Obesity Impacts Hospitalizations for Bacterial Pneumonia

Background Community-acquired pneumonia is a significant cause of morbidity and mortality worldwide caused by a wide variety of micro-organisms, most commonly bacterial. The study aimed to compare the mortality rates and secondary complications of disease severity in obese and nonobese with bacterial pneumonia (bPNE). Methods This was an observational cohort study of the National Inpatient Sample. The primary outcome was inpatient mortality. The secondary outcomes included sepsis, septic shock, acute respiratory failure, pulmonary embolism, need for mechanical ventilation, length of hospital stay, and total hospital charges. The findings were analyzed and compared with nonobese patients. Results and interpretation Patients with obesity class I/II and class III, had lower odds of inpatient mortality (adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.67–0.88; P < 0.001 and aOR, 0.73; 95% CI, 0.64–0.88; P < 0.001, respectively) compared with nonobese patients with bPNE. There was a decrease in odds of having sepsis (aOR, 0.81; 95% CI, 0.70–0.93; P = 0.004) and septic shock (aOR, 0.67; 95% CI, 0.49–0.92; P = 0.014) in patients with obesity class I/II as compared with nonobese patients. Patients with obesity class III were associated with higher odds of acute respiratory failure (aOR, 1.51; 95% CI, 1.46–1.58; P < 0.001), acute respiratory distress syndrome (aOR, 1.37; 95% CI, 1.13–1.66; P < 0.001), mechanical ventilation (aOR, 1.49; 95% CI, 1.36–1.64; P < 0.001), deep vein thrombosis (aOR, 1.34; 95% CI, 1.18–1.54; P < 0.001), pulmonary embolism (aOR, 1.42; 95% CI, 1.22–1.67; P < 0.001), as well as increased total hospital charges and length of hospital stay as compared with nonobese patients. Conclusions Both obesity class I/II and class III were found to be associated with lower odds of inpatient mortality in patients admitted with bPNE, the reported obesity paradox. Obesity continues to be associated with significantly increased health care utilization, which may have a long-term impact on the population if the trend toward a higher proportion of obese patients continues.