Introduction
Materials and methods
Subjects and setting
Definition of obesity
Clinical characteristics and sepsis interventions
Outcomes
Statistical analysis
Results
Baseline characteristics
Variables | < 18.50 Number = 196 | 18.50 to 24.99 Number = 1,020 | 25.0 to 29.99 Number = 816 | 30.0 to -39.99 Number = 680 | ≥ 40 Number = 170 | P value |
---|---|---|---|---|---|---|
Age (years), mean (SD) | 59.1 (19.2) | 62.2 (16.8) | 63.5 (15.9) | 62.2 (14.6) | 58.4 (13.0) | < 0.001 |
Gender, female, number (%) | 82 (41.8) | 390 (38.2) | 316 (38.7) | 334 (49.1) | 102 (60.0) | < 0.001 |
Actual body weight (kg), mean (SD) | 47.3 (7.1) | 63.4 (10.2) | 77.3 (10.1) | 93.4 (14.7) | 128.9 (28.1) | < 0.001 |
Ideal body weight (kg), mean (SD) | 61.7 (10.9) | 62.9 (11.5) | 62.4 (10.7) | 60.4 (12.0) | 58.3 (13.4) | < 0.001 |
Dosing body weight (kg), mean (SD) | 58.1 (9.7) | 63.0 (10.9) | 66.1 (10.4) | 68.6 (12.3) | 75.9 (15.8) | < 0.001 |
Height (cms), mean (SD) | 167.3 (10.6) | 168.8 (11.1) | 167.9 (10.1) | 166.3 (11.5) | 164.5 (13.3) | < 0.001 |
BMI (kg/m2), mean (SD) | 16.8 (1.3) | 22.2 (1.8) | 27.3 (1.4) | 33.6 (2.7) | 47.4 (7.4) | < 0.001 |
Mechanical ventilation, number (%) | 146 (74.5) | 777 (76.2) | 605 (74.1) | 491 (72.2) | 128 (75.3) | 0.48 |
APACHE II, mean (SD) | 25.5 (8.0) | 25.7 (8.1) | 25.6 (8.4) | 25.4 (7.9) | 24.4(7.3) | 0.43 |
Admission physiologic data, mean (SD) | ||||||
Heart rate (beats/minute) | 120.9 (30.3) | 119.2 (29.4) | 116.7 (29.9) | 119.1 (29.5) | 112.2 (31.0) | 0.02 |
Respiratory rate (beats/minute) | 29.0 (8.8) | 27.0 (10.2) | 26.6 (10.4) | 26.0 (10.0) | 25.8 (9.1) | 0.005 |
Temperature (°C) | 37.2 (1.8) | 37.5 (1.7) | 37.7 (1.7) | 37.8 (1.6) | 37.8 (1.7) | < 0.001 |
Mean arterial pressure (mmHg) | 53.3 (13.3) | 56.6 (16.5) | 58.0 (19.0) | 60.3 (20.1) | 62.6 (22.2) | < 0.001 |
Co-morbidities, number (%) | ||||||
Immunosuppressive disorder | 56 (28.6) | 300 (29.4) | 213 (26.1) | 188 (27.7) | 32 (18.8) | 0.06 |
Liver failure | 14 (7.1) | 91 (8.9) | 67 (8.2) | 53 (7.8) | 19 (11.2) | 0.59 |
New York Heart Association class IV heart failure | 16 (8.2) | 70 (6.9) | 95 (11.6) | 77 (11.3) | 21 (12.4) | 0.002 |
Severe COPD (requiring medication or oxygen) | 22 (11.2) | 102 (10.0) | 88 (10.8) | 83 (12.2) | 32 (18.8) | 0.02 |
Chronic renal failurea | 35 (17.9) | 155 (15.2) | 126 (15.4) | 100 (14.7) | 34 (20.0) | 0.43 |
Chronic renal failure-dialysis dependence | 17 (8.7) | 81 (7.9) | 45 (5.5) | 41 (6.0) | 12 (7.1) | 0.20 |
Diabetes mellitus (medication dependent) | 10 (5.1) | 127 (12.5) | 141 (17.3) | 159 (23.4) | 45 (26.5) | < 0.001 |
