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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1067 — Impact of Obesity on Mortality for Veterans with Sepsis

Restrepo MI (VERDICT/STVHCS-ALM/UTHSCSA), Mortensen EM (VERDICT/STVHCS-ALM/UTHSCSA), Bollinger M (VERDICT/STVHCS-ALM/UTHSCSA), Sutton S (UTHSCSA), Copeland LA (VERDICT/STVHCS-ALM/UTHSCSA), Pugh MJ (VERDICT/STVHCS-ALM/UTHSCSA), Noel PH (VERDICT/STVHCS-ALM/UTHSCSA)

Objectives:
Obesity is an increasing problem in the US and the Department of Veterans Affairs (VA). Sepsis is a major cause of hospital admissions and death worldwide. However, limited data are available regarding the impact of obesity on mortality for patients with sepsis. Therefore, our aim was to assess the impact of obesity on all-cause mortality at 30 and 90 days among veteran subjects hospitalized with sepsis.

Methods:
We used VA administrative data to identify hospitalized subjects with sepsis (ICD-9 code 0.20-0.38) within fiscal years 2002-2006. The cohort was stratified according to the Body Mass Index (BMI in kg/m2) as underweight (< 18.5), normal (18.5-24.9, reference group), overweight (25- 29.9), obese (30-39.9), and morbidly obese (> 40). Our primary models were generalized linear mixed effect models with mortality (30-day or 90-day mortality) as the primary outcomes. The models were adjusted for potential confounders including demographics/utilization, comorbid conditions, and severity of illness. Model results were reported as odds ratio (OR) and 95% confidence intervals (95% CI).

Results:
There were 5,602 subjects with sepsis, with a mean age of 65.8 years (standard deviation 11.6 years). The distribution of the sepsis cohort according to the BMI was 2.5% underweight, 25.3% normal, 34.2% overweight, 31.9% obese, and 6.2% morbidly obese. The mortality at 30 days was lower among obese (31.4%) and morbidly obese (28.2%) patients compared to those with normal BMI (45.3%, P < .0001). In addition, 90-day mortality rates showed similar results among obese (41.9%) and morbidly obese (38.8%) vs. normal BMI septic patients (58.5%, P < .0001). After adjusting for potential confounders, obese patients with sepsis had a lower 30-day (OR = 0.65, 95%CI 0.53-0.78) and 90-day mortality (OR = 0.68, 95%CI 0.51-0.81). However, morbid obesity was associated with decreased 30-day (OR = 0.73, 95%CI 0.54-0.99), but not 90-day mortality (OR = 0.83, 95%CIs 0.62-1.11).

Implications:
Contrary to what was expected, obese and morbidly obese patients had lower rates of 30- and 90-day mortality compared to normal BMI patients with sepsis.

Impacts:
Further studies are needed to assess the association of obesity in patients with sepsis in other morbidity and health care utilization outcomes due to the magnitude of this growing population in the US.


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