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Obesity and early sepsis-associated acute respiratory distress syndrome: A prospective multicenter study
Lina Zhao1, Yun Li2, Xuezhen Lin3
1Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China.
Respiratory Medicine
|July 4, 2026
Summary
Obesity increases the risk of sepsis-associated acute respiratory distress syndrome (SA-ARDS). However, this survival benefit seen with the Berlin definition disappears when using expanded criteria including high-flow nasal cannula (HFNC).
Area of Science:
- Critical Care Medicine
- Pulmonology
- Epidemiology
Background:
- The impact of obesity on sepsis-associated acute respiratory distress syndrome (SA-ARDS) is not fully understood, especially with evolving diagnostic criteria.
- Current definitions may not fully capture the spectrum of SA-ARDS, influencing our understanding of obesity's role.
Purpose of the Study:
- To investigate how obesity differentially affects SA-ARDS incidence and mortality.
- To compare outcomes using the Berlin definition versus an expanded framework including high-flow nasal cannula (HFNC).
Main Methods:
- A prospective multicenter cohort study of 1,799 adult sepsis patients (Sepsis 3.0).
- SA-ARDS diagnosis utilized both the Berlin criteria and a new definition incorporating HFNC.
- Primary outcome was SA-ARDS incidence; secondary outcomes included 28- and 90-day mortality.
Main Results:
- Obesity was independently linked to higher SA-ARDS incidence under the new definition (aOR 5.61) and Berlin criteria (aOR 6.66).
- No survival differences were found across BMI categories in the new definition cohort (including HFNC).
- Under the Berlin definition, obesity was associated with lower 90-day mortality, particularly in the elderly and those with prolonged hospital stays.
Conclusions:
- Obesity independently elevates SA-ARDS risk across both diagnostic frameworks.
- The mortality benefit observed with the Berlin definition is lost when using expanded criteria including HFNC.
- Obesity contributes to susceptibility but does not confer a universal survival advantage in contemporary ARDS cohorts.
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