Diabetes mellitus (insulin-dependent) | 11 (5.6) | 76 (7.5) | 82 (10.1) | 80 (11.8) | 35 (20.6) | < 0.001 |
Alcohol abuse | 29 (14.8) | 162 (15.9) | 107 (13.1) | 76 (11.2) | 15 (8.8) | 0.02 |
Elective surgery | 28 (14.3) | 160 (15.7) | 159 (19.5) | 130 (19.1) | 25 (14.7) | 0.09 |
Emergency surgery/trauma | 17 (8.7) | 97 (9.5) | 73 (9.0) | 49 (7.2) | 8 (4.7) | 0.19 |
No co-morbidity | 58 (29.6) | 285 (27.9) | 227 (27.8) | 170 (25.0) | 38 (22.4) | 0.33 |
Any co-morbidity | 138 (70.4) | 735 (72.1) | 589 (72.2) | 510 (75.0) | 132 (77.6) | |
Laboratory findings on day-1, mean (SD) | ||||||
White blood count (×109/L) | 16.1 (16.4) | 16.1 (15.3) | 16.5 (16.9) | 17.9 (16.1) | 16.0 (10.6) | 0.20 |
Creatinine (μmol/L) | 164.3 (148.2) | 195.3 (160.6) | 207.7 (167.9) | 221.7 (165.2) | 242.3 (201.8) | < 0.001 |
Bicarbonate (mmol/L) | 19.4 (6.7) | 19.1 (6.4) | 18.8 (6.4) | 19.0 (6.7) | 20.1 (6.1) | 0.32 |
Bilirubin (μmol/L) | 33.2 (54.4) | 41.5 (76.3) | 44.1 (92.5) | 41.5 (68.1) | 31.1 (76.0) | 0.29 |
Platelets (×109/L) | 206.9 (140.5) | 198.4 (156.6) | 185.6 (133.3) | 210.3 (140.6) | 223.5 (132.2) | 0.004 |
International normalized ratio | 1.8 (1.2) | 1.7 (1.1) | 1.8 (1.1) | 1.8 (1.4) | 1.7 (1.3) | 0.78 |
Creatinine clearance (mL/minute), mean (SD) | ||||||
MDRDb equation | 85.9 (148.2) | 56.5 (49.3) | 48.1 (40.6) | 43.1 (36.0) | 37.1 (27.6) | < 0.001 |
Cockcroft-Gault equation | 69.6 (98.6) | 49.8 (41.3) | 42.3 (34.3) | 37.9 (29.9) | 33.6 (22.7) | < 0.001 |
Source of infection, number (%) | ||||||
Community acquired infection | 102 (52.0) | 555 (54.4) | 410 (50.3) | 350 (51.5) | 105 (61.8) | 0.06 |
Nosocomial infection | 94 (48.0) | 465 (45.6) | 406 (49.8) | 330 (48.5) | 65 (38.2) | |
Bacteremia, Number (%) | 68 (34.7) | 361 (35.4) | 289 (35.4) | 266 (39.1) | 48 (28.2) | 0.10 |
Organ failures on day-1, number (%) | ||||||
Cardiovascular | 196 (100) | 1020 (100) | 816 (100) | 680 (100) | 170 (100) | * |
Renal | 80 (40.8) | 550 (53.9) | 501 (61.4) | 447 (65.7) | 112 (65.9) | < 0.001 |
Respiratory | 146 (74.5) | 777 (76.2) | 605 (74.1) | 491 (72.2) | 128 (75.3) | 0.48 |
Hematologic | 56 (28.6) | 261 (25.6) | 241 (29.5) | 163 (24.0) | 29 (17.1) | 0.006 |
Metabolic | 110 (56.1) | 551 (54.0) | 441 (54.0) | 367 (54.0) | 91 (53.5) | 1.00 |
Central nervous system | 47 (24.0) | 289 (28.3) | 210 (25.7) | 168 (24.7) | 45 (26.5) | 0.44 |
Hepatic | 32 (16.3) | 195 (19.1) | 157 (19.2) | 144 (21.2) | 31 (18.2) | 0.60 |
Coagulation | 89 (45.4) | 454 (44.5) | 350 (42.9) | 284 (41.8) | 69 (40.6) | 0.70 |
Country, number (%) | ||||||
Canada | 147 (75.0) | 813 (79.7) | 655 (80.3) | 548 (80.6) | 130 (76.5) | 0.15 |
