Influence of overweight and obesity on the mortality of hospitalized patients with community-acquired pneumonia

doi:10.12998/wjcc.v10.i1.104

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World Journal of Clinical Cases

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World J Clin Cases. Jan 7, 2022; 10(1): 104-116
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.104

Table 1 Clinical and laboratory characteristics of 2327 patients admitted to hospital with pneumonia in different body mass index groups

Characteristics	BMI categories (kg/m²)			P value
Characteristics	< 18.5 (n = 297)	18.5-23.9 (n = 1013)	≥ 24 (n = 1017)	P value
Age (yr), (median, IQR), n (%)	77 (63, 84)	68 (56, 79)^a	65 (53, 77)^c	< 0.001
< 65	80 (26.9)	416 (41.4)^a	476 (46.8)^b^,^c	< 0.001
≥ 65	217 (73.1)	597 (58.9)^a	541 (53.2)^b^,^c	< 0.001
Sex, n (%)				0.025
Male	156 (52.5)	617 (60.9)^a	581 (57.2)
Female	141 (47.5)	396 (39.1)^a	436 (42.8)
Diabetes history, n (%)				0.002
No	260 (87.4)	995 (81.3)	758 (74.3)^b^,^c
Yes	37 (12.6)	185 (18.7)	259 (25.7)^b^,^c
Consciousness, n (%)				< 0.001
Conscious	247 (83.2)	919 (90.7)^a	948 (93.3)^c
Confusion	50 (16.8)	94 (9.3)^a	69 (6.7)^c
RR (breaths/min), (median, IQR), n (%)	20 (20, 21)	20 (20, 20)^a	20 (20, 20)	0.036
< 30	282 (94.9)	975 (96.2)	974 (95.8)	0.597
≥ 30	15 (5.1)	38 (3.8)	43 (4.2)	0.597
SBP (mmHg), (median, IQR), n (%)	121.5 (110.0, 142.0)	127.0 (113.0, 140.0)^a	130.0 (120.0, 145.0)^b^,^c	< 0.001
≥ 90	280 (94.3)	990 (97.7)^a	1002 (98.5)^c	< 0.001
< 90	17 (5.7)	23 (2.3)^a	15 (1.5)^c	< 0.001
DBP (mmHg), (median, IQR), n (%)	73.0 (65.0, 81.0)	77.0 (70.0, 84.0)^a	80.0 (70.0, 88.0)^b^,^c	< 0.001
> 60	248 (83.5)	890 (87.9)	933 (91.7)^b^,^c	< 0.001
≤ 60	49 (16.5)	123 (12.1)	84 (8.3)^b^,^c	< 0.001
WBC (10⁹/L), (median, IQR), n (%)	8.56 (6.03, 12.85)	8.19 (5.84, 11.73)^a	7.99 (5.86, 11.31)^c	0.039
Normal	159 (53.5)	554 (54.7)	576 (56.7)	0.519
Abnormal	138 (46.5)	459 (45.3)	441 (43.3)	0.519
NEUT (10^9/L), (median, IQR), n (%)	6.75 (4.28, 10.64)	6.03 (3.78, 9.49)^a	5.68 (3.75, 8.79)^c	0.002
Normal	125 (42.1)	478 (47.2)^a	516 (50.7)^c	0.025
Abnormal	172 (57.9)	535 (52.8)^a	501 (49.3)^c	0.025
CRP (mg/L), (median, IQR), n (%)	48.26 (10.55, 105.05)	26.53 (5.96, 79.17)^a	21.24 (2.92, 72.30)^b^,^c	< 0.001
Normal	58 (19.5)	266 (26.3)	313 (30.7)^c	< 0.001
Abnormal	239 (80.5)	747 (73.7)	704 (69.3)^c	< 0.001
BUN (mmol/L), (median, IQR), n (%)	6.30 (4.30, 9.45)	5.60 (4.20, 8.10)^a	5.50 (4.10, 7.38)^c	0.001
Normal	177 (59.6)	656 (64.8)^a	721 (71.0)^b^,^c	< 0.001
Abnormal	120 (40.4)	357 (35.2)^a	296 (29.0)^b^,^c	< 0.001
ALB (g/L), (median, IQR), n (%)	33.0 (29.9, 37.2)	34.7 (31.0, 38.3)^a	36.9 (33.2, 40.1)^b^,^c	< 0.001
Normal	98 (33.0)	461 (45.5)^a	621 (61.1)^b^,^c	< 0.001
Abnormal	199 (67.0)	552 (54.5)^a	396 (38.9)^b^,^c	< 0.001
HOD (d), (median, IQR), n (%)	10 (7, 15)	10 (7, 14)	10 (7, 14)	0.599
Ventilator use	47 (16.0)	108 (10.7)^a	95 (9.4)^c	0.006
ICU admission	61 (20.5)	182 (18.0)	123 (12.1)^b^,^c	< 0.001
CURB-65 score, (median, IQR), n (%)	1 (1, 2)	1 (0, 2)^a	1 (0, 2)^b^,^c	< 0.001
Low risk	156 (52.5)	675 (66.6)^a	745 (73.2)^b^,^c	< 0.001
Moderate risk	86 (29.0)	236 (23.3)^a	205 (20.2)^b^,^c
High risk	205 (20.2)	102 (10.1)^a	67 (6.6)^b^,^c
Death, n (%)	27 (9.1)	51 (5.0)^a	28 (2.8)^b^,^c	< 0.001

