Obese Patients Have Decreased Mortality and Express a Lower Inflammatory Cytokine Profile During Septic Shock

Background No clear association between standard vasopressin doses and body mass index exists, despite potential pharmacokinetic and pharmacodynamic variability among patients with septic shock. It is unknown if higher doses may alter hemodynamic response. Objective The purpose of this study was to evaluate the effect of vasopressin dose on hemodynamic response in obese patients with septic shock. Methods A single-center, retrospective cohort study was conducted in adult, obese patients with septic shock receiving catecholamine vasopressors and vasopressin. Patients were analyzed according to vasopressin dose received: standard dose (≤0.04 U/min) and high dose (>0.04 U/min). The primary outcome was percentage change in norepinephrine equivalent (NEQ) dose. Results A total of 182 patients were included in the analysis, with 136 in the standard-dose vasopressin group and 46 in the high-dose vasopressin group. There was no difference in percentage change in NEQ dose at 6 hours after standard- or high-dose vasopressin attainment (−28.6% vs −19.1%; P = 0.166). A greater increase in mean arterial pressure (MAP) at 6 hours was observed with receipt of high-dose vasopressin (23.3% vs 15.3%; P = 0.023). Duration of shock and length of stay were significantly longer in patients who received high-dose vasopressin, with no difference in in-hospital mortality. Conclusion and Relevance This represents the first analysis comparing standard and higher doses of vasopressin in obese patients with septic shock. Receipt of high-dose vasopressin was not associated with a difference in catecholamine requirement or improved outcomes. Further studies are warranted to provide guidance on the use of high-dose vasopressin in septic shock.

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Norepinephrine Dosing in Obese and Nonobese Patients With Septic Shock

American Journal of Critical Care ◽

10.4037/ajcc2016667 ◽

2016 ◽

Vol 25 (1) ◽

pp. 27-32 ◽

Cited By ~ 10

Author(s):

John J. Radosevich ◽

Asad E. Patanwala ◽

Brian L. Erstad

Keyword(s):

Body Mass Index ◽

Septic Shock ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Body Mass ◽

Secondary Outcome ◽

Obese Patients ◽

Hemodynamic Status ◽

Norepinephrine Infusion ◽

Nonobese Patients

Background Whether or not norepinephrine infusions for support of hemodynamic status in patients with septic shock should be weight based is unknown. This situation is particularly pertinent in patients who are extremely overweight or obese. Objective To compare dosing requirements and effect of norepinephrine on blood pressure in obese and nonobese patients with septic shock. Methods In a retrospective cohort study, data on adult patients with septic shock who received norepinephrine infusion for support of hemodynamic status in a tertiary care, academic medical center were analyzed. Patients were categorized as obese (body mass index ≥ 30) or nonobese (body mass index < 30). The primary outcome was dosing requirements of norepinephrine at 60 minutes after the start of the infusion. The secondary outcome was the log-transformed ratio of mean arterial pressure to norepinephrine. Results The final cohort consisted of 100 obese and 100 nonobese patients. Mean norepinephrine infusion rate at 60 minutes was 0.09 (SD, 0.08) μg/kg per minute in the obese group and 0.13 (SD, 0.14) μg/kg per minute in the nonobese group (P = .006). The non–weight-based dose at 60 minutes was 9 μg/min in obese patients and 8 μg/min in nonobese patients (P = .72). The log transformed mean arterial pressure to norepinephrine ratio at 60 minutes was 2.5 (SD, 0.9) in obese patients and 2.5 (SD, 0.8) in nonobese patients (P = .54) Conclusions Compared with nonobese patients, obese patients with septic shock require lower weight-based doses of norepinephrine and similar total norepinephrine doses.

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Corticosteroid Therapy, Vitamin D Status, and Inflammatory Cytokine Profile in the HIV-Tuberculosis Immune Reconstitution Inflammatory Syndrome

Clinical Infectious Diseases ◽

10.1093/cid/cis577 ◽

2012 ◽

Vol 55 (7) ◽

pp. 1004-1011 ◽

Cited By ~ 51

Author(s):

Anali Conesa-Botella ◽

Graeme Meintjes ◽

Anna K. Coussens ◽

Helen van der Plas ◽

Rene Goliath ◽

...

Keyword(s):

Vitamin D ◽

Corticosteroid Therapy ◽

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Inflammatory Cytokine ◽

Cytokine Profile ◽

Vitamin D Status ◽

Inflammatory Syndrome

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Influence of adjunctive non-surgical peri-implant therapy on clinical and salivary cytokine profile in obese patients

Photodiagnosis and Photodynamic Therapy ◽

10.1016/j.pdpdt.2022.102721 ◽

2022 ◽

pp. 102721

Author(s):

Mohammed N. Alasqah

Keyword(s):

Cytokine Profile ◽

Obese Patients ◽

Implant Therapy

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Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition

Journal of Clinical Medicine ◽

10.3390/jcm9010046 ◽

2019 ◽

Vol 9 (1) ◽

pp. 46 ◽

Cited By ~ 1

Author(s):

Caspar Mewes ◽

Carolin Böhnke ◽

Tessa Alexander ◽

Benedikt Büttner ◽

José Hinz ◽

...

Keyword(s):

Septic Shock ◽

Protective Effect ◽

Cox Regression ◽

Obese Patients ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Threatening Condition ◽

Life Threatening ◽

Caucasian Patients ◽

Patient Prognosis

Septic shock is a frequent life-threatening condition and a leading cause of mortality in intensive care units (ICUs). Previous investigations have reported a potentially protective effect of obesity in septic shock patients. However, prior results have been inconsistent, focused on short-term in-hospital mortality and inadequately adjusted for confounders, and they have rarely applied the currently valid Sepsis-3 definition criteria for septic shock. This investigation examined the effect of obesity on 90-day mortality in patients with septic shock selected from a prospectively enrolled cohort of septic patients. A total of 352 patients who met the Sepsis-3 criteria for septic shock were enrolled in this study. Body-mass index (BMI) was used to divide the cohort into 24% obese (BMI ≥ 30 kg/m2) and 76% non-obese (BMI < 30 kg/m2) patients. Kaplan-Meier survival analysis revealed a significantly lower 90-day mortality (31% vs. 43%; p = 0.0436) in obese patients compared to non-obese patients. Additional analyses of baseline characteristics, disease severity, and microbiological findings outlined further statistically significant differences among the groups. Multivariate Cox regression analysis estimated a significant protective effect of obesity on 90-day mortality after adjustment for confounders. An understanding of the underlying physiologic mechanisms may improve therapeutic strategies and patient prognosis.

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