USA | 28 (14.3) | 101 (9.9) | 90 (11.0) | 75 (11.0) | 28 (16.5) | |
Saudi Arabia | 21 (10.7) | 106 (10.4) | 71 (8.7) | 57 (8.4) | 12 (7.1) | |
Period, number (%) | ||||||
≤ 1997 | 57 (29.1) | 301 (29.5) | 218 (26.7) | 191 (28.1) | 32 (18.8) | 0.18 |
1998 to 2000 | 72 (36.7) | 378 (37.1) | 292 (35.8) | 235 (34.6) | 67 (39.4) | |
2001 to 2002 | 57 (29.1) | 296 (29.0) | 265 (32.5) | 207 (30.4) | 62 (36.5) | |
≥ 2003 | 10 (5.1) | 45 (4.4) | 41 (5.0) | 47 (6.9) | 9 (5.3) |
Microbiologic data and sites of infections
Number (%) | < 18.50 Number = 196 | 18.50 to 24.99 Number = 1,020 | 25.0 to29.99 Number = 816 | 30.0 to 39.99 Number = 680 | ≥ 40 Number = 170 | P value |
---|---|---|---|---|---|---|
Total culture negative | 49 (25.0) | 270 (26.5) | 242 (29.7) | 204 (30.0) | 53 (31.2) | 0.28 |
Total culture positive | 147 (75.0) | 750 (73.5) | 574 (70.3) | 476 (70.0) | 117 (68.8) | |
Gram-negative organisms | 72 (36.7) | 384 (37.7) | 281 (34.4) | 230 (33.8) | 45 (26.5) | 0.05 |
Escherichia coli | 23 (11.7) | 163 (16.0) | 115 (14.1) | 97 (14.3) | 19 (1.2) | 0.32 |
Klebsiella | 16 (8.2) | 62 (6.1) | 41 (5.0) | 36 (5.3) | 7 (4.1) | 0.38 |
Pseudomonas aeruginosa | 13 (6.6) | 68 (6.7) | 48 (5.9) | 28 (4.1) | 8 (4.7) | 0.23 |
Enterobacter species | 5 (2.6) | 27 (2.7) | 21 (2.6) | 25 (3.7) | 1 (0.6) | 0.25 |
Haemophilus influenzae | 6 (3.1) | 12 (1.2) | 10 (1.2) | 8 (1.2) | 3 (1.8) | 0.29 |
Acinetobacter species | 4 (2.0) | 10 (1.0) | 6 (0.8) | 11 (1.6) | 2 (1.2) | 0.38 |
Other Gram-negative bacilli | 5 (2.6) | 42 (4.1) | 40 (4.9) | 25 (3.7) | 5 (2.9) | 0.49 |
Gram-positive organisms | 41 (20.9) | 247 (24.2) | 183 (22.4) | 168 (24.7) | 60 (35.3) | 0.007 |
Staphylococcus aureus | 19 (9.7) | 110 (10.8) | 81 (9.9) | 71 (10.4) | 22 (12.9) | 0.81 |
Streptococcus pneumonia | 9 (4.6) | 60 (5.9) | 37 (4.5) | 37 (5.4) | 8 (4.7) | 0.74 |
Streptococci faecalis | 4 (2.0) | 19 (1.9) | 17 (2.1) | 17 (2.5) | 6 (3.5) | 0.68 |
Streptococcus faecium | 2 (1.0) | 11 (1.1) | 8 (1.0) | 4 (0.6) | 3 (1.8) | 0.69 |
Group A streptococcus species | 2 (1.0) | 18 (1.8) | 17 (2.1) | 14 (2.1) | 10 (5.9) | 0.01 |
Other β-hemolytic streptococci | 3 (1.5) | 12 (1.2) | 10 (1.2) | 13 (1.9) | 8 (4.7) | 0.01 |
Other Gram-positive bacilli | 2 (1.0) | 17 (1.7) | 13 (1.6) | 12 (1.8) | 3 (1.8) | 0.97 |
Fungi/Yeast | 20 (10.2) | 77 (7.6) | 84 (10.3) | 62 (9.1) | 8 (4.7) | 0.08 |
Candida albicans | 11 (5.6) | 44 (4.3) | 50 (6.1) | 37 (5.4) | 7 (4.1) | 0.46 |
Other candida/yeast | 9 (4.6) | 33 (3.2) | 34 (4.2) | 25 (3.7) | 1 (0.6) | 0.18 |
