No obesity paradox in patients with community-acquired pneumonia – secondary analysis of a randomized controlled trial
Abstract
Background Obesity is associated with an increased risk for several chronic conditions and mortality. However, there are data in support of beneficial outcome in acute medical conditions such as community-acquired pneumonia (CAP), termed “obesity paradox”. The aim of this study was to test the association of BMI with clinical outcomes in a large randomized clinical trial of patients hospitalized with CAP. Design and Methods In total, 773 patients hospitalized with CAP were included in this study. Patients were stratified into four groups according to their baseline BMI (underweight 30 kg/m 2 ). The primary endpoint was time to clinical stability (TTCS). Secondary endpoints included 30-day mortality, ICU admission rate, CAP complications, and duration of antibiotic treatment. Results BMI and TTCS had a U-shaped association with shortest TTCS among patients at an overweight BMI of 28 kg/m 2 . In patients with obesity, there was a trend towards reduced hazards to reach clinical stability when compared to patients with normal weight (HR 0.82; 95%CI, 0.67–1.02; p = 0.07). In underweight BMI group TTCS was prolonged by 1 day (HR 0.63; 95%CI, 0.45–0.89; p = 0.008). There was no difference in mortality or ICU admission rates between BMI groups ( p > 0.05 ). While in the underweight BMI group the total duration of antibiotic treatment was prolonged by 2.5 days (95%CI, 0.88–4.20, p = 0.003), there was no difference in patients with obesity. Conclusions The overweight BMI group had…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 773 participants or records.
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