The Effect of Body Mass Index and Weight-Adjusted Fluid Dosing on Mortality in Sepsis
Purpose: The Surviving Sepsis Campaign guidelines recommend 30 mL/kg of fluids within 3 hours (30by3) of sepsis-induced hypoperfusion, but a national mandate released an allowance for dosing based on ideal instead of actual body weight (IBW/ABW) for obese patients. This study aims to determine the d...
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| Veröffentlicht in: | Journal of intensive care medicine 2022-01, Vol.37 (1), p.83-91 |
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| creator | Ward, Michael A. Kuttab, Hani I. Lykins V, Joseph D. Wroblewski, Kristen Hughes, Michelle D. Keast, Eric P. Kopec, Jason A. Rourke, Erron M. Purakal, John |
| description | Purpose:
The Surviving Sepsis Campaign guidelines recommend 30 mL/kg of fluids within 3 hours (30by3) of sepsis-induced hypoperfusion, but a national mandate released an allowance for dosing based on ideal instead of actual body weight (IBW/ABW) for obese patients. This study aims to determine the dose-effect of 30by3 for patients with severe sepsis or septic shock (SS/SS) with respect to body mass index (BMI) categories and secondarily, examine the clinical impact of IBW vs. ABW-based dosing.
Methods:
Retrospective cohort study of adults (≥18 years; n = 1,032) with SS/SS presenting to an urban, tertiary-care emergency department. Models include MEDS score, antibiotic timing, lactate, renal and heart failure, among others.
Results:
The cohort was 10.2% underweight and 28.7% obese. Overall mortality was 17.1% with 20.4% shock mortality. An exponential increase in mortality was observed for each 5 mL/kg under 30by3 for underweight (p = 0.02), but not obese patients. ABW vs IBW-30by3 dosing was reached in 80.0 vs 52.4% (underweight), 56.4 vs 56.9% (normal/overweight), and 23.3 vs 46.0% (obese). Across all BMI categories, there was increased mortality for not reaching ABW-based 30by3 dosing (OR 1.78, 95% CI 1.18-2.69) with no significant impact for IBW (OR 1.28, 95% CI 0.87 -1.91). The increased mortality for failing to reach ABW-dosed 30by3 remained for underweight patients ABW (OR 5.82, 95% CI 1.32-25.57) but not obese patients. Longer ICU stays were observed for not reaching 30by3 based on ABW (β = 2.40, 95% CI 0.84-3.95) and IBW dosing (β = 1.58, 95% CI 0.07-3.08) overall. This effect remained for obese and underweight (except IBW dosing) patients.
Conclusions:
An exponential, dose-effect increase in mortality was observed for underweight patients not receiving 30by3. Therefore, the mortality impact of under-dosing may be amplified using ABW for underweight patients. Fluid dosing did not impact mortality for obese patients, but we caution against deviation from guidelines without further studies. |
| doi_str_mv | 10.1177/0885066620973917 |
| format | Article |
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The Surviving Sepsis Campaign guidelines recommend 30 mL/kg of fluids within 3 hours (30by3) of sepsis-induced hypoperfusion, but a national mandate released an allowance for dosing based on ideal instead of actual body weight (IBW/ABW) for obese patients. This study aims to determine the dose-effect of 30by3 for patients with severe sepsis or septic shock (SS/SS) with respect to body mass index (BMI) categories and secondarily, examine the clinical impact of IBW vs. ABW-based dosing.
Methods:
Retrospective cohort study of adults (≥18 years; n = 1,032) with SS/SS presenting to an urban, tertiary-care emergency department. Models include MEDS score, antibiotic timing, lactate, renal and heart failure, among others.
Results:
The cohort was 10.2% underweight and 28.7% obese. Overall mortality was 17.1% with 20.4% shock mortality. An exponential increase in mortality was observed for each 5 mL/kg under 30by3 for underweight (p = 0.02), but not obese patients. ABW vs IBW-30by3 dosing was reached in 80.0 vs 52.4% (underweight), 56.4 vs 56.9% (normal/overweight), and 23.3 vs 46.0% (obese). Across all BMI categories, there was increased mortality for not reaching ABW-based 30by3 dosing (OR 1.78, 95% CI 1.18-2.69) with no significant impact for IBW (OR 1.28, 95% CI 0.87 -1.91). The increased mortality for failing to reach ABW-dosed 30by3 remained for underweight patients ABW (OR 5.82, 95% CI 1.32-25.57) but not obese patients. Longer ICU stays were observed for not reaching 30by3 based on ABW (β = 2.40, 95% CI 0.84-3.95) and IBW dosing (β = 1.58, 95% CI 0.07-3.08) overall. This effect remained for obese and underweight (except IBW dosing) patients.
