Medicina intensiva · 2026
Obesity paradox in sepsis: a systematic review and meta-analysis of short- and long-term mortality risks.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Yang Sa, Yang Shuying, Li Hongjie, Xu Hua, Liu Dingbin, Gao Hongmei
Аннотация
OBJECTIVE: To clarify the association of elevated BMI with short- and long-term mortality in sepsis, and to evaluate this association specifically in patients with a BMI ≥ 40 kg/m2.
DESIGN: Systematic review and meta-analysis.
SETTING: PubMed, Embase, and the Cochrane Library were searched for studies published up to December 2025. Twelve studies met the inclusion criteria.
PARTICIPANTS: Twelve retrospective studies with 130755 adult sepsis patients. Elevated BMI was defined as ≥30 kg/m2; normal weight as 18.5-25.0 kg/m2.
INTERVENTIONS: Not applicable.
MAIN VARIABLES OF INTEREST: Exposure: BMI ≥ 30 kg/m2.
OUTCOMES: short-term (28-day, 30-day, ICU, in-hospital) and long-term (1-year) mortality. A separate analysis targeted BMI ≥ 40 kg/m2.
RESULTS: An elevated BMI was associated with reduced short-term mortality (8 studies: OR 0.75, 95% CI 0.69-0.81; I2 = 11.8%), 28-/30-day mortality (5 studies: OR 0.74, 95% CI 0.68-0.81; I2 = 7.7%), and long-term mortality (2 studies: OR 0.68, 95% CI 0.60-0.77; I2 = 0.0%). This inverse association persisted in patients with BMI ≥ 40 kg/m2 (4 studies: OR 0.70, 95% CI 0.62-0.79; I2 = 26.3%). Sensitivity analyses confirmed robustness.
CONCLUSIONS: Elevated BMI is associated with lower short- and long-term mortality in sepsis, consistent with the obesity paradox. The inverse association also persisted in patients with a BMI ≥ 40 kg/m2.
DESIGN: Systematic review and meta-analysis.
SETTING: PubMed, Embase, and the Cochrane Library were searched for studies published up to December 2025. Twelve studies met the inclusion criteria.
PARTICIPANTS: Twelve retrospective studies with 130755 adult sepsis patients. Elevated BMI was defined as ≥30 kg/m2; normal weight as 18.5-25.0 kg/m2.
INTERVENTIONS: Not applicable.
MAIN VARIABLES OF INTEREST: Exposure: BMI ≥ 30 kg/m2.
OUTCOMES: short-term (28-day, 30-day, ICU, in-hospital) and long-term (1-year) mortality. A separate analysis targeted BMI ≥ 40 kg/m2.
RESULTS: An elevated BMI was associated with reduced short-term mortality (8 studies: OR 0.75, 95% CI 0.69-0.81; I2 = 11.8%), 28-/30-day mortality (5 studies: OR 0.74, 95% CI 0.68-0.81; I2 = 7.7%), and long-term mortality (2 studies: OR 0.68, 95% CI 0.60-0.77; I2 = 0.0%). This inverse association persisted in patients with BMI ≥ 40 kg/m2 (4 studies: OR 0.70, 95% CI 0.62-0.79; I2 = 26.3%). Sensitivity analyses confirmed robustness.
CONCLUSIONS: Elevated BMI is associated with lower short- and long-term mortality in sepsis, consistent with the obesity paradox. The inverse association also persisted in patients with a BMI ≥ 40 kg/m2.