This retrospective cohort study examined the association between body mass index (BMI) and clinical outcomes in 559 adult ICU patients with sepsis admitted between January 2021 and December 2023. Patients were categorized into underweight (n=51), normal weight (n=206), overweight (n=158), and obese (n=184) groups.

The primary outcome, ICU mortality, showed no significant differences across BMI categories (p > 0.05).

Secondary outcomes—including rates of septic shock and acute respiratory distress syndrome, 30- and 90-day mortality, ICU and hospital length of stay, and vasopressor- or ventilation-free days—were also comparable between groups.

These results indicate that BMI does not influence worse outcomes in sepsis patients, neither supporting an “obesity paradox” protective effect nor highlighting increased risks for underweight individuals in this cohort.

The authors conclude that BMI appears neutral in sepsis prognosis and call for larger prospective studies to validate these findings and resolve ongoing controversies in the literature.

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