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Background: The aim of this study was to investigate the association between body mass index (BMI) and survival in patients with severe sepsis or septic shock. Methods: We analyzed the sepsis registry of patients presenting to the emergency department (ED) of a tertiary urban hospital and meeting the criteria for severe sepsis or septic shock from August 2008 to March 2012. We categorized patients into the underweight group (BMI < 18.5 kg/m2), the normal weight group (18.5 ≤ BMI < 25 kg/m2) and the obese group (BMI ≥ 25 kg/m2). Then, we analyzed the registry to evaluate the relation between obesity and in-hospital mortality. Results: A total of 770 adult patients with severe sepsis and septic shock were analyzed. In-hospital mortality rate of the underweight group (n = 86), the normal weight group (n = 489) and the obese group (n = 195) was 22.1%, 15.3% and 16.4%, respectively. In a multivariate regression analysis, the underweight group had a significant association with in-hospital mortality compared with the normal weight group (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.68-1.87; p = 0.028). The obese group showed no significant difference in mortality (OR, 2.04; 95% CI, 1.08-3.86; p = 0.65). Conclusions: The underweight patients showed significantly higher mortality than the normal weight patients with severe sepsis and septic shock.

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