The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study. (18th December 2017)

• Record Type: Journal Article
• Authors: Kok, Beverley; Karvellas, Constantine J.; Abraldes, Juan G.; Jalan, Rajiv; Sundaram, Vinay; Gurka, David; Keenan, Sean; Kumar, Aseem; Martinka, Greg; Bookatz, Brian; Wood, Gordon; Kumar, Anand
• Other Names: Arabi Yaseen investigator.; Dellinger Phillip investigator.; Dial Sandra investigator.; Dodek Peter investigator.; Ellis Paul investigator.; Feinstein Daniel investigator.; Gurka Dave investigator.; Guzman Jose investigator.; Kramer Andreas investigator.; Lapinsky Stephen investigator.; Laporta Denny investigator.; Light Bruce investigator.; Maki Dennis investigator.; Mirzanejad Yazdan investigator.; Parrillo Joseph E. investigator.; Patel Gourang investigator.; Roberts Dan investigator.; Ronald John investigator.; Simon Dave investigator.; Skrobik Yoanna investigator.; Wood Kenneth E. investigator.; Ahsan Muhammed Wali investigator.; Bahrainian Mozdeh investigator.; Bohmeier Rob investigator.; Carter Lindsey investigator.; Chou Harris investigator.; Delgra Sofia investigator.; Egbujuo Collins investigator.; Fu Winnie investigator.; Gonzales Catherine investigator.; Gulati Harleena investigator.; Gutierrez Oliver investigator.; Jindal Aparna investigator.; Halmarson Erica investigator.; Haque Ziaul investigator.; Harvey Johanne investigator.; Esfahani Koohpayehzadeh investigator.; Khan Farah investigator.; Kolesar Laura investigator.; Kravetsky Laura investigator.; Kumar Runjun investigator.; Merali Nasreen investigator.; Muggaberg Sheri investigator.; Paulin Heidi investigator.; Peters Cheryl investigator.; Richards Jody investigator.; Serrano Honorata investigator.; Singh Amrinder investigator.; Sullivan Katherine investigator.; Suppes Robert investigator.; Taiberg Leo investigator.; Tchokonte Ronny investigator.; Torshizi Ahmadi investigator.; Wiebe Kym investigator.;
• Is Part Of: Liver international. Volume 38:Number 7(2018)
• Page Start: 1230
• Page End: 1241
• Publication Date: 2017-12-18
• Subjects: cirrhosis -- mortality -- obesity -- septic shock; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.13648
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background & Aims: The prevalence of obesity in cirrhosis is rising. The impact of obesity in critically ill cirrhotic patients with sepsis/septic shock has not been evaluated. This study aimed to examine the relationship between obesity and mortality in cirrhotic patients admitted to the intensive care unit with septic shock. Methods: A retrospective cohort study of all cirrhotic patients with septic shock (n = 362) and a recorded body mass index (BMI) from an international, multicentre (CATSS) database (1996‐2015) was performed. Patients were classified by BMI as per WHO categories. Primary outcome was in‐hospital mortality. Multivariate logistic regression analyses were carried out to determine independent associations with outcome. Results: In this analysis, mean age was 56.4 years, and 62% were male. Median BMI was 26.3%, and 57.7% were overweight/obese. In‐hospital mortality was 71%. Obese patients were more likely to have comorbidities of cardiac disease, lung disease and diabetes. Compared to survivors (n = 105), non‐survivors (n = 257) had significantly higher MELD and APACHEII scores and higher requirements for renal replacement therapy and mechanical ventilation ( P < .03 for all). Using multivariable logistic regression, increase in BMI (OR 1.07, P = .034), time delay to appropriate antimicrobials (OR 1.16 per hour, P = .003), APACHEII (OR 1.12 per unit, P = .008) and peak lactate (OR 1.15, P = .028) were independently associated with in‐hospital mortality. Conclusions: Septic shock in cirrhosis carries a high mortality. Increased BMI is common in critically ill cirrhotic patients and independently associated with increased in‐hospital mortality.