Obesity is independently associated with infection in hospitalised patients with end-stage liver disease

V. Sundaram, A. Kaung, A. Rajaram, S. C. Lu, T. T. Tran, N. N. Nissen, A. S. Klein, R. Jalan, M. R. Charlton, C. Y. Jeon

Research output: Contribution to journalArticle

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Abstract

Summary Background Infection is the most common cause of mortality in end-stage liver disease (ESLD). The impact of obesity on infection risk in ESLD is not established. Aim To characterise the impact of obesity on infection risk in ESLD. Methods We evaluated the association between infection and obesity in patients with ESLD. Patients grouped as non-obese, obesity class I-II and obesity class III were studied using the Nationwide Inpatient Sample. Validated diagnostic code based algorithms were utilised to determine weight category and infections, including bacteraemia, skin/soft tissue infection, urinary tract infection (UTI), pneumonia/respiratory infection, Clostridium difficile infection (CDI) and spontaneous bacterial peritonitis (SBP). Risk factors for infection and mortality were assessed using multivariable logistic regression analysis. Results Of 115 465 patients identified, 100 957 (87.5%) were non-obese and 14 508 (12.5%) were obese, with 9489 (8.2%) as obesity class I-II and 5019 (4.3%) as obesity class III. 37 117 patients (32.1%) had an infection diagnosis. Infection was most prevalent among obesity class III (44.0%), followed by obesity class I-II (38.9%) and then non-obese (31.9%). In multivariable modelling, class III obesity (OR = 1.41; 95% CI 1.32-1.51; P <0.001), and class I-II obesity (OR = 1.08; 95% CI 1.01-1.15; P = 0.026) were associated with infection. Compared to non-obese patients, obese individuals had greater prevalence of bacteraemia, UTI, and skin/soft tissue infection as compared to non-obese patients. Conclusions Obesity is newly identified to be independently associated with infection in end-stage liver disease. The distribution of infection sites varies based on weight category.

Original languageEnglish (US)
Pages (from-to)1271-1280
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume42
Issue number11-12
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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End Stage Liver Disease
Obesity
Infection
Soft Tissue Infections
Bacteremia
Urinary Tract Infections
Clostridium Infections
Weights and Measures
Skin
Clostridium difficile
Mortality
Peritonitis
Respiratory Tract Infections
Inpatients
Pneumonia
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Sundaram, V., Kaung, A., Rajaram, A., Lu, S. C., Tran, T. T., Nissen, N. N., ... Jeon, C. Y. (2015). Obesity is independently associated with infection in hospitalised patients with end-stage liver disease. Alimentary Pharmacology and Therapeutics, 42(11-12), 1271-1280. https://doi.org/10.1111/apt.13426

Obesity is independently associated with infection in hospitalised patients with end-stage liver disease. / Sundaram, V.; Kaung, A.; Rajaram, A.; Lu, S. C.; Tran, T. T.; Nissen, N. N.; Klein, A. S.; Jalan, R.; Charlton, M. R.; Jeon, C. Y.

In: Alimentary Pharmacology and Therapeutics, Vol. 42, No. 11-12, 01.12.2015, p. 1271-1280.

Research output: Contribution to journalArticle

Sundaram, V, Kaung, A, Rajaram, A, Lu, SC, Tran, TT, Nissen, NN, Klein, AS, Jalan, R, Charlton, MR & Jeon, CY 2015, 'Obesity is independently associated with infection in hospitalised patients with end-stage liver disease', Alimentary Pharmacology and Therapeutics, vol. 42, no. 11-12, pp. 1271-1280. https://doi.org/10.1111/apt.13426
Sundaram, V. ; Kaung, A. ; Rajaram, A. ; Lu, S. C. ; Tran, T. T. ; Nissen, N. N. ; Klein, A. S. ; Jalan, R. ; Charlton, M. R. ; Jeon, C. Y. / Obesity is independently associated with infection in hospitalised patients with end-stage liver disease. In: Alimentary Pharmacology and Therapeutics. 2015 ; Vol. 42, No. 11-12. pp. 1271-1280.
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abstract = "Summary Background Infection is the most common cause of mortality in end-stage liver disease (ESLD). The impact of obesity on infection risk in ESLD is not established. Aim To characterise the impact of obesity on infection risk in ESLD. Methods We evaluated the association between infection and obesity in patients with ESLD. Patients grouped as non-obese, obesity class I-II and obesity class III were studied using the Nationwide Inpatient Sample. Validated diagnostic code based algorithms were utilised to determine weight category and infections, including bacteraemia, skin/soft tissue infection, urinary tract infection (UTI), pneumonia/respiratory infection, Clostridium difficile infection (CDI) and spontaneous bacterial peritonitis (SBP). Risk factors for infection and mortality were assessed using multivariable logistic regression analysis. Results Of 115 465 patients identified, 100 957 (87.5{\%}) were non-obese and 14 508 (12.5{\%}) were obese, with 9489 (8.2{\%}) as obesity class I-II and 5019 (4.3{\%}) as obesity class III. 37 117 patients (32.1{\%}) had an infection diagnosis. Infection was most prevalent among obesity class III (44.0{\%}), followed by obesity class I-II (38.9{\%}) and then non-obese (31.9{\%}). In multivariable modelling, class III obesity (OR = 1.41; 95{\%} CI 1.32-1.51; P <0.001), and class I-II obesity (OR = 1.08; 95{\%} CI 1.01-1.15; P = 0.026) were associated with infection. Compared to non-obese patients, obese individuals had greater prevalence of bacteraemia, UTI, and skin/soft tissue infection as compared to non-obese patients. Conclusions Obesity is newly identified to be independently associated with infection in end-stage liver disease. The distribution of infection sites varies based on weight category.",
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AU - Sundaram, V.