^aP < 0.05, body mass index (BMI) 18.5-23.9 kg/m² group vs BMI <18.5 kg/m² group.

^bP < 0.05, BMI ≥ 24 kg/m² group vs BMI 18.5-23.9 kg/m² group.

^cP < 0.05, BMI < 18.5 kg/m² group vs BMI ≥ 24 kg/m² group.

Data are expressed as median with interquartile ranges or n with percentiles (%). When data were not normally distributed, they were Log-n transformed for analysis. The CURB-65 score is a tool for assessing the severity of patients with community-acquired pneumonia, including new onset confusion; urea > 7 mmol/L; respiratory rate ≥ 30 breaths/min, systolic blood pressure < 90 mmHg and/or diastolic blood pressure ≤ 60 mmHg; and age ≥ 65 years. BMI: Body mass index; IQR: Interquartile range; ALB: Albumin; BUN: Blood urea nitrogen; CRP: C-reactive protein; DBP: Diastolic blood pressure; HOD: Hospital day; ICU: Intensive care unit; NEUT: Neutrophil granulocyte; RR: Respiratory rate; SBP: Systolic blood pressure; WBC: White blood cell.

Table 2 Clinical and laboratory characteristics of 2327 patients admitted to hospital with pneumonia in different survival state groups

Characteristics	Survival (n = 2221)	Death (n = 106)	P value
Age (yr), (median, IQR), n (%)	68 (55, 79)	78.5 (70, 85.25)	< 0.001
< 65	955 (43.0)	17 (16.0)	< 0.001
≥ 65	1266 (57.0)	89 (84.0)	< 0.001
Sex, n (%)			0.206
Male	1287 (57.9)	68 (64.2)
Female	934 (42.1)	38 (35.8)
BMI (kg/m²), (median, IQR), n (%)	23.44 (20.57, 25.99)	21.10 (18.40, 24.08)	< 0.001
Underweight	270 (12.2)	27 (25.5)	< 0.001
Normal weight	962 (43.3)	51 (48.1)
Overweight/obesity	988 (44.5)	28 (26.4)
Diabetes history, n (%)	442 (20.2)	39 (37.9)	< 0.001
Smoking history (yr), n (%)	409 (18.8)	10 (9.7)	0.020
Consciousness, n (%)			< 0.001
Conscious	2038 (91.8)	77 (72.6)
Confusion	183 (8.2)	29 (27.4)
RR (breaths/min), (median, IQR), n (%)	20 (20, 20)	20 (19, 24)	0.093
< 30	2135 (96.1)	96 (90.6)	0.010
≥ 30	86 (3.9)	10 (9.4)	0.010
SBP (mmHg), (median, IQR), n (%)	130.0 (116.0, 144.0)	130.0 (104.5, 150.0)	0.186
≥ 90	2178 (98.1)	94 (88.7)	< 0.001
< 90	43 (1.9)	12 (11.3)	< 0.001
DBP (mmHg), (median, IQR), n (%)	79.0 (70.0, 86.0)	77.5 (62.8, 86.0)	0.078
> 60	1989 (89.6)	82 (77.4)	< 0.001
≤ 60	232 (10.4)	24 (22.6)	< 0.001
WBC (10⁹/L), (median, IQR), n (%)	7.99 (5.80, 11.39)	11.65 (8.67, 16.38)	< 0.001
Normal	1258 (56.6)	32 (30.2)	< 0.001
Abnormal	963 (43.4)	74 (69.8)	< 0.001
NEUT (10⁹/L), (median, IQR), n (%)	5.86 (3.74, 9.00)	10.02 (6.88, 14.64)	< 0.001
Normal	1099 (49.5)	20 (18.9)	< 0.001
Abnormal	1122 (50.5)	86 (81.1)	< 0.001
CRP (mg/L), (median, IQR), n (%)	24.96 (4.52, 78.38)	52.48 (18.27, 139.64)	< 0.001
≤ 10 mg/L	626 (28.2)	11 (10.4)	< 0.001
> 10 mg/L	1595 (71.8)	95 (89.6)	< 0.001
BUN (mmol/L), (median, IQR), n (%)	5.50 (4.10, 7.70)	8.95 (5.65, 14.33)	< 0.001
Normal	1507 (67.9)	48 (45.3)	< 0.001
Abnormal	714 (32.1)	58 (54.7)	< 0.001
ALB (g/L), (median, IQR), n (%)	35.70 (31.90, 39.20)	31.20 (28.00, 34.30)	< 0.001
Normal	1159 (52.2)	22 (20.8)	< 0.001
Abnormal	1062 (47.8)	84 (79.2)	< 0.001
HOD (days), (median, IQR)	9 (7, 14)	15 (6, 25)	0.014
Ventilator use, n (%)	200 (9.1)	50 (47.6)	< 0.001
ICU admission, n (%)	310 (14.0)	56 (52.8)	< 0.001
CURB-65 score, (median, IQR), n (%)	1 (0, 2)	2 (1, 3)	< 0.001
Low risk	1542 (69.4)	34 (32.1)	< 0.001
Medium risk	491 (22.1)	36 (34.0)
High risk	188 (8.5)	36 (34.0)

