 

Results: The median BMI of septic patients was 25.8 kg/m² (IQR: 22.7–29). Compared to Group 1, patients in Group 2 had a significantly higher prevalence of type 2 diabetes mellitus (DM, 44.6% vs. 33%, p = 0.017) and neurologic diseases (33.8% vs. 23%, p = 0.017). The 28-day mortality was significantly lower in Group 2 compared to Group 1 (37.1% vs. 48.2%, p = 0.024). Variables that were significant in univariate analysis were further evaluated using multivariable logistic regression. In the adjusted model, the presence of type 2 DM (OR: 1.68; 95% CI: 1.11–2.53; p = 0.014) and neurologic diseases (OR: 1.70; 95% CI: 1.09–2.65; p = 0.020) remained independently associated with an increased likelihood of having a BMI ≥25 kg/m². The 28-day mortality was independently associated with a lower probability of being overweight or obese (OR: 0.62; 95% CI: 0.41–0.92; p = 0.019).

Conclusion: In septic ICU patients, a BMI between 25 and 39.9 kg/m² was associated with lower 28-day mortality rates compared to those with normal BMI, despite a higher prevalence of DM and neurologic diseases. This finding suggests that patients with elevated BMI may exhibit a distinct clinical phenotype during sepsis and could potentially benefit from a short-term survival advantage. However, as this association is observational in nature, further prospective and controlled studies are warranted to evaluate the validity of the obesity paradox hypothesis in this context.

References: 1. Jagan N, Morrow LE, Walters RW, Plambeck RW, Wallen TJ, Patel TM, et al. Sepsis and the obesity paradox: Size matters in more than one way. Crit Care Med. 2020 Sep;48(9):e776–e782. 

2. Yeo HJ, Kim TH, Jang JH, Jeon K, Oh DK, Park MH, et al; Korean Sepsis Alliance (KSA) Investigators. Obesity paradox and functional outcomes in sepsis: A multicenter prospective study. Crit Care Med. 2023 Jun 1;51(6):742–752. 

3. Gao L, Liu JJ, Fan QC, Ling LT, Ding HB. Association of obesity and mortality in sepsis patients: A meta-analysis from observational evidence. Heliyon. 2023 Aug 30;9(9):e19556.

4. Lee Y, Ahn S, Han M, Lee JA, Ahn JY, Jeong SJ, et al. The obesity paradox in younger adult patients with sepsis: analysis of the MIMIC-IV database. Int J Obes (Lond). 2024 Sep;48(9):1223-1230. 

Disclosure of Interest: None declared