(C-058) Obesity and Ventilator-Associated Pneumonia: Results from Electronic Health Record

Background: Patients with obesity are at a higher risk for developing infections in the intensive critical care units. Among these infections, ventilator-associated pneumonia (VAP) is a major cause of mortality.

Objectives: To examine the impact of obesity on the outcomes of patients diagnosed with VAP.

Methods: Using electronic health record data from 2019-2023 at the University of Kentucky HealthCare (UKHC) Intensive Care Units (ICUs), we conducted a retrospective cohort study in patients diagnosed with VAP, comparing individuals with a diagnosis of obesity to those without one. Demographic characteristics such as age, race and sex were analyzed. Group comparisons were performed using the chi-square test or Fisher’s exact test, as appropriate. The primary outcome was in-hospital mortality, while the secondary outcome was the need for tracheostomy. Multivariable Cox proportional hazards model and multivariable logistic regression model were used to adjust for potential confounders including diabetes mellitus, hypertension, corona virus disease 2019 (COVID-19) co-infection, chronic kidney disease (CKD), heart failure and end stage renal disease (ESRD), with a p-value <0.05 considered significant.

Results: The study included 684 patients with VAP, 360 of whom were obese. The mean age was 56±16 years, and 59.7% of the obese group was male compared to 65.7% in the non-obese group. Race differs significantly between groups (p=0.02), with the majority being white (88%) in the overall group. The obese group had more comorbidities including CKD (p=0.02), diabetes mellitus (p < 0.0001), hypertension (p=0.005), heart failure (p=0.007) and ESRD (p < 0.0001). COVID-19 was more common in obese patients (34.7%) compared to non-obese patients (23.8%, p=0.002). After adjusting for demographic and clinical characteristics, obesity was significantly associated with an increased risk of in-hospital mortality among patients with VAP (adjusted hazard ratio [aHR] = 1.47; 95% Confidence Interval [CI]: 1.10–1.98; p = 0.01). However, obesity was not significantly associated with the odds of receiving a tracheostomy (adjusted odds ratio [aOR] = 0.80; 95% CI: 0.57–1.14; p = 0.21).

Conclusions: Among ICU patients with VAP, obesity was independently associated with an increased risk of in-hospital mortality; however, it was not identified as an independent risk factor for the need for tracheostomy.