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Obesity and 1-Year Outcomes in Older Americans With Severe Sepsis*

Prescott, Hallie C. MD1; Chang, Virginia W. MD, PhD2; O’Brien, James M. Jr MD, MS3; Langa, Kenneth M. MD, PhD1,4,5; Iwashyna, Theodore J. MD, PhD1,4,5

doi: 10.1097/CCM.0000000000000336
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Objectives: Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index.

Design: Observational cohort study.

Setting: U.S. hospitals.

Patients: We analyzed 1,404 severe sepsis hospitalizations (1999–2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.

Interventions: None.

Measurements and Main Results: Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39–0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26–0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64).

Conclusions: Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.

Supplemental Digital Content is available in the text.

1Department of Medicine, University of Michigan, Ann Arbor, MI.

2Steindhart School of Culture, Education, and Human Development, New York University, New York, NY.

3Riverside Methodist Hospital, Columbus, OH.

4VA Center for Clinical Management Research, HSR&D Center for Excellence, Ann Arbor, MI.

5Institute for Social Research, Ann Arbor, MI.

* See also p. 1935.

Dr. Prescott has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Prescott’s institution received grant support (this work was supported by grants K08 HL091249, R01 AG030155, and U01 AG09740 from the National Institutes of Health [NIH] and IIR 11–109 from the Department of Veterans Affairs Health Services Research and Development Service). Dr. Chang received support for travel from other universities (for invited research presentations) and received support for article research from American Diabetes Association. Her institution received grant support from the American Diabetes Association and the NIH. Dr. O’Brien served as board member for Sepsis Alliance (Chairman of the Board), consulted for Ortho Clinical Diagnostics (Honorarium donated to Sepsis Alliance. Travel and accommodations provided to Dr. O’Brien), lectured for Siemens (Honorarium donated to Sepsis Alliance), lectured for GE (Honorarium donated to Sepsis Alliance. Travel and board provided), received support for travel from Wolters Kluwer, served on the Global Sepsis Alliance Executive Board, and organizes a charity tournament to benefit Sepsis Alliance (Spike Out Sepsis). Dr. Langa disclosed “Government” work and received support for article research from the NIH. His institution received grant support from the NIH. Dr. Iwashyna received support for article research from the NIH. His institution received grant support from the NIH and VA (competitively awarded grants).

For information regarding this article, E-mail: hprescot@med.umich.edu

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins