Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 104-116
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.104
Influence of overweight and obesity on the mortality of hospitalized patients with community-acquired pneumonia
Ning Wang, Bo-Wei Liu, Chun-Ming Ma, Ying Yan, Quan-Wei Su, Fu-Zai Yin
Ning Wang, Department of Endocrinology, Hebei Medical University, Shijiazhuang 050017, Hebei Province, China
Bo-Wei Liu, Chun-Ming Ma, Fu-Zai Yin, Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao 066001, Hebei Province, China
Ying Yan, Quan-Wei Su, Department of Endocrinology, Chengde Medical University, Chengde 067000, Hebei Province, China
Author contributions: Su QW and Yang Y carried out the studies, participated in collecting data, and drafted the manuscript; Yin FZ and Ma CM performed the statistical analysis and participated in its design; Wang N and Liu BW participated in the acquisition, analysis, or interpretation of data and drafted the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the First Hospital of Qinhuangdao.
Informed consent statement: The need for individual consent was waived by the committee.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Zai Yin, BSc, Doctor, Department of Endocrinology, First Hospital of Qinhuangdao, No. 258 Cultural Road, Haigang District, Qinhuangdao 066001, Hebei Province, China. fuzai_yin@126.com
Received: June 2, 2021
Peer-review started: June 2, 2021
First decision: June 25, 2021
Revised: June 25, 2021
Accepted: November 30, 2021
Article in press: November 30, 2021
Published online: January 7, 2022
ARTICLE HIGHLIGHTS
Research background

Obesity is associated with a better prognosis in patients with community-acquired pneumonia (the so-called obesity survival paradox), but conflicting results have been found.

Research motivation

To investigate the relationship between all-cause mortality and body mass index (BMI) in patients with community-acquired pneumonia.

Research objectives

To investigate the relationship between all-cause mortality and BMI in patients with community-acquired pneumonia.

Research methods

This retrospective study included patients with community-acquired pneumonia hospitalized at the First Hospital of Qinhuangdao from June 2013 to November 2018. The patients were grouped as underweight (< 18.5 kg/m2), normal weight (18.5-23.9 kg/m2), and overweight/obesity (≥ 24 kg/m2). The primary outcome was all-cause hospital mortality.

Research results

Among 2327 patients, 297 (12.8%) were underweight, 1013 (43.5%) normal weight, and 1017 (43.7%) overweight/obesity. The all-cause hospital mortality was 4.6% (106/2327). Mortality was lowest in the overweight/obesity group and highest in the underweight group (2.8% vs 5.0% vs 9.1%, P < 0.001). All-cause mortality of overweight/obesity patients was lower than normal-weight patients [odds ratio (OR) = 0.535, 95% confidence interval (CI): 0.334-0.855, P = 0.009], while the all-cause mortality of underweight patients was higher than that of normal-weight patients (OR = 1.886, 95%CI: 1.161-3.066, P = 0.010). Multivariable analysis showed that abnormal neutrophil counts (OR = 2.38, 95%CI: 1.55-3.65, P < 0.001), abnormal albumin levels (OR = 0.20, 95%CI: 0.06-0.72, P = 0.014), high-risk Confusion-Urea-Respiration-Blood pressure-65 score (OR = 2.89, 95%CI: 1.48-5.64, P = 0.002), and intensive care unit admission (OR = 3.11, 95%CI: 1.77-5.49, P < 0.001) were independently associated with mortality.

Research conclusions

All-cause mortality of normal-weight patients was higher than overweight/obesity patients, and lower than that of underweight patients. Neutrophil counts, albumin levels, Confusion-Urea-Respiration-Blood pressure-65 score, and intensive care unit admission were independently associated with mortality in patients with community-acquired pneumonia.

Research perspectives

This study found that the all-cause mortality of community-acquired pneumonia in overweight or obese patients was lower than that in normal-weight patients, and the infection index was lower than that in normal-weight patients. The sample size in this study was large, and it breaks the traditional BMI grouping method. The grouping method of this study is consistent with the traditional grouping method.