ORLANDO — The use of a standardized therapeutic approach for treating severe sepsis may help to mitigate the increased mortality associated with a high body mass index, according to research presented at the annual congress of the Society of Critical Care Medicine.
Dr. Puneet S. Garcha and his colleagues at Drexel University, Philadelphia, performed a retrospective review of 62 patients with severe sepsis who were treated under a standardized therapeutic sepsis guideline based on early goal-directed therapy. The patients were admitted to a tertiary care unit medical ICU over a 15-month period between December 2004 and March 2006.
Patients with a body mass index (BMI) of 30 kg/m
The researchers compared 41 patients with a BMI of 29.9 or less to 21 patients with a BMI of 30 or greater. Patients in both groups had similar mean Acute Physiology and Chronic Health Evaluation (APACHE II) scores (25.8 in the lower BMI group, compared with 25.3 in the higher BMI group). In addition, the time to achievement of resuscitation goals and time from onset of severe sepsis to antibiotic administration was similar in both groups.
The researchers analyzed 28-day mortality, number of days on a ventilator, days spent in the ICU, and days in the hospital in an effort to see the impact of higher BMI on outcomes. None of the factors was statistically significant.
The 28-day mortality among patients with a BMI of 29.9 or less was 32.7%, compared with 34% among those with a BMI of 30 or greater.
While higher BMI was not associated with an increase in 28-day mortality, the researchers did observe a trend in the data indicating increased resource use in that group. For example, patients in the higher BMI group seemed to spend more time in the hospital. Among survivors, those with a BMI of 29.9 or less spent 48 days in the hospital on average, compared with 59 days on average among survivors in the higher BMI group. The difference approached statistical significance (P =.06).
Long-term follow-up will be necessary to determine if the mortality benefit seen at 28 days continues over time despite the morbidity and risk of complications seen in higher BMI patients, the researchers wrote.