Table 1 presents the clinical variables and laboratory values of the three groups of patients, including maximal levels of WBC, LDH, fibrinogen and minimal levels of eGFR, and albumin during hospitalization.
Table 1
Clinical characteristics and laboratory values of the three study groups. .
|
Pneumonia
|
UTI
|
Cellulitis
|
P-value
|
N=287
|
N=80
|
N=78
|
Age
|
64.5 (17.5)
[66, 20-94]
|
69.1 (14)
[71, 22-93]
|
55 (15.5)
[55, 21-85]
|
<.0001
|
Gender - male
|
172 (59.93%)
|
26 (32.5%)
|
53 (67.95%)
|
<.0001
|
BMI
|
27.5 (6.3)
[26.4, 14.8-76.5]
|
28.3 (5.1)
[27.5, 18-44.9]
|
32.4 (8.5)
[30.8, 18.7-62.5]
|
<.0001
|
GFR
|
69.7 (29.7)
[75, 10-148]
|
63.2 (25.3)
[60.5, 11-122]
|
83.2 (28)
[89, 10-140]
|
<.0001
|
Norton_score
|
17.1 (2.2)
[17, 13-20]
|
16.1 (2.4)
[16, 13-20]
|
17.3 (2.1)
[17, 13-20]
|
0.0015
|
WBCmax
|
14.5 (6.1)
[13.7, 4-40]
|
13.1 (5.8)
[11.9, 4.8-32]
|
13.5 (5.2)
[12.6, 4.3-31]
|
0.1307
|
LDHmax
|
487.3 (173.1)
[446.5, 76-1641]
|
456.5 (233.9)
[382, 240-1800]
|
448.3 (125.8)
[476, 237-726]
|
0.0093
|
Albumin_min
|
3.1 (0.4)
[3.2, 1.5-4.1]
|
3.1 (0.4)
[3.1, 2-4.3]
|
3.4 (0.4)
[3.4, 2.4-4.3]
|
0.0013
|
Fibrinogen_max*
|
723.1 (190.6)
[704, 352-1354]
|
671.6 (184.1)
[655, 392-1257]
|
692.3 (177.1)
[701, 264-1108]
|
0.1472
|
Death in 90 days
|
13 (4.53%)
|
5 (6.25%)
|
0 (0%)
|
0.0753
|
Continuous variables are presented with mean (SD) [median, range].
*%missing: Fibrinogen_max 29%; LDHmax 13%; Albumin_min 2%
|
Patients with cellulitis were younger, their BMI was greater, and their albumin levels decreased, but to a lesser extent than those observed in patients with UTIs or pneumonia. Among patients with UTIs, females were more prevalent. (p<0.0001).
Mortality rates three months after hospitalization were 4.5%, 6.3% and 0% for patients with pneumonia, UTIs, and cellulitis, respectively (p=NS).
Table 2 shows the clinical characteristics and laboratory values of the three groups of infections stratified by their BMI.
Table 2
Clinical characteristics and laboratory values of the three study groups according to BMIs
A - Pneumonia
|
BMI<30
|
BMI≥30
|
P-value
|
N=223
|
N=64
|
Age
|
65.2 (18)
[67, 20-94]
|
62.1 (15.6)
[65, 24-88]
|
0.1553
|
Gender - male
|
143 (64.13%)
|
29 (45.31%)
|
0.0068
|
CR
|
1.3 (1)
[1, 0.4-7]
|
1.2 (0.6)
[1, 0.4-5.1]
|
0.7924
|
GFR
|
70.1 (30.3)
[76, 10-148]
|
68.3 (27.6)
[68.5, 10-130]
|
0.6643
|
|
|
|
|
Norton score
|
185 (82.96%)
|
53 (82.81%)
|
0.9780
|
WBCmax
|
14.5 (6)
[13.7, 4-39]
|
14.5 (6.4)
[13.6, 5.5-40]
|
0.9535
|
LDHmax
|
485.8 (174)
[446, 76-1641]
|
492.4 (171.5)
[453, 280-1196]
|
0.8106
|
Albumin_min
|
3.1 (0.4)
[3.1, 1.8-4.1]
|
3.2 (0.4)
[3.4, 1.5-3.9]
|
0.0196
|
Fibrinogen_max*
|
728.2 (193.4)
[715, 352-1354]
|
705.1 (181.2)
[658, 441-1199]
|
0.4732
|
Death in 90 days
|
8 (3.59%)
|
5 (7.81%)
|
0.1730
|
