BMC Infect Dis. 2013 Aug 16;13:377. doi: 10.1186/1471-2334-13-377.
Recent sepsis guidelines have focused on the early identification and risk stratification of patients on presentation. Obesity is associated with alterations in multiple inflammatory regulators similar to changes seen in sepsis, suggesting a potential interaction between the presence of obesity and the severity of illness in sepsis.
We performed a retrospective chart review of patients admitted with a primary billing diagnosis of sepsis at a single United States university hospital from 2007 to 2010. Seven hundred and ninety-two charts were identified meeting inclusion criteria. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2. The data recorded included age, race, sex, vital signs, laboratory values, length of stay, comorbidities, weight, height, and survival to discharge. A modified APACHE II score was calculated to estimate disease severity. The primary outcome variable was inpatient mortality.
Survivors had higher average BMI than nonsurvivors (27.6 vs. 26.3 kg/m2, p = 0.03) in unadjusted analysis. Severity of illness and comorbid conditions including cancer were similar across BMI categories. Increased incidence of diabetes mellitus type 2 was associated with increasing BMI (p < 0.01) and was associated with decreased mortality, with an odds ratio of 0.53 compared with nondiabetic patients. After adjusting for age, gender, race, severity of illness, length of stay, and comorbid conditions, the trend of decreased mortality for increased BMI was no longer statistically significant, however diabetes continued to be strongly protective (odds ratio 0.52, p = 0.03).
This retrospective analysis suggests obesity may be protective against mortality in septic inpatients. The protective effect of obesity may be dependent on diabetes, possibly through an unidentified hormonal intermediary. Further prospective studies are necessary to elaborate the specific mechanism of this protective effect.
最近的脓毒症指南侧重于患者就诊时的早期识别和风险分层。肥胖与多种炎症调节剂的改变有关，类似于脓毒症中观察到的变化，这表明肥胖的存在与脓毒症的疾病严重程度之间存在潜在的相互作用。
我们对 2007 年至 2010 年期间在美国一家大学医院因主要计费诊断为脓毒症而入院的患者进行了回顾性病历审查。确定了 792 份符合纳入标准的病历。肥胖定义为体质量指数（BMI）≥30 kg/m2。记录的数据包括年龄、种族、性别、生命体征、实验室值、住院时间、合并症、体重、身高和出院时的存活情况。计算改良的 APACHE II 评分以评估疾病严重程度。主要结局变量是住院死亡率。
在未调整分析中，幸存者的平均 BMI 高于非幸存者（27.6 与 26.3 kg/m2，p=0.03）。各 BMI 类别之间的疾病严重程度和合并症情况相似。2 型糖尿病的发病率随着 BMI 的增加而增加（p<0.01），与死亡率降低相关，与非糖尿病患者相比，比值比为 0.53。在校正年龄、性别、种族、疾病严重程度、住院时间和合并症后，BMI 增加与死亡率降低的趋势不再具有统计学意义，但糖尿病仍然具有很强的保护作用（比值比 0.52，p=0.03）。
这项回顾性分析表明肥胖可能对脓毒症住院患者的死亡率具有保护作用。肥胖的保护作用可能依赖于糖尿病，可能通过未识别的激素中介起作用。需要进一步的前瞻性研究来阐述这种保护作用的具体机制。
