Journal
OBESITY RESEARCH & CLINICAL PRACTICE
Volume 15, Issue 3, Pages 235-242Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.orcp.2021.03.010
Keywords
Morbid obesity; Obesity; Influenza; Mortality; Pneumonia
Categories
Funding
- Taiwan Ministry of Science and Technology [MOST107-2314-B-002 -196, MOST 108-2314-B-002 -137 -MY2]
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This study found that obesity was associated with higher in-hospital 30-day mortality risk in influenza patients, but with reduced mortality risk in pneumonia patients. This divergent effect of obesity in different infections was not adequately explained by lower admission threshold.
Objectives: Previous literature has suggested that obesity impacts mortality risk differently in bacterial versus viral infections. This study sought to further elucidate this association in pneumonia versus influenza. Design: Retrospective cohort study. Setting and participants: Data were collected from the US Nationwide Readmission Database from 2013 to 2014. Methods: Patients were categorized into three weight groups: normal weight (BMI 18.5-25.0 kg/m(2)), obese (BMI 30-40.0 kg/m(2)), and morbidly obese (BMI >= 40 kg/m(2)). To minimize confounding, we excluded patients with a history of smoking, alcoholism, or chronic wasting conditions, as suggested by the Global BMI Mortality Collaboration. To further isolate obesity from baseline differences across cohorts, we performed a three-way propensity matching analysis. The association between body weight and in-hospital all-cause 30-day mortality was assessed using Cox proportional hazard regression analysis. Results: 132,965 influenza and 34,177 pneumonia hospitalizations were identified. For patients with influenza, obesity (hazard ratio [HR]: 1.51; 95% CI: 1.01-2.26) and morbid obesity (HR: 1.64; 95% CI: 1.10-2.44) were associated with higher in-hospital 30-day mortality compared to normal weight. For pneumonia, obesity (HR, 0.41; 95% CI, 0.20-0.84) and morbid obesity (HR, 0.49; 95% CI, 0.25-0.96) were associated with reduced 30-day mortality compared to normal weight. Conclusions and implications: Obesity may increase 30-day mortality risk during influenza hospitalization but provide mortality benefit in pneumonia, a divergent effect not adequately explained by lower admission threshold. (C) 2021 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
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