Continuous variables are presented with mean (SD) [median, range]. |
B - UTI
|
BMI<30
|
BMI≥30
|
P-value
|
N=58
|
N=22
|
Age
|
69.3 (14.6)
[71, 22-93]
|
68.4 (12.3)
[66, 42-91]
|
0.4250
|
Gender - male
|
18 (31.03%)
|
8 (36.36%)
|
0.6495
|
CR
|
1.1 (0.5)
[1, 0.3-3.8]
|
1.4 (0.9)
[1, 0.7-4]
|
0.2380
|
GFR
|
65.7 (25.3)
[62, 11-122]
|
56.5 (24.6)
[59.5, 14-98]
|
0.2336
|
Norton score
|
41 (70.69%)
|
11 (50%)
|
0.0832
|
WBCmax
|
13.3 (5.4)
[11.9, 4.8-30]
|
12.8 (6.9)
[11.4, 5.3-32]
|
0.4377
|
LDHmax
|
451.9 (217.1)
[390, 256-1800]
|
469.5 (282.6)
[367, 240-1500]
|
0.7821
|
Albumin_min
|
3.2 (0.4)
[3.1, 2-4.3]
|
3.1 (0.4)
[3.1, 2.2-3.9]
|
0.5602
|
Fibrinogen_max*
|
660.9 (170.8)
[655, 392-1200]
|
699.1 (218.3)
[693.5, 424-1257]
|
0.5759
|
Death in 90 days
|
3 (5.17%)
|
2 (9.09%)
|
0.6117
|
Continuous variables are presented with mean (SD) [median, range]. |
C - Cellulitis
|
BMI<30
|
BMI≥30
|
P-value
|
N=34
|
N=44
|
Age
|
51.1 (17.1)
[53, 21-83]
|
58 (13.7)
[56, 25-85]
|
0.0643
|
Gender - male
|
27 (79.41%)
|
26 (59.09%)
|
0.0565
|
CR
|
1 (0.4)
[0.9, 0.6-2.4]
|
1.1 (1)
[0.9, 0.5-7.4]
|
0.8040
|
GFR
|
86.9 (28.8)
[90, 26-130]
|
80.3 (27.5)
[87, 10-140]
|
0.3101
|
|
|
|
|
Norton score
|
31 (91.18%)
|
35 (79.55%)
|
0.1580
|
WBCmax
|
13.3 (6.2)
[11.8, 4.3-31]
|
13.7 (4.4)
[12.9, 6.4-24]
|
0.3888
|
LDHmax
|
422.6 (123.4)
[398, 237-648]
|
462.8 (126.8)
[484.5, 237-726]
|
0.2588
|
Albumin_min
|
3.4 (0.5)
[3.5, 2.4-4.3]
|
3.3 (0.4)
[3.4, 2.6-4.2]
|
0.3562
|
Fibrinogen_max
|
687.6 (189.6)
[690, 264-1101]
|
694.6 (173.5)
[705, 440-1108]
|
0.9068
|
Death in 90 days
|
0 (0%)
|
0 (0%)
|
-
|
Continuous variables are presented with mean (SD) [median, range]. |
Overall, in the three groups, most patients with BMI³30 kg/m2 were females, and albumin levels were lowest in the non-obese group.
In the cellulitis group, obese patients were older than patients whose BMI was <30.On days 0-1 of hospitalization, the mean CRP level was 12.6±9.9 mg/dl for all patients with a BMI<30 kg/m2, and 10.4±10 mg/dl for all obese patients (BMI≥30 kg/m²) (p=0.06).
On days 2-4 of hospital stay, the mean CRP level was 7.5±9.5 mg/dl in the non-obese group vs. 6.5±6.8 mg/dl in the obese group (p=0.7), and 3.7±4.2 vs. 4.4±4.9 (p=0.6) on days 5-7, respectively (Figure 1).As expected, CRP levels were observed to decrease from days 0-1 of hospitalization towards day 7 as shown in figure 2, but a counterintuitive observation was that mean CRP levels in the non-obese group was consistently greater than in the obese group.
No correlation between BMIs and CRP levels was detected at any sampling on days 0-1, 2-4, and 5-7. (Figure 3).
Other markers of inflammation including LDH, fibrinogen, maximal WBC levels during hospitalization and minimal albumin levels were measured. None of these markers correlated with the maximal CRP levels.