Anaerobes | 10 (5.1) | 26 (2.6) | 17 (2.1) | 14 (2.1) | 4 (2.4) | 0.15 |
Other organisms | 4 (2.0) | 16 (1.6) | 9 (1.1) | 2 (0.3) | 0 | 0.04 |
Site of infection | ||||||
Lung | 95 (48.5) | 445 (43.6) | 301 (36.9) | 226 (33.2) | 53 (31.2) | < 0.001 |
Pneumonia | 91 (46.4) | 435 (42.7) | 296 (36.3) | 223 (32.8) | 51 (30.0) | 0.45 |
Empyema | 4 (2.0) | 10 (1.0) | 5 (0.6) | 3 (0.4) | 2 (1.2) | 0.22 |
Intraabdominal | 53 (27.0) | 299 (29.3) | 268 (32.8) | 228 (33.5) | 53 (31.2) | 0.20 |
Intraabdominal abscess | 5 (2.6) | 23 (2.3) | 23 (2.8) | 28 (4.1) | 8 (4.7) | 0.15 |
Ascending Cholangitis | 2 (1.0) | 23 (2.3) | 14 (1.7) | 13 (1.9) | 0 | 0.28 |
Cholecystitis | 1 (0.5) | 9 (0.9) | 14 (1.7) | 12 (1.8) | 1 (0.6) | 0.26 |
Ischemic bowel/bowel infarction | 7 (3.6) | 48 (4.7) | 51 (6.3) | 35 (5.2) | 5 (2.9) | 0.27 |
Viscous bowel perforation | 21 (10.7) | 104 (10.2) | 104 (12.8) | 66 (9.7) | 20 (11.8) | 0.34 |
Spontaneous bacterial peritonitis | 3 (1.5) | 31 (3.0) | 14 (1.7) | 17 (2.5) | 1 (0.6) | 0.16 |
Clostridium difficile enterocolitis/toxic megacolon | 7 (3.6) | 25 (2.5) | 18 (2.2) | 12 (1.8) | 2 (1.2) | 0.49 |
Infected pancreatic necrosis | 0 | 4 (0.4) | 11 (1.4) | 16 (2.4) | 3 (1.8) | 0.002 |
Others | 7 (3.6) | 32 (3.1) | 19 (2.3) | 29 (4.3) | 13 (7.7) | 0.009 |
Skin and soft tissue | 14 (7.1) | 69 (6.8) | 72 (8.8) | 79 (11.6) | 37 (21.8) | < 0.001 |
Cellulitis | 2 (1.0) | 7 (0.7) | 11 (1.4) | 19 (2.8) | 12 (7.1) | < 0.001 |
Necrotizing soft tissue infections | 5 (2.6) | 20 (2.0) | 16 (2.0) | 23 (3.4) | 12 (7.1) | 0.001 |
Others | 7 (3.6) | 42 (4.1) | 45 (5.5) | 37 (5.4) | 13 (7.7) | 0.22 |
Genitourinary | 17 (8.7) | 92 (9.0) | 80 (9.8) | 70 (10.3) | 18 (10.6) | 0.88 |
Intravascular catheter infection | 8 (4.1) | 38 (3.7) | 29 (3.6) | 36 (5.3) | 6 (3.5) | 0.46 |
Primary bloodstream infection (bacteremia without identifiable source) | 8 (4.1) | 49 (4.8) | 44 (5.4) | 37 (5.4) | 7 (4.1) | 0.87 |
Systemically disseminated infection (including yeast and tuberculosis) | 6 (3.1) | 29 (2.8) | 26 (3.2) | 18 (2.7) | 5 (2.9) | 0.98 |
Septic arthritis | 0 | 5 (0.5) | 7 (0.9) | 7 (1.0) | 6 (3.5) | 0.002 |
Variable | < 18.50 Number = 196 | 18.50 to 24.99 Umber = 1,020 | 25.0 to 29.99 Number = 816 | 30.0 to 39.99 Number = 680 | ≥ 40 Number = 170 | P value |
---|---|---|---|---|---|---|
Vasopressors used, Number (%) | ||||||
Dopamine | 117 (59.7) | 594 (58.2) | 465 (57.0) | 408 (60.0) | 91 (53.5) | 0.54 |
Norepinephrine | 122 (62.2) | 566 (55.5) | 480 (58.8) | 362 (53.2) | 86 (50.6) | 0.04 |
Phenylephrine | 58 (29.6) | 336 (32.9) | 255 (31.3) | 219 (32.2) | 48 (28.2) | 0.70 |
