Beverley Kok1,2, Constantine J Karvellas1,2, Juan G Abraldes1, Rajiv Jalan3, Vinay Sundaram4, David Gurka5, Sean Keenan6, Aseem Kumar7, Greg Martinka8, Brian Bookatz9, Gordon Wood10, Anand Kumar11. 1. Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada. 2. Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada. 3. Institute for Liver and Digestive Health, University College London, London, UK. 4. Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 5. Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA. 6. Royal Columbian Hospital, New Westminster, BC, Canada. 7. Laurentian University, Sudbury, Ontario, Canada. 8. Richmond General Hospital, Richmond, British Columbia, Canada. 9. Brandon General Hospital, Brandon, Manitoba, Canada. 10. Victoria General Hospital, Victoria, British Columbia, Canada. 11. Section of Critical Care Medicine and Section of Infectious Disease, Health Sciences Center and St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
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.
BACKGROUND & AIMS: The prevalence of obesity in cirrhosis is rising. The impact of obesity in critically ill cirrhoticpatients with sepsis/septic shock has not been evaluated. This study aimed to examine the relationship between obesity and mortality in cirrhoticpatients admitted to the intensive care unit with septic shock. METHODS: A retrospective cohort study of all cirrhoticpatients 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%. Obesepatients 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 cirrhoticpatients and independently associated with increased in-hospital mortality.