Association Between Body Mass Index and Mortality in Patients With Gram-Negative Bloodstream Infections. Issue 2 (March 2019)

• Record Type: Journal Article
• Authors: Lines, Jacob; Yang, Zhengguan; Bookstaver, Paul Brandon; Catchings, Erin; Justo, Julie Ann; Kohn, Joseph; Albrecht, Helmut; Al-Hasan, Majdi N.
• Is Part Of: Infectious diseases in clinical practice. Volume 27:Issue 2(2019:Mar.)
• Publication Date: 2019-03
• Subjects: bacteremia -- sepsis -- survival -- outcome -- statins; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Periodicals; Electronic journals; 616.9
• DOI: 10.1097/IPC.0000000000000711
• Languages: English
• ISSNs: 1056-9103

Abstract

Abstract : Background: Obesity is an established risk factor for many infections. Emerging data demonstrate that increased body mass index (BMI) may paradoxically protect against mortality in several disease processes. The interaction between BMI and mortality in gram-negative bloodstream infections (GN-BSIs) remains unclear. Aim: This retrospective cohort study examines the impact of BMI on mortality in patients with GN-BSI. Materials and Methods: Hospitalized adults with first episodes of GN-BSI from 2010 to 2015 were identified. Patients were grouped by BMI in kilograms per meter squared as normal weight (18.5–24.9; reference), overweight (25.0–29.9), obese (30.0–39.9), and morbidly obese (≥40). Multivariate Cox proportional hazards regression was used to examine risk factors for 28-day mortality after GN-BSI. Results: Among 1069 unique patients with GN-BSI, 352 (33%) were normal weight, 319 (30%) were overweight, 303 (28%) were obese, and 95 (9%) were morbidly obese. Overall, mean age was 63 years, and 54% were women. Crude 28-day mortality was higher in the normal-weight group (21.5%) than in the overweight (11.7%), obese (11.8%), and morbidly obese groups (8.7%; P = 0.003). After adjustments for age, chronic comorbidities, acute severity of illness, and antimicrobial therapy in a multivariate model, overweight BMI remained independently associated with reduced mortality (adjusted hazards ratio [aHR], 0.53; 95% confidence intervals [CI], 0.31–0.88; P = 0.01). There was no significant reduction in mortality in obese (aHR, 0.72; 95% CI, 0.43–1.15; P = 0.17) and morbidly obese patients (aHR, 0.71; 95% CI, 0.27–1.56; P = 0.41). Conclusions: Compared with normal BMI, overweight patients had improved survival after GN-BSI. However, this potential protective effect was lost in obese and morbidly obese patients. Abstract : The impact of weight on outcome of patients with serious infections, including bloodstream infections (BSIs), remains unclear. In this retrospective cohort study, overweight patients with Gram-negative BSIs had lower 28-day mortality than those with normal body mass index. However, this potential protective effect of weight was lost in obese and morbidly obese patients. Future prospective studies evaluating the short- and long-term effect of weight on survival following BSI are warranted.