Epinephrine | 12 (6.1) | 45 (4.4) | 41 (5.0) | 31 (4.6) | 15 (8.8) | 0.15 |
Dobutamine | 16 (8.2) | 98 (9.6) | 84 (10.3) | 75 (11.0) | 18 (10.6) | 0.77 |
Vasopressor dose - at six hours, mean (SD) | ||||||
Dopamine (μcg/kg/minute) | 7.7 (7.3) | 6.7 (4.9) | 6.5 (4.7) | 6.4 (4.3) | 6.2 (5.1) | 0.22 |
Norepinephrine (μcg/kg/minute) | 0.39 (0.41) | 0.37 (0.60) | 0.33 (0.43) | 0.30 (0.47) | 0.18 (0.18) | 0.05 |
Phenylephrine (μcg/kg/minute) | 3.4 (4.1) | 2.2 (2.1) | 2.1 (2.3) | 2.0 (2.4) | 1.2 (1.4) | 0.003 |
Epinephrine (μcg/kg/minute) | 0.85 (0.61) | 0.30 (0.26) | 0.33 (0.73) | 0.18 (0.12) | 0.21 (0.18) | 0.04 |
Dobutamine (μcg/kg/minute) | 5.1 (1.7) | 4.4 (2.5) | 4.7 (2.9) | 4.0 (2.8) | 4.4 (2.5) | 0.82 |
Sepsis specific therapy | ||||||
Activated protein C, number (%) | 9 (4.6) | 36 (3.5) | 29 (3.6) | 42 (6.2) | 13 (7.7) | 0.01 |
Low-dose steroids, number (%) | 73 (37.2) | 305 (29.9) | 256 (31.4) | 222 (32.7) | 46 (27.1) | 0.19 |
Inappropriate antimicrobials therapy, number (%) | 46 (23.5) | 188 (18.4) | 160 (19.6) | 120 (17.7) | 31 (18.2) | 0.43 |
Single versus combined antimicrobial therapy, number (%) | 142 (72.5) | 711 (69.7) | 568 (69.6) | 456 (67.1) | 118 (69.4) | 0.62 |
Delay in antimicrobial therapy, mean (SD) | 17.8 (30.3) | 13.9 (24.0) | 15.1 (26.0) | 12.6 (18.8) | 16.7 (29.9) | 0.12 |
Others | ||||||
Pulmonary artery catheter, number (%) | 91 (46.4) | 513 (50.3) | 428 (52.5) | 386 (56.8) | 89 (52.4) | 0.04 |
Pulmonary capillary wedge pressure, (mmHG), mean (SD) | 15.0 (5.2) | 16.5 (6.1) | 17.6 (6.1) | 18.6 (6.4) | 20.5 (6.7) | < 0.001 |
Cardiac output (L/minute), mean (SD) | 6.4 (2.8) | 7.1 (3.2) | 7.6 (3.2) | 7.7 (3.4) | 8.7 (3.5) | < 0.001 |
Cardiac index(L/minute/m2), mean (SD) | 4.1 (1.7) | 4.1 (1.7) | 4.0 (1.6) | 3.8 (1.5) | 3.9 (1.5) | 0.11 |
Interventiona mean (SD) | < 18.50 Number = 196 | 18.50 to 4.99 Number = 1,020 | 25.0 to 29.99 Number = 816 | 30.0 to 39.99 Number = 680 | ≥ 40 Number = 170 | P value | Adjusted P valueb | Adjusted P valuec | |
---|---|---|---|---|---|---|---|---|---|
Crystalloid | Number = 1,506 (52.3%) | Number = 96 (49.0) | Number = 537 (52.6) | Number = 439 (53.8) | Number = 346 (50.9) | Number = 88 (51.8) | |||
Total (ml) | 2,580.3 (1,874.9) | 2,690.0 (2,050.2) | 2,861.7 (2,445.1) | 2,537.4 (2,032.0) | 2,602.3 (1,919.1) | 0.30 | 0.76 | 0.59 | |
Dose per kg of actual body weight (ml/kg) | 55.0 (40.1) | 43.2 (33.4) | 37.1 (30.8) | 27.7 (22.0) | 21.4 (16.8) | < 0.001 | < 0.001 | < 0.001 | |
Colloid | Number = 1,506 (52.3%) | Number = 96 (49.0) | Number = 537 (52.6) | Number = 439 (53.8) | Number = 346 (50.9) | Number = 88 (51.8) | |||
