Associations of Body Mass Index with Outcomes of Sepsis: A Meta-Analysis

Abstract

Background: Sepsis is an atypical systemic reaction to infection with high morbidity and mortality. Recently, an association between improved prognosis and obesity in sepsis has been reported;However, the results remain controversial. The objective of the present study was to investigate the association between body mass index (BMI) and sepsis mortality by performing a meta-analysis. Methods: Considering pre-established inclusion and exclusion criteria, eligible studies were retrieved from PubMed, Embase, and Web of Science. Cochran’s Q test and I² test were used to evaluate the heterogeneity among studies for each outcome. Statistical analysis was conducted using Stata12.0 software (version 12 SE;Stata Corporation, College Station, TX, USA). Odds ratios (OR) and 95% confidence intervals (CI) were used as effect sizes to evaluate differences in hospital, intensive care unit (ICU), 30-day, 90-day, and 1-year mortality in underweight, overweight, and obese patients with sepsis when compared with those with normal-weight. Results: In patients with sepsis, underweight was associated with increased in-hospital, ICU, and 1-year mortality (all odds ratio [OR] >1, p < 0.05), whereas no significant association was detected with 30- and 90-day mortality (all OR >1, p > 0.05). The association between underweight and in-hospital mortality disappeared in the non-Asian (OR [95% CI] = 1.13 [0.90, 1.41], p = 0.310) and non-adjusted subgroups (OR [95% CI] = 1.19 [0.92, 1.53], p = 0.186). Overweight was associated with decreased ICU mortality, 30-day mortality, 90-day mortality, and 1-year mortality in patients with sepsis (all OR <1, p < 0.05), exhibiting no significant association with in-hospital mortality (OR [95% CI] = 0.89 [0.78, 1.01], p = 0.074). Obesity was associated with decreased in-hospital, ICU, 30-day, 90-day, and 1-year mortality in patients with sepsis (all OR <1, p < 0.05). Conclusions: The results of the present meta-analysis supported the view of the “obesity paradox”. An underweight BMI was associated with increased sepsis mortality, whereas overweight and obesity were associated with low mortality in sepsis. These findings suggest that the clinical management of sepsis should follow the principle of a personalized approach, and the impact of obesity on the pattern of infection, fluids, and antibiotic administration should be carefully considered.