P101 | Metainflammation and coagulation response of the obese patients during sepsis: an observational-prospective study

L. Molinari¹, A. Di Vincenzo², B. Barbato², C. Purificati², A. Postal², S. Pavone², M. Marchegiani², S. Cuppini¹, L. Spiezia³, R. Vettor² | ¹Medicina Interna, Azienda Ospedaliera di Rovigo, ²Clinica Medica 3, Azienda Università degli Studi di Padova, ³Medicina Generale, Azienda Università degli Studi di Padova, Italy

Premises and purpose: Few data corroborate the “obesity paradox”: an association between obesity and higher survival rate during sepsis. We aim to verify the impact of obesity in terms of outcome in patients with sepsis.
Methods: We analyzed all septic patients referred to our Subintensive Medical Unit recording clinical data, history and comorbidities. We collected BMI, body circumference, cytokines, clotting factors, leptin and thromboelastography (TEG). A mediation analysis was performed to identify potential mediators in the relationship between obesity, and mortality during sepsis. A 3-month follow-up was conducted.
Results: 36 septic patients have been enrolled and divided according to BMI. No differences were found in terms of in-hospital mortality, septic shock, and rehospitalisation (p>0.05). Leptin remained higher in patients with severe obesity (p<0.01). During early stages, cytokines increased compared to baseline, particularly in the obesity group. This trend manifested only in severe sepsis (SOFA>4pt) for IL6 and IL8. Regardless of the BMI, LAD and TNF-α correlated with mortality (p=0.05). The coagulation profile tended to a procoagulant state and TEG revealed a prolonged extrinsic pathway activation exclusively in severe obesity (p=0.04). On the contrary, we recorded a transient hypoaggregating trend independent of BMI. No discrepancies in terms of incidence of CID or TEP were found.
Conclusions: Despite multiple comorbidities and an unfavourable anthropometric profile, no higher in-hospital mortality nor complications were recorded among patients with obesity.