Obesity Effects on Critical Illness Outcomes
Summary
Obesity is a growing global health challenge that intersects significantly with critical illness. Epidemiological data reveal a paradoxical association in which overweight and moderately obese patients often exhibit lower short-term mortality in intensive care or during sepsis, yet this apparent protection diminishes or reverses in severe or morbid obesity. Mechanistic studies point to altered immune responses, with adipose tissue-derived cytokines modulating systemic inflammation, and to differences in pharmacokinetics and dosing of fluids and antimicrobials. At the same time, obesity predisposes to complications such as steatohepatitis, insulin resistance and prolonged organ dysfunction after critical insults. Understanding how excess adiposity influences host defence, drug distribution and metabolic resilience is essential for optimising resuscitation strategies, antimicrobial dosing and long-term rehabilitation in critically ill patients.
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Obesity Effects on Critical Illness Outcomes publication trend
The graph below shows the total number of articles in obesity effects on critical illness outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Body mass index (BMI): A measure of weight relative to height (kg/m²) used to categorise underweight, normal weight, overweight and obesity.
Obesity paradox: The observation that overweight or moderately obese patients sometimes have better short-term survival in critical illness than those of normal weight.
Sepsis: A life-threatening organ dysfunction caused by a dysregulated host response to infection.
Steatohepatitis: Inflammation and injury of the liver associated with fatty infiltration, which may follow critical illness or persist in obesity.
Cytokines: Small proteins released by immune and adipose cells that regulate inflammation and may modulate outcomes in sepsis and critical care.
References
- Pneumosepsis survival in the setting of obesity leads to persistent steatohepatitis and metabolic dysfunction. Hepatology Communications (2023).
- Impact of obesity on all-cause and cause-specific mortality among critically ill men and women: a cohort study on the eICU database. Frontiers in Nutrition (2023).
- Association of body mass index with mortality of sepsis or septic shock: an updated meta-analysis. Journal of Intensive Care (2023).
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