Body Mass Index and 90-Day Mortality Among 35,406 Danish Patients Hospitalized for Infection

被引:21
作者
Gribsholt, Sigrid B. [1 ,2 ,3 ]
Pedersen, Lars [1 ]
Richelsen, Bjorn [3 ]
Sorensen, Henrik T. [1 ]
Thomsen, Reimar W. [1 ]
机构
[1] Aarhus Univ, Dept Clin Epidemiol, Aarhus, Denmark
[2] Aarhus Univ Hosp, Dept Endocrinol & Internal Med, Aarhus, Denmark
[3] Aarhus Univ Hosp, Steno Diabet Ctr Aarhus, Aarhus, Denmark
关键词
OBESITY PARADOX; TUBERCULOSIS; VALIDITY; DATABASE; OUTCOMES; SYSTEM;
D O I
10.1016/j.mayocp.2020.06.062
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To examine the association between body mass index (BMI) and mortality after hospitalization for infection because obesity is associated with increased energy reserves that may protect against death from severe infections. Patients and Methods: Of 76,044 patients admitted with a primary infection diagnosis from January 1, 2011, to September 30, 2015, in Central Denmark, we examined a subgroup of 35,406 patients with a known BMI. We compared the 90-day death risk among patients with underweight, overweight, or obesity with a reference cohort of normal-weight patients. We also examined the impact of comorbid conditions, including cancer, tobacco smoking, and recent weight changes, on the associations and adjusted for other potential confounding factors. Results: The 90-day mortality after hospital admission was 9.8% (3479 of 35,406) for any infection, 10.5% (466 of 4425) for urinary tract infection, 17.3% (1536 of 8855) for pneumonia, 24.9% (986 of 3964) for sepsis, and 6.2% (114 of 1831) for skin infection. The 90-day adjusted hazard ratio (aHR) for death was substantially increased in patients with underweight (aHR, 1.75; 95% CI, 1.58 to 1.94) compared with normal-weight patients. In contrast, mortality aHRs were decreased in patients with overweight (aHR, 0.64; 95% CI; 0.58 to 0.69) and obesity (aHR, 0.55; 95% CI; 0.49 to 0.62). Mortality reductions with overweight and obesity were consistent for all major infection types and remained robust independent of recent weight changes, smoking status, or comorbid conditions. Mortality was highest in patients without an apparent reason for their underweight (smoking/known disease), suggesting a role of undiagnosed comorbid conditions. Conclusion: We found evidence that higher BMI (overweight and obesity) is associated with improved survival following acute hospitalization for infection, whereas underweight increases the risk for death. (C) 2020 Mayo Foundation for Medical Education and Research
引用
收藏
页码:550 / 562
页数:13
相关论文
共 45 条
  • [1] Change in Body Mass Index Associated With Lowest Mortality in Denmark, 1976-2013
    Afzal, Shoaib
    Tybjaerg-Hansen, Anne
    Jensen, Gorm B.
    Nordestgaard, Borge G.
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2016, 315 (18): : 1989 - 1996
  • [2] [Anonymous], 2012, OPEN INFECT DIS J, V6, P27
  • [3] How obesity impacts outcomes of infectious diseases
    Atamna, A.
    Elis, A.
    Gilady, E.
    Gitter-Azulay, L.
    Bishara, J.
    [J]. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 2017, 36 (03) : 585 - 591
  • [4] Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies
    Aune, Dagfinn
    Keum, NaNa
    Giovannucci, Edward
    Fadnes, Lars T.
    Boffetta, Paolo
    Greenwood, Darren C.
    Tonstad, Serena
    Vatten, Lars J.
    Riboli, Elio
    Norat, Teresa
    [J]. BMJ-BRITISH MEDICAL JOURNAL, 2016, 353
  • [5] The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement
    Benchimol, Eric I.
    Smeeth, Liam
    Guttmann, Astrid
    Harron, Katie
    Moher, David
    Petersen, Irene
    Sorensen, Henrik T.
    von Elm, Erik
    Langan, Sinead M.
    [J]. PLOS MEDICINE, 2015, 12 (10)
  • [6] The obesity paradox in community-acquired bacterial pneumonia
    Corrales-Medina, Vicente F.
    Valayam, Josemon
    Serpa, Jose A.
    Rueda, Adriana M.
    Musher, Daniel M.
    [J]. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, 2011, 15 (01) : E54 - E57
  • [7] Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents
    Di Angelantonio, Emanuele
    Bhupathiraju, Shilpa N.
    Wormser, David
    Gao, Pei
    Kaptoge, Stephen
    de Gonzalez, Amy Berrington
    Cairns, Benjamin J.
    Huxley, Rachel
    Jackson, Chandra L.
    Joshy, Grace
    Lewington, Sarah
    Manson, JoAnn E.
    Murphy, Neil
    Patel, Alpa V.
    Samet, Jonathan M.
    Woodward, Mark
    Zheng, Wei
    Zhou, Maigen
    Bansal, Narinder
    Barricarte, Aurelio
    Carter, Brian
    Cerhan, James R.
    Collins, Rory
    Smith, George Davey
    Fang, Xianghua
    Franco, Oscar H.
    Green, Jane
    Halsey, Jim
    Hildebrand, Janet S.
    Jung, Keum Ji
    Korda, Rosemary J.
    McLerran, Dale F.
    Moore, Steven C.
    O'Keeff, Linda M.
    Paige, Ellie
    Ramond, Anna
    Reeves, Gillian K.
    Rolland, Betsy
    Sacerdote, Carlotta
    Sattar, Naveed
    Sofianopoulou, Eleni
    Stevens, June
    Thun, Michael
    Ueshima, Hirotsugu
    Yang, Ling
    Yun, Young Duk
    Willeit, Peter
    Banks, Emily
    Beral, Valerie
    Chen, Zhengming
    [J]. LANCET, 2016, 388 (10046) : 776 - 786
  • [8] The obesity paradox: weighing the benefit
    Doehner, Wolfram
    Clark, Andrew
    Anker, Stefan D.
    [J]. EUROPEAN HEART JOURNAL, 2010, 31 (02) : 146 - 148
  • [9] Ehrenstein Vera, 2010, Clin Epidemiol, V2, P273, DOI 10.2147/CLEP.S13458
  • [10] A Nearly Unavoidable Mechanism for Collider Bias with Index-Event Studies
    Flanders, W. Dana
    Eldridge, Ronald C.
    McClellan, William
    [J]. EPIDEMIOLOGY, 2014, 25 (05) : 762 - 764