AU - Kaung, A.

AU - Rajaram, A.

AU - Lu, S. C.

AU - Tran, T. T.

AU - Nissen, N. N.

AU - Klein, A. S.

AU - Jalan, R.

AU - Charlton, M. R.

AU - Jeon, C. Y.

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N2 - Summary Background Infection is the most common cause of mortality in end-stage liver disease (ESLD). The impact of obesity on infection risk in ESLD is not established. Aim To characterise the impact of obesity on infection risk in ESLD. Methods We evaluated the association between infection and obesity in patients with ESLD. Patients grouped as non-obese, obesity class I-II and obesity class III were studied using the Nationwide Inpatient Sample. Validated diagnostic code based algorithms were utilised to determine weight category and infections, including bacteraemia, skin/soft tissue infection, urinary tract infection (UTI), pneumonia/respiratory infection, Clostridium difficile infection (CDI) and spontaneous bacterial peritonitis (SBP). Risk factors for infection and mortality were assessed using multivariable logistic regression analysis. Results Of 115 465 patients identified, 100 957 (87.5%) were non-obese and 14 508 (12.5%) were obese, with 9489 (8.2%) as obesity class I-II and 5019 (4.3%) as obesity class III. 37 117 patients (32.1%) had an infection diagnosis. Infection was most prevalent among obesity class III (44.0%), followed by obesity class I-II (38.9%) and then non-obese (31.9%). In multivariable modelling, class III obesity (OR = 1.41; 95% CI 1.32-1.51; P <0.001), and class I-II obesity (OR = 1.08; 95% CI 1.01-1.15; P = 0.026) were associated with infection. Compared to non-obese patients, obese individuals had greater prevalence of bacteraemia, UTI, and skin/soft tissue infection as compared to non-obese patients. Conclusions Obesity is newly identified to be independently associated with infection in end-stage liver disease. The distribution of infection sites varies based on weight category.

AB - Summary Background Infection is the most common cause of mortality in end-stage liver disease (ESLD). The impact of obesity on infection risk in ESLD is not established. Aim To characterise the impact of obesity on infection risk in ESLD. Methods We evaluated the association between infection and obesity in patients with ESLD. Patients grouped as non-obese, obesity class I-II and obesity class III were studied using the Nationwide Inpatient Sample. Validated diagnostic code based algorithms were utilised to determine weight category and infections, including bacteraemia, skin/soft tissue infection, urinary tract infection (UTI), pneumonia/respiratory infection, Clostridium difficile infection (CDI) and spontaneous bacterial peritonitis (SBP). Risk factors for infection and mortality were assessed using multivariable logistic regression analysis. Results Of 115 465 patients identified, 100 957 (87.5%) were non-obese and 14 508 (12.5%) were obese, with 9489 (8.2%) as obesity class I-II and 5019 (4.3%) as obesity class III. 37 117 patients (32.1%) had an infection diagnosis. Infection was most prevalent among obesity class III (44.0%), followed by obesity class I-II (38.9%) and then non-obese (31.9%). In multivariable modelling, class III obesity (OR = 1.41; 95% CI 1.32-1.51; P <0.001), and class I-II obesity (OR = 1.08; 95% CI 1.01-1.15; P = 0.026) were associated with infection. Compared to non-obese patients, obese individuals had greater prevalence of bacteraemia, UTI, and skin/soft tissue infection as compared to non-obese patients. Conclusions Obesity is newly identified to be independently associated with infection in end-stage liver disease. The distribution of infection sites varies based on weight category.

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