|Title||Obesity and 1-year outcomes in older Americans with severe sepsis.|
|Publication Type||Journal Article|
|Year of Publication||2014|
|Authors||Prescott, HC, Chang, VW, O'Brien, Jr, JM, Langa, KM, Iwashyna, TJ|
|Journal||Crit Care Med|
|Date Published||2014 Aug|
|Keywords||Aged, Aged, 80 and over, Body Mass Index, Cohort Studies, Comorbidity, Critical Illness, Delivery of Health Care, Female, Health Expenditures, Hospitalization, Humans, Male, Medicare, Middle Aged, Obesity, Sepsis, Survival Rate, Survivors, United States|
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.
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.
Export Date: 21 April 2014 Source: Scopus Article in Press
|User Guide Notes|
|Endnote Keywords|| |
body mass index/critical care/outcomes assessment/prognosis/sepsis/utilization
|Endnote ID|| |
|Alternate Journal||Crit Care Med|
|PubMed Central ID||PMC4205159|
|Grant List||T32 HL007749 / HL / NHLBI NIH HHS / United States |
U01 AG009740 / AG / NIA NIH HHS / United States
P30 DK092926 / DK / NIDDK NIH HHS / United States
R01 AG030155 / AG / NIA NIH HHS / United States
U01 AG09740 / AG / NIA NIH HHS / United States
K08 HL091249 / HL / NHLBI NIH HHS / United States