Evidence map›Paper›PMID 27306751›Full record

SynthesisCritical care (London, England)2016

Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis.

Dominique J Pepper, Junfeng Sun, Judith Welsh, Xizhong Cui, Anthony F Suffredini, Peter Q Eichacker

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 119 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
119citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

119 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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59 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Dominique J PepperCritical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA. dominique.pepper@nih.gov.
Junfeng SunCritical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA.
Judith WelshNational Institutes of Health Library, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
Xizhong CuiCritical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA.
Anthony F SuffrediniCritical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA.
Peter Q EichackerCritical Care Medicine Department, Clinical Center, National Institutes of Health, Clinical Center Building 10, Room 2C145, 10 Center Drive, Bethesda, MD, 20892, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAt least 25 % of adults admitted to intensive care units (ICU) in the United States have an overweight, obese or morbidly obese body mass index (BMI). The effect of BMI on adjusted mortality in adults requiring ICU treatment for sepsis is unclear. We performed a systematic review of adjusted all-cause mortality for underweight, overweight, obese and morbidly obese BMIs relative to normal BMI for adults admitted to the ICU with sepsis, severe sepsis, and septic shock.

methodPubMed, the Cochrane Library, and EMBASE electronic databases were searched through November 18, 2015, without language restrictions. We included studies that reported multivariate regression analyses for all-cause mortality using standard BMI categories for adults admitted to the ICU for sepsis, severe sepsis, and septic shock. Articles were selected by consensus among multiple reviewers. Electronic database searches yielded 10,312 articles, of which six were eligible. Data were extracted by one reviewer and then reviewed by three independent reviewers. For the meta-analyses performed, the adjusted odds ratios (aOR) of mortality were combined using a random-effects model. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale for cohort studies.

resultsFour retrospective (n = 6609 patients) and two prospective (n = 556) studies met inclusion criteria. Compared to normal BMI, across five studies each, overweight or obese BMIs reduced the adjusted odds ratio (95 % CI) of mortality [aOR] [0.83 (0.75, 0.91) p < 0.001 and 0.82 (0.67, 0.99) p = 0.04, respectively] with low or moderate heterogeneity (I(2) = 15.7 %, p = 0.31 and I(2) = 53.0 %, p = 0.07, respectively). Across three studies each, morbidly obese BMI and underweight BMI did not alter aOR [0.90 (0.59, 1.39), p = 0.64; I(2) = 43.3 %, p = 0.17; and 1.24 (0.79, 1.95), p = 0.35; I(2) = 15.6 %, p = 0.31 respectively]. Only one study clearly defined how and when height and weight measurements were calculated. Site of underlying infection and illness severity may have favored overweight and obese BMIs.

conclusionsThis is the first meta-analysis to show that overweight or obese BMIs reduce adjusted mortality in adults admitted to the ICU with sepsis, severe sepsis, or septic shock. More rigorous studies that address these limitations are needed to clarify the impact of BMI on sepsis ICU outcomes.

trial registrationPROSPERO International prospective register of systematic reviews 10.15124/ CRD42014010556 . Registered on July 11, 2014.

Indexed as

Body Mass IndexHospital MortalityHumansIntensive Care UnitsObesityOverweightRisk AssessmentSepsisShock, SepticBody mass indexMeta-analysisMortalityObesityOverweightSepsis

Identifiers

PMID27306751
PMCPMC4908772

What OpenQuestion holds

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Registered trials

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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.