Total (ml) | 656.8 (864.8) | 509.8 (781.0) | 593.5 (788.7) | 705.5 (2,824.5) | 538.9 (939.8) | 0.44 | 0.79 | 0.31 | |
Dose per kg of actual body weight (ml/kg) | 14.3 (19.3) | 8.2 (12.7) | 7.7 (10.2) | 8.5 (44.2) | 4.3 (7.2) | 0.06 | 0.02 | < 0.001 | |
Packed red blood cell | Number = 94 (3.3%) | Number = 5 (2.6) | Number = 29 (2.8) | Number = 31(3.8) | Number = 24 (3.5) | Number = 5 (2.9) | |||
Total (ml) | 462.0 (180.7) | 601.0 (630.3) | 522.5 (243.2) | 502.0 (250.0) | 961.2 (781.5) | 0.26 | 0.68 | 0.79 | |
Dose per kg of actual body weight (ml/kg) | 9.6 (4.1) | 9.7 (10.8) | 6.8 (3.1) | 5.4 (3.0) | 7.3 (5.5) | 0.18 | 0.02 | 0.53 | |
Fresh frozen plasma | Number 70 (2.4%) | Number = 4 (2.0) | Number = 22 (2.2) | Number = 21(2.6) | Number = 18 (2.6) | Number = 5 (2.9) | |||
Total (ml) | 737.5 (715.7) | 498.7 (224.4) | 600.0 (336.9) | 526.8 (333.1) | 1,260.0 (1,34.9) | 0.01 | 0.005 | 0.02 | |
Dose per kg of actual body weight (ml/kg) | 18.9 (20.8) | 8.2 (4.4) | 7.8 (4.7) | 5.8 (3.7) | 10.4 (8.4) | 0.01 | 0.77 | 0.62 | |
Piperacillin/tazo-bactam | Number = 564 (19.6%) | Number = 46 (23.5) | Number = 214 (21.0) | Number = 145 (17.8) | Number = 129 (19.0) | Number = 30 (17.6) | |||
Total dose (mg) | 10,214.7 (3,216.3) | 10,714.8 (3,155.2) | 11,005.3 (3,074.6) | 10,754.8 (3,264.7) | 10,766.7 (2,699.9) | 0.68 | 0.06 | ||
Dose per kg of dosing body weight | 183.5 (66.7) | 174.8 (59.9) | 168.3 (56.1) | 161.0 (59.9) | 133.2 (40.2) | 0.001 | < 0.001 | ||
Cefotaxime | Number = 772 (26.8%) | Number = 51 (26.0) | Number = 297 (29.1) | Number = 212 (26.0) | Number = 173 (25.4) | Number = 39 (22.9) | |||
Total dose (mg) | 3,549.0 (1,932.0) | 3,477.8 (1,821.8) | 3,787.7 (1,857.4) | 3,359.8 (1,531.0) | 4,256.4 (2,220.9) | 0.02 | 0.006 | ||
Dose per kg of dosing body weight | 62.1 (38.5) | 56.5 (31.6) | 57.2 (28.7) | 49.7 (24.4) | 53.5 (30.2) | 0.04 | 0.32 | ||
Imipenem | Number = 242 (8.4%) | Number = 15 (7.7) | Number = 79 (7.7) | Number = 75 (9.2) | Number = 56 (8.2) | Number = 17 (10.0) | |||
Total dose (mg) | 1,566.7 (457.7) | 1,665.2 (597.5) | 1,693.3 (700.6) | 1,705.4 (796.5) | 1,426.5 (584.7) | 0.60 | 0.36 | ||
Dose per kg of dosing body weight | 25.9 (9.0) | 27.0 (9.9) | 24.9 (10.3) | 24.2 (13.1) | 7.3 (54.6) | 0.002 | < 0.001 | ||
Gentamycin | Number = 511 (17.7%) | Number = 33 (16.8) | Number = 184 (18.0) | Number = 149 (18.3) | Number = 122 (17.9) | Number = 23 (13.5) | |||
Total dose (mg) | 173.3 (82.4) | 219.9 (241.4) | 256.7 (229.4) | 239.4 (118.3) | 262.0 (121.9) | 0.18 | 0.01 | ||
