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Clinical Research

The obesity paradox in younger adult patients with sepsis: analysis of the MIMIC-IV database

International Journal of Obesity (2024)Cite this article

Subjects

Abstract

Background

The obesity paradox suggests that individuals with obesity may have a survival advantage against specific critical illnesses, including sepsis. However, whether this paradox occurs at younger ages remains unclear. Therefore, we aimed to investigate whether obesity could improve survival in younger adult patients with sepsis.

Methods

We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients with Sequential Organ Failure Assessment score ≥2 and suspected infection at the time of ICU admission were identified as having sepsis, following the Sepsis-3 definition. Individuals were classified into the obesity (BMI ≥30 kg/m²) and non-obesity (BMI <30 kg/m²) groups. Patients aged <50 and ≥50 years were categorized as younger adult patients and older patients, respectively.

Results

Of 73,181 patients in the MIMIC-IV ICU database, 18,120 satisfied the inclusion criteria: 2642 aged <50 years and 15,478 aged ≥50 years. The Kaplan–Meier curve showed that obesity was not associated with an improved mortality rate among younger adult patients with sepsis (log-rank test: P = 0.197), while obesity exhibited a survival benefit in older patients with sepsis (log-rank test: P < 0.001). After propensity score matching, in-hospital mortality did not differ significantly between the obesity and non-obesity groups (13.3% vs. 12.2%; P = 0.457) in the younger adult patients with sepsis. Multivariate logistic regression analysis revealed that BMI was not an independent risk factor for in-hospital mortality in younger adult patients with sepsis (underweight: adjusted odds ratio [aOR] 1.72, P = 0.076; overweight: aOR 0.88, P = 0.437; obesity: aOR 0.93, P = 0.677; and severe obesity: aOR 1.22, P = 0.580, with normal weight as the reference).

Conclusion

Contrary to findings regarding older patients with sepsis, our findings suggest that the obesity paradox does not apply to younger adult patients with sepsis.

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Fig. 1: Flowchart of study participant enrollment.
Fig. 2: Kaplan-Meier survival curves of patients with sepsis.

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Data availability

The dataset analyzed in the current study is available on the MIMIC-IV website (https://physionet.org/content/mimiciv/2.2/).

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Acknowledgements

We appreciate the Medical Illustration & Design (MID) team, a member of Medical Research Support Services of Yonsei University College of Medicine, for their excellent support with medical illustration.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Yongseop Lee, Sangmin Ahn, Min Han, Jung Ah Lee, Jin Young Ahn, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Joon-Sup Yeom & Jung Ho Kim

  2. Department of Internal Medicine, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea

    Se Hee Park

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Contributions

KJH and PSH conceived the idea for the study. LY contributed to data curation, formal analysis, investigation, visualization, and original draft writing. AJY, JSJ, KNS, CJY, YJ, and KJH contributed to supervision. All authors contributed to the review and editing of the manuscript.

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Correspondence to Se Hee Park or Jung Ho Kim.

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The authors declare no competing interests.

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The Institutional Review Board of the Beth Israel Deaconess Medical Center approved the study and waived the requirement for informed consent (IRB Protocol #2001P001699).

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Lee, Y., Ahn, S., Han, M. et al. The obesity paradox in younger adult patients with sepsis: analysis of the MIMIC-IV database. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01523-5

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