Relationship Between Body Mass Index and Outcomes Among Hospitalized Patients With Community-Acquired Pneumonia

• Type of Material: Article
• Authors: Anna M. Bramley, Center for Disease Control and Prevention; Carrie Reed, Emory University; Lyn Finelli, Center for Disease Control and Prevention; Wesley Self, Vanderbilt University; Krow Ampofo, University of Utah; Sandra R. Arnold, Le Bonheur Children’s Hospital; Derek J. Williams, Vanderbilt University; Carlos G. Grijalva, Vanderbilt University; Evan Anderson, Emory University; Chris Stockmann, University of Utah; Christopher Trabue, University of Tennessee; Sherene Fakhran, John H. Stroger, Jr Hospital of Cook County; Robert Balk, Rush University; Jonathan A. McCullers, Le Bonheur Children’s Hospital; Andrew T. Pavia, University of Utah; Kathryn M. Edwards, Vanderbilt University; Richard G. Wunderink, Northwestern University; Seema Jain, Center for Disease Control and Prevention
• Language: English
• Date: 2017-06-15
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C
• Publication Version: Final Published Version
• Copyright Statement: © Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.
• Final Published Version (URL): http://dx.doi.org/10.1093/infdis/jix241
• Title of Journal or Parent Work: Journal of Infectious Diseases
• ISSN: 0022-1899
• Volume: 215
• Issue: 12
• Start Page: 1873
• End Page: 1882
• Grant/Funding Information: C. S. was supported by grants from Merck, the Thrasher Research Fund, and the Primary Children’s Hospital Foundation.; This work was supported by the Influenza Division in the National Center for Immunization and Respiratory Diseases at the CDC through cooperative agreements with each study site and was based on a competitive research funding opportunity.
• Keywords: Infectious Diseases; SEVERITY; INFECTION; CHILDREN; CAP; ADULTS; obesity; SURVIVAL; Immunology; Science & Technology; RISK-FACTORS; OBESITY; Life Sciences & Biomedicine; outcomes; METAANALYSIS; BMI; Microbiology; REQUIRING HOSPITALIZATION; pneumonia; INFLUENZA-A H1N1
• Research Categories: Health Sciences, Immunology; Biology, Microbiology; Health Sciences, Medicine and Surgery

Abstract

Background. The effect of body mass index (BMI) on community-acquired pneumonia (CAP) severity is unclear. Methods. We investigated the relationship between BMI and CAP outcomes (hospital length of stay [LOS], intensive care unit [ICU] admission, and invasive mechanical ventilation) in hospitalized CAP patients from the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, adjusting for age, demographics, underlying conditions, and smoking status (adults only). Results. Compared with normal-weight children, odds of ICU admission were higher in children who were overweight (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.1-2.8) or obese (aOR, 2.1; 95% CI, 1.4-3.2), and odds of mechanical ventilation were higher in children with obesity (aOR, 2.7; 95% CI, 1.3-5.6). When stratified by asthma (presence/absence), these findings remained significant only in children with asthma. Compared with normal-weight adults, odds of LOS >3 days were higher in adults who were underweight (aOR, 1.6; 95% CI, 1.1-2.4), and odds of mechanical ventilation were lowest in adults who were overweight (aOR, 0.5; 95% CI,.3-.9). Conclusions. Children who were overweight or obese, particularly those with asthma, had higher odds of ICU admission or mechanical ventilation. In contrast, adults who were underweight had longer LOS. These results underscore the complex relationship between BMI and CAP outcomes.