Trial reportCritical care (London, England)2013
One size does not fit all in severe infection: obesity alters outcome, susceptibility, treatment, and inflammatory response.
Trial report in Critical care (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 59 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Vasopressin Plasma Concentrations in Responders and Non-responders to Exogenous Vasopressin Infusion in Patients With Septic Shock
Fluid Resuscitation in Septic Shock Patients With BMI Elevation
Who cites it
59 citing papers in PubMed, 2 syntheses or guidelines pooled it, 122 citations in OpenAlex.
- The role of increased body mass index in outcomes of sepsis: a systematic review and meta-analysis.BMC anesthesiology · 2017Pooled it
- Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis.Critical care (London, England) · 2016Pooled it
- Class II obese and healthy pregnant controls exhibit indistinguishable pro- and anti-inflammatory immune responses to Caesarian section.Immunity, inflammation and disease · 2017Trial
- Mortality, Renal Replacement Therapy and Renal Impairment Markers in Critically Ill Patients in a Multinational Point-Prevalence ICU Cohort over 2007 to 2024: A nutritionDay Descriptive Multivariable Analysis.Journal of clinical medicine · 2026Article
- Vasopressor-Associated Limb Ischemia Resulting in Quadruple Amputation in Suspected Septic Shock.Clinical case reports · 2026Article
- Association between triglyceride glucose-body mass index and all-cause mortality in critically ill patients with atherosclerotic cardiovascular diseases: a retrospective cohort study using the MIMIC-IV database.BMC cardiovascular disorders · 2026Article
- Attenuated hemodynamic response to adjunct vasopressin in obese septic shock patients: a physiological or dose-dependent effect?Critical care (London, England) · 2026Article
- Do Obesity Classifications Create the Obesity Paradox? A Scoping Review of Obesity Definitions Applied in Sepsis Research.Clinical obesity · 2026Article
- Risk Factors for Adverse Outcomes in Cancer Patients With Sepsis.Journal of clinical medicine research · 2026Article
- Sepsis in multimorbidity: a domain-based framework for systemic vulnerability and precision care.Frontiers in medicine · 2026Review
- Endotoxin retention in adipose tissue leading to persistent hypotension in catecholamine-dependent acute obstructive suppurative cholangitis.Journal of translational internal medicine · 2025Article
- Exploring Sarcopenic Obesity in the Cancer Setting: Insights from the National Health and Nutrition Examination Survey on Prognosis and Predictors Using Machine Learning.Bioengineering (Basel, Switzerland) · 2025Article
- Hemodynamic effects of adjunct arginine vasopressin to norepinephrine in septic shock: insights from a prospective multicenter registry study.Annals of intensive care · 2025Article
- Obesity as a Risk Factor in Pediatric Sepsis: A Retrospective Comparative Study Under the Phoenix Definition.Journal of clinical medicine · 2025Article
- L-shaped association of body mass index with prognosis in individuals with sepsis: a multicenter cohort study.Diabetology & metabolic syndrome · 2025Article
- Association between BMI and outcomes in critically ill patients: an analysis of the MIMIC-III database.Scientific reports · 2024Article
- The Utility of C-Reactive Protein, Procalcitonin, and Leukocyte Values in Predicting the Prognosis of Patients with Pneumosepsis and Septic Shock.Medicina (Kaunas, Lithuania) · 2024Observational
- The Association of Body Mass Index and Waist Circumference with Sepsis-Related Mortality in South Korea.Diagnostics (Basel, Switzerland) · 2024Article
- Physical and respiratory therapy in the critically ill patient with obesity: a narrative review.Frontiers in medicine · 2024Review
- Role of obesity in lower mortality risk in sepsis: a meta-analysis of observational studies.American journal of translational research · 2024Review
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
introductionObesity is an increasingly common comorbidity in critically ill patients. Whether obesity alters sepsis outcome, susceptibility, treatment, and response is not completely understood.
methodsWe conducted a retrospective analysis comparing three group of septic shock patients based on the intervals of actual body mass index (BMI) in patients enrolled in the VASST (Vasopressin and Septic Shock Trial) cohort. Primary outcome measurement was 28-day mortality. We tested for differences in patterns of infection by comparing the primary site of infection and organism. We also compared the treatments (fluids and vasopressors) and inflammatory response, measuring adipose tissue-related cytokine concentrations (interleukin [IL]-6, monocyte chemotactic protein [MCP]-1, tumor necrosis factor [TNF]-α, and resistin) in plasma in a subset of 382 patients. Of the 778 patients in VASST, 730 patients who had body weight and height measurements were analyzed. Patients with BMI<25 kg/m2 (n=276) were grouped as a reference and compared to 'overweight' (25<BMI<30 kg/m2, n=209) and 'obese' (BMI>30 kg/m2, n=245) patients.
resultsObese patients had the lowest 28-day mortality followed by overweight patients while patients with BMI<25 kg/m2 had the highest mortality (p=0.02). Compared to the patients with BMI<25 kg/m2, obese and overweight patients also had a different pattern of infection with less lung (obese 35%, overweight 45%, BMI<25 kg/m2 50%, p=0.003) and fungal infection (obese 8.2%, overweight 11%, and BMI<25 kg/m2 15.6%, p=0.03). Per kilogram, obese and overweight patients received less fluid during the first four days (p<0.05) and received less norepinephrine (obese 0.14, overweight 0.21, BMI<25 kg/m2 0.26 µg/kg/min, p<0.0001) and vasopressin (obese 0.28, overweight 0.36, BMI<25 kg/m2 0.43 µU/kg/min, p<0.0001) on day 1 compared to patients with BMI<25 kg/m2. Obese and overweight patients also had a lower plasma IL-6 concentration at baseline (obese 106 [IQR 34-686], overweight 190 [IQR 44-2339], BMI<25 kg/m2 235 [IQR 44-1793] pg/mL, p=0.046).
conclusionsOverall obesity was associated with improved survival in septic shock and differences in pattern of infection, fluids, and vasopressors. Importantly, the magnitude of inflammatory IL-6 response is muted in the obese.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.