Conclusions:
An exponential, dose-effect increase in mortality was observed for underweight patients not receiving 30by3. Therefore, the mortality impact of under-dosing may be amplified using ABW for underweight patients. Fluid dosing did not impact mortality for obese patients, but we caution against deviation from guidelines without further studies.</description><identifier>ISSN: 0885-0666</identifier><identifier>EISSN: 1525-1489</identifier><identifier>DOI: 10.1177/0885066620973917</identifier><identifier>PMID: 33213268</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Body Mass Index ; Humans ; Obesity - complications ; Overweight - complications ; Retrospective Studies ; Sepsis - drug therapy ; Sepsis - mortality</subject><ispartof>Journal of intensive care medicine, 2022-01, Vol.37 (1), p.83-91</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-4eeb061d2585d71a186039e6af1ef842d05ce71f91c91fec8aa422c57fcf310a3</citedby><cites>FETCH-LOGICAL-c434t-4eeb061d2585d71a186039e6af1ef842d05ce71f91c91fec8aa422c57fcf310a3</cites><orcidid>0000-0001-9776-8929</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0885066620973917$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0885066620973917$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>230,314,780,784,885,21818,27923,27924,43620,43621</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33213268$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ward, Michael A.</creatorcontrib><creatorcontrib>Kuttab, Hani I.</creatorcontrib><creatorcontrib>Lykins V, Joseph D.</creatorcontrib><creatorcontrib>Wroblewski, Kristen</creatorcontrib><creatorcontrib>Hughes, Michelle D.</creatorcontrib><creatorcontrib>Keast, Eric P.</creatorcontrib><creatorcontrib>Kopec, Jason A.</creatorcontrib><creatorcontrib>Rourke, Erron M.</creatorcontrib><creatorcontrib>Purakal, John</creatorcontrib><title>The Effect of Body Mass Index and Weight-Adjusted Fluid Dosing on Mortality in Sepsis</title><title>Journal of intensive care medicine</title><addtitle>J Intensive Care Med</addtitle><description>Purpose:
The Surviving Sepsis Campaign guidelines recommend 30 mL/kg of fluids within 3 hours (30by3) of sepsis-induced hypoperfusion, but a national mandate released an allowance for dosing based on ideal instead of actual body weight (IBW/ABW) for obese patients. This study aims to determine the dose-effect of 30by3 for patients with severe sepsis or septic shock (SS/SS) with respect to body mass index (BMI) categories and secondarily, examine the clinical impact of IBW vs. ABW-based dosing.
Methods:
Retrospective cohort study of adults (≥18 years; n = 1,032) with SS/SS presenting to an urban, tertiary-care emergency department. Models include MEDS score, antibiotic timing, lactate, renal and heart failure, among others.
Results:
The cohort was 10.2% underweight and 28.7% obese. Overall mortality was 17.1% with 20.4% shock mortality. An exponential increase in mortality was observed for each 5 mL/kg under 30by3 for underweight (p = 0.02), but not obese patients. ABW vs IBW-30by3 dosing was reached in 80.0 vs 52.4% (underweight), 56.4 vs 56.9% (normal/overweight), and 23.3 vs 46.0% (obese). Across all BMI categories, there was increased mortality for not reaching ABW-based 30by3 dosing (OR 1.78, 95% CI 1.18-2.69) with no significant impact for IBW (OR 1.28, 95% CI 0.87 -1.91). The increased mortality for failing to reach ABW-dosed 30by3 remained for underweight patients ABW (OR 5.82, 95% CI 1.32-25.57) but not obese patients. Longer ICU stays were observed for not reaching 30by3 based on ABW (β = 2.40, 95% CI 0.84-3.95) and IBW dosing (β = 1.58, 95% CI 0.07-3.08) overall. This effect remained for obese and underweight (except IBW dosing) patients.
Conclusions:
An exponential, dose-effect increase in mortality was observed for underweight patients not receiving 30by3. Therefore, the mortality impact of under-dosing may be amplified using ABW for underweight patients. Fluid dosing did not impact mortality for obese patients, but we caution against deviation from guidelines without further studies.</description><subject>Adult</subject><subject>Body Mass Index</subject><subject>Humans</subject><subject>Obesity - complications</subject><subject>Overweight - complications</subject><subject>Retrospective Studies</subject><subject>Sepsis - drug therapy</subject><subject>Sepsis - mortality</subject><issn>0885-0666</issn><issn>1525-1489</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1UU1PGzEUtCqqkkLvPVU-ctniZ3u93kslPgsSqAdAPVrGfk4cbeyw3kXk33ejUNRW6uk9aebNjN4Q8hnYV4CmOWZa10wpxVnbiBaad2QGNa8rkLrdI7MtXG3xffKxlCVjILiAD2RfCD6tSs_Iw_0C6UUI6AaaAz3NfkNvbSn0Onl8oTZ5-hPjfDFUJ345lgE9vezG6Ol5LjHNaU70NveD7eKwoTHRO1yXWA7J-2C7gp9e5wF5uLy4P7uqbn58vz47uamcFHKoJOIjU-B5rWvfgAWtmGhR2QAYtOSe1Q4bCC24FqaI2lrJuaub4IIAZsUB-bbTXY-PK_QO09Dbzqz7uLL9xmQbzd9Iigszz89Gg5CKy0ng6FWgz08jlsGsYnHYdTZhHovhUk1GQkiYqGxHdX0upcfwZgPMbNsw_7YxnXz5M97bwe_3T4RqRyh2jmaZxz5N7_q_4C8y3pH4</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Ward, Michael A.