Dose per kg of dosing body weight | 3.2 (1.5) | 3.6 (4.0) | 3.8 (3.2) | 3.3 (1.7) | 3.2 (1.6) | 0.63 | 0.96 | ||
Meropenem | Number = 277 (9.6%) | Number = 19 (9.7) | Number = 83 (8.1) | Number = 85 (10.4) | Number = 70 (10.3) | Number = 20 (11.8) | |||
Total dose (mg) | 2,342.1 (1,179.1) | 1,807.2 (791.8) | 1,865.9 (990.6) | 1,678.6 (920.9) | 2,050.0 (916.2) | 0.07 | 0.75 | ||
Dose per kg of dosing body weight | 40.7 (19.4) | 29.8 (15.0) | 28.8 (15.7) | 25.0 (15.5) | 26.1 (11.3) | 0.003 | 0.01 | ||
Levofloxacin | Number = 301 (10.4%) | Number = 28 (14.3) | Number = 110 (10.8) | Number = 81 (9.9) | Number = 62 (9.1) | Number = 20 (11.8) | |||
Total dose (mg) | 426.8 (118.2) | 489.8 (164.3) | 488.0 (205.8) | 441.5 (251.8) | 462.5 (91.6) | 0.32 | 0.82 | ||
Dose per kg of dosing body weight | 8.0 (2.5) | 8.0 (3.1) | 7.1 (2.8) | 6.2 (4.4) | 5.3 (1.3) | < 0.001 | < 0.001 | ||
Vancomycin | Number = 771 (26.8%) | Number = 53 (27.0) | Number = 261(25.6) | Number = 209 (25.6) | Number = 194 (28.5) | Number = 54 (32.1) | |||
Total dose (mg) | 1,292.5 (521.6) | 1,421.2 (630.3) | 1,380.4 (578.4) | 1,353.1 (623.0) | 1,441.4 (680.6) | 0.54 | 0.20 | ||
Dose per kg of dosing body weight | 28.5 (13.7) | 22.9 (11.2) | 17.9 (7.6) | 14.8 (7.2) | 11.3 (5.8) | < 0.001 | < 0.001 | ||
Ciprofloxacin | Number = 634 (22.0%) | Number = 39 (19.9) | Number = 218 (21.4) | Number = 186 (22.8) | Number = 165 (24.3) | Number = 26 (15.3) | |||
Total dose (mg) | 682.9 (280.3) | 674.4 (237.0) | 671.4 (255.8) | 670.3 (363.1) | 682.7 (210.2) | 1.0 | 0.13 | ||
Dose per kg of dosing body weight | 13.0 (5.2) | 10.9 (4.4) | 10.1 (4.1) | 9.1 (5.0) | 7.6 (2.6) | < 0.001 | < 0.001 | ||
Ampicillin | Number = 340 (11.8%) | Number = 19 (9.7) | Number = 122 (12.0) | Number = 115 (14.1) | Number = 70 (10.3) | Number = 14 (8.2) | |||
Total dose (mg) | 4,106.6 (1,788.6) | 4,002.3 (1,940.8) | 4,326.1 (2,019.7) | 4,072.1 (1,64.0) | 5,071.4 (2,302.7) | 0.31 | 0.01 | ||
Dose per kg of dosing body weight | 71.8 (38.4) | 64.8 (32.2) | 66.5 (33.0) | 61.3 (31.0) | 67.0 (36.3) | 0.74 | 0.85 | ||
Amphotericin B | Number = 102 (3.5%) | Number = 5 (2.6) | Number = 34 (3.3) | Number = 36 (0.4) | Number = 25 (3.7) | Number = 2 (1.2) | |||
Total dose (mg) | 3,897.2 (4,330.8) | 5,531.1 (3,998.5) | 6,866.2 (5,977.6) | 5,079.2 (4,933.2) | 10,520.0 (10,521.7) | 0.35 | 0.53 | ||
Dose per kg of dosing body weight | 85.4 (91.9) | 84.9 (59.7) | 90.9 (80.2) | 54.3 (52.4) | 83.5 (86.7) | 0.33 | 0.15 | ||
Ceftazidime | Number = 292 (10.1%) | Number = 25 (1.3) | Number = 106 (10.4) | Number = 89 (10.9) | Number = 58 (8.5) | Number = 14 (8.2) | |||
