The impact of obesity in cirrhotic patients with septic shock: A retrospective cohort study

Liver Int. 2018 Jul;38(7):1230-1241. doi: 10.1111/liv.13648. Epub 2017 Dec 18.


Background & aims: The prevalence of obesity in cirrhosis is rising. The impact of obesity in critically ill cirrhotic patients with sepsis/septic shock has not been evaluated. This study aimed to examine the relationship between obesity and mortality in cirrhotic patients admitted to the intensive care unit with septic shock.

Methods: A retrospective cohort study of all cirrhotic patients with septic shock (n = 362) and a recorded body mass index (BMI) from an international, multicentre (CATSS) database (1996-2015) was performed. Patients were classified by BMI as per WHO categories. Primary outcome was in-hospital mortality. Multivariate logistic regression analyses were carried out to determine independent associations with outcome.

Results: In this analysis, mean age was 56.4 years, and 62% were male. Median BMI was 26.3%, and 57.7% were overweight/obese. In-hospital mortality was 71%. Obese patients were more likely to have comorbidities of cardiac disease, lung disease and diabetes. Compared to survivors (n = 105), non-survivors (n = 257) had significantly higher MELD and APACHEII scores and higher requirements for renal replacement therapy and mechanical ventilation (P < .03 for all). Using multivariable logistic regression, increase in BMI (OR 1.07, P = .034), time delay to appropriate antimicrobials (OR 1.16 per hour, P = .003), APACHEII (OR 1.12 per unit, P = .008) and peak lactate (OR 1.15, P = .028) were independently associated with in-hospital mortality.

Conclusions: Septic shock in cirrhosis carries a high mortality. Increased BMI is common in critically ill cirrhotic patients and independently associated with increased in-hospital mortality.

Keywords: cirrhosis; mortality; obesity; septic shock.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Body Mass Index*
  • Canada / epidemiology
  • Comorbidity
  • Critical Illness / mortality
  • Databases, Factual
  • Female
  • Hospital Mortality / trends
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Lactic Acid / blood
  • Liver Cirrhosis / microbiology
  • Liver Cirrhosis / mortality*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Obesity / epidemiology*
  • Retrospective Studies
  • Saudi Arabia / epidemiology
  • Severity of Illness Index
  • Shock, Septic / microbiology
  • Shock, Septic / mortality*
  • Survival Analysis
  • United States / epidemiology


  • Lactic Acid