Data are expressed as medians with interquartile ranges or n with percentiles %. When data were not normally distributed, they were Log-n transformed for analysis. The CURB-65 score is a tool for assessing the severity of patients with community-acquired pneumonia, including new onset confusion; urea > 7 mmol/L; respiratory rate ≥ 30 breaths/min, systolic blood pressure < 90 mmHg and/or diastolic blood pressure ≤ 60 mmHg; and age ≥ 65 years. Normal weight: 18.5 kg/m²BMI ≤ 23.9 kg/m²; Overweight: BMI ≥ 24 kg/m²; Underweight: BMI <18.5 kg/m². BMI: Body mass index; IQR: Interquartile range; ALB: Albumin; BUN: Blood urea nitrogen; CRP: C-reactive protein; DBP: Diastolic blood pressure; HOD: Hospital day; ICU: Intensive care unit; NEUT: Neutrophil granulocyte; RR: Respiratory rate; SBP: Systolic blood pressure; WBC: White blood cell.

Table 3 Univariable and multivariable logistic regression analysis for all-cause mortality of 2327 patients with community-acquired pneumonia

Characteristics	Univariable			Multivariable
Characteristics	OR	95%CI	P value	OR	95%CI	P value
Sex (male vs female)	1.299	0.865-1.949	0.207
Diabetes history	1.718	1.205-2.450	0.003	1.423	0.994-2.037	0.054
WBC (abnormal vs normal)	3.138	2.233-4.408	< 0.001
NEUT (abnormal vs normal)	3.559	2.573-4.925	< 0.001	2.378	1.549-3.651	< 0.001
CRP (abnormal vs normal)	1.321	1.136-1.537	< 0.001
ALB (abnormal vs normal)	0.029	0.011-0.078	< 0.001	0.201	0.056-0.724	0.014
CURB-65 score (moderate risk vs low risk)	3.325	2.058-5.372	< 0.001	1.430	0.742-2.753	0.285
(High risk vs Low risk)	8.685	5.307-14.212	< 0.001	2.885	1.476-5.641	0.002
BMI (overweight/obesity vs normal weight)	0.535	0.334-0.855	0.009
BMI (underweight vs normal weight)	1.886	1.161-3.066	0.010
ICU admission	6.904	4.629-10.298	< 0.001	3.113	1.765-5.488	< 0.001

The CURB-65 score is a tool for assessing the severity of patients with community-acquired pneumonia, including new onset confusion; urea > 7 mmol/L; respiratory rate ≥ 30 breaths/min, systolic blood pressure < 90 mmHg and/or diastolic blood pressure ≤ 60 mmHg; and age ≥ 65 years. Normal weight: 18.5 kg/m²BMI ≤ 23.9 kg/m²; Overweight: BMI ≥ 24 kg/m²; Underweight: BMI < 18.5 kg/m². WBC: White blood cell; NEUT: Neutrophil granulocyte; CRP: C-reactive protein; ALB: Albumin; BMI: Body mass index; ICU: Intensive care unit; OR: Odds ratio; CI: Confidence interval.

Citation: Wang N, Liu BW, Ma CM, Yan Y, Su QW, Yin FZ. Influence of overweight and obesity on the mortality of hospitalized patients with community-acquired pneumonia. World J Clin Cases 2022; 10(1): 104-116
URL: https://www.wjgnet.com/2307-8960/full/v10/i1/104.htm
DOI: https://dx.doi.org/10.12998/wjcc.v10.i1.104