Total dose (mg) | 2,710.0 (1,154.0) | 3,547.2 (1,867.7) | 2,995.3 (1,691.5) | 3,025.9 (1,590.6) | 3,285.7 (1,683.8) | 0.08 | 0.10 | ||
Dose per kg of dosing body weight | 47.2 (18.3) | 57.5 (30.7) | 46.9 (28.0) | 43.9 (23.6) | 42.7 (17.7) | 0.01 | 0.48 | ||
Ceftriaxone | Number = 232 (8.0%) | Number = 12 (6.1) | Number = 77 (7.5) | Number = 67 (7.6) | Number = 58 (8.5) | Number = 18 (10.6) | |||
Total dose (mg) | 1,666.7 (492.4) | 1,655.8 (1,052.1) | 1,776.1 (884.6) | 1,672.4 (943.8) | 1,611.1 (607.7) | 0.93 | 0.77 | ||
Dose per kg of dosing body weight | 31.9 (10.2) | 26.1 (14.4) | 27.5 (12.7) | 24.6 (13.7) | 21.5 (8.7) | 0.20 | 0.02 | ||
Cefuroxime | Number = 772 (26.8%) | Number = 19 (9.7) | Number = 74 (7.3) | Number = 68 (8.3) | Number = 55 (8.1) | Number = 11(6.5) | |||
Total dose (mg) | 2,578.9 (920.6) | 2,171.8 (1,063.2) | 2,216.9 (808.0) | 2,386.4 (842.7) | 2,181.8 (975.3) | 0.39 | 0.68 | ||
Dose per kg of dosing body weight | 45.3 (18.9) | 35.1 (17.0) | 32.7 (12.9) | 34.6 (15.0) | 26.7 (12.1) | 0.01 | 0.02 |
Outcomes
< 18.50 Number = 196 | 18.50 to 24.99 Number = 1,020 | 25.0 to 29.99 Number = 816 | 30.0 to 39.99 Number = 680 | ≥ 40 Number = 170 | P value | |
---|---|---|---|---|---|---|
Hospital mortality, number (%) | 121 (61.7) | 580 (56.9) | 444 (54.4) | 349 (51.3) | 76 (44.7) | 0.003 |
ICU mortality, number (%) | 102 (52.0) | 451 (44.2) | 335 (41.1) | 265 (39.0) | 57 (33.5) | 0.001 |
ICU length of stay, mean (SD) | 9.9 (9.4) | 10.5 (12.5) | 11.4 (14.7) | 11.2 (14.3) | 12.2 (12.7) | 0.30 |
Hospital length of stay, mean (SD) | 25.1 (33.6) | 25.1 (31.8) | 27.8 (35.2) | 26.5 (34.8) | 34.3 (44.2) | 0.02 |
Discussion
Conclusions
Key messages
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The presentation, microbiology and organ failures are different among obese patients compared to the non-obese.
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Very obese patients presented at an early age to the ICU with septic shock and had more underlying chronic co-morbidities compared to non-obese patients.
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There is a considerable variation in the volume of fluid resuscitation per kg and antibiotic dosing among different BMI groups.
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The obesity paradox (lower mortality in the obese) as reported in other populations was observed in septic shock patients as well.
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The true paradox may lie in the variations in the sepsis interventions, such as the administration of resuscitation fluids.