</creator><creator>Kuttab, Hani I.</creator><creator>Lykins V, Joseph D.</creator><creator>Wroblewski, Kristen</creator><creator>Hughes, Michelle D.</creator><creator>Keast, Eric P.</creator><creator>Kopec, Jason A.</creator><creator>Rourke, Erron M.</creator><creator>Purakal, John</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9776-8929</orcidid></search><sort><creationdate>20220101</creationdate><title>The Effect of Body Mass Index and Weight-Adjusted Fluid Dosing on Mortality in Sepsis</title><author>Ward, Michael A. ; Kuttab, Hani I. ; Lykins V, Joseph D. ; Wroblewski, Kristen ; Hughes, Michelle D. ; Keast, Eric P. ; Kopec, Jason A. ; Rourke, Erron M. ; Purakal, John</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c434t-4eeb061d2585d71a186039e6af1ef842d05ce71f91c91fec8aa422c57fcf310a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Body Mass Index</topic><topic>Humans</topic><topic>Obesity - complications</topic><topic>Overweight - complications</topic><topic>Retrospective Studies</topic><topic>Sepsis - drug therapy</topic><topic>Sepsis - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ward, Michael A.</creatorcontrib><creatorcontrib>Kuttab, Hani I.</creatorcontrib><creatorcontrib>Lykins V, Joseph D.</creatorcontrib><creatorcontrib>Wroblewski, Kristen</creatorcontrib><creatorcontrib>Hughes, Michelle D.</creatorcontrib><creatorcontrib>Keast, Eric P.</creatorcontrib><creatorcontrib>Kopec, Jason A.</creatorcontrib><creatorcontrib>Rourke, Erron M.</creatorcontrib><creatorcontrib>Purakal, John</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ward, Michael A.</au><au>Kuttab, Hani I.</au><au>Lykins V, Joseph D.</au><au>Wroblewski, Kristen</au><au>Hughes, Michelle D.</au><au>Keast, Eric P.</au><au>Kopec, Jason A.</au><au>Rourke, Erron M.</au><au>Purakal, John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Effect of Body Mass Index and Weight-Adjusted Fluid Dosing on Mortality in Sepsis</atitle><jtitle>Journal of intensive care medicine</jtitle><addtitle>J Intensive Care Med</addtitle><date>2022-01-01</date><risdate>2022</risdate><volume>37</volume><issue>1</issue><spage>83</spage><epage>91</epage><pages>83-91</pages><issn>0885-0666</issn><eissn>1525-1489</eissn><abstract>Purpose:
The Surviving Sepsis Campaign guidelines recommend 30 mL/kg of fluids within 3 hours (30by3) of sepsis-induced hypoperfusion, but a national mandate released an allowance for dosing based on ideal instead of actual body weight (IBW/ABW) for obese patients. This study aims to determine the dose-effect of 30by3 for patients with severe sepsis or septic shock (SS/SS) with respect to body mass index (BMI) categories and secondarily, examine the clinical impact of IBW vs. ABW-based dosing.
Methods:
Retrospective cohort study of adults (≥18 years; n = 1,032) with SS/SS presenting to an urban, tertiary-care emergency department. Models include MEDS score, antibiotic timing, lactate, renal and heart failure, among others.
Results:
The cohort was 10.2% underweight and 28.7% obese. Overall mortality was 17.1% with 20.4% shock mortality. An exponential increase in mortality was observed for each 5 mL/kg under 30by3 for underweight (p = 0.02), but not obese patients. ABW vs IBW-30by3 dosing was reached in 80.0 vs 52.4% (underweight), 56.4 vs 56.9% (normal/overweight), and 23.3 vs 46.0% (obese). Across all BMI categories, there was increased mortality for not reaching ABW-based 30by3 dosing (OR 1.78, 95% CI 1.18-2.69) with no significant impact for IBW (OR 1.28, 95% CI 0.87 -1.91). The increased mortality for failing to reach ABW-dosed 30by3 remained for underweight patients ABW (OR 5.82, 95% CI 1.32-25.57) but not obese patients. Longer ICU stays were observed for not reaching 30by3 based on ABW (β = 2.40, 95% CI 0.84-3.95) and IBW dosing (β = 1.58, 95% CI 0.07-3.08) overall. This effect remained for obese and underweight (except IBW dosing) patients.
Conclusions:
An exponential, dose-effect increase in mortality was observed for underweight patients not receiving 30by3. Therefore, the mortality impact of under-dosing may be amplified using ABW for underweight patients. Fluid dosing did not impact mortality for obese patients, but we caution against deviation from guidelines without further studies.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>33213268</pmid><doi>10.1177/0885066620973917</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9776-8929</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of intensive care medicine, 2022-01, Vol.37 (1), p.83-91 |
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| source | MEDLINE; SAGE Complete A-Z List |
| subjects | Adult Body Mass Index Humans Obesity - complications Overweight - complications Retrospective Studies Sepsis - drug therapy Sepsis - mortality |
| title | The Effect of Body Mass Index and Weight-Adjusted Fluid Dosing on Mortality in Sepsis |
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