Does the obesity paradox predict functional outcome in intracerebral hemorrhage?

Neha S. Dangayach; Harpreet Singh Grewal; Gian Marco De Marchis; Roberta K. Sefcik; Rachel Bruce; Aarti Chhatlani; E. Sander Connolly; M. Cristina Falo; Sachin Agarwal; Jan Claassen; J. Michael Schmidt; Stephan A. Mayer

doi:10.3171/2017.5.JNS163266

Does the obesity paradox predict functional outcome in intracerebral hemorrhage?

Neha S. Dangayach, Harpreet Singh Grewal, Gian Marco De Marchis, Roberta K. Sefcik, Rachel Bruce, Aarti Chhatlani, E. Sander Connolly, M. Cristina Falo, Sachin Agarwal, Jan Claassen, J. Michael Schmidt, Stephan A. Mayer

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

Abstract

Objective: Being overweight or mildly obese has been associated with a decreased risk of death or hospitalization in patients with cardiovascular disease. Similarly, overweight patients admitted to an intensive care unit (ICU) have improved survival up to 1 year after admission. These counterintuitive observations are examples of the "obesity paradox." Does the obesity paradox exist in patients with intracerebral hemorrhage (ICH)? In this study the authors examined whether there was an association between obesity and functional outcome in patients with ICH. Methods: The authors analyzed 202 patients admitted to the neurological ICU (NICU) who were prospectively enrolled in the Columbia University ICH Outcomes Project between September 2009 and December 2012. Patients were categorized into 2 groups: overweight (body mass index [BMI] ≥ 25 kg/m²) and not overweight (BMI < 25 kg/m²). The primary outcome was defined as survival with favorable outcome (modified Rankin Scale [mRS] score 0.3) versus death or severe disability (mRS score 4.6) at 3 months. Results: The mean age of the patients in the study was 61 years. The mean BMI was 28 ± 6 kg/m². The mean Glasgow Coma Scale score was 10 ± 4 and the mean ICH score was 1.9 ± 1.3. The overall 90-day mortality rate was 41%. Among patients with a BMI < 25 kg/m², 24% (17/70) had a good outcome, compared with 39% (52/132) among those with a BMI ≥ 25 kg/m² (p = 0.03). After adjusting for ICH score, sex, do-not-resuscitate code status, and history of hypertension, being overweight or obese (BMI ≥ 25 kg/m²) was associated with twice the odds of having a good outcome compared with patients with BMI < 25 kg/m² (adjusted odds ratio 2.05, 95% confidence interval 1.03.4.06, p = 0.04). Conclusions: In patients with ICH admitted to the NICU, being overweight or obese (BMI ≥ 25 kg/m²) was associated with favorable outcome after adjustment for established predictors. The reason for this finding requires further study.

Original language	English
Pages (from-to)	1125-1129
Number of pages	5
Journal	Journal of Neurosurgery
Volume	129
Issue number	5
DOIs	https://doi.org/10.3171/2017.5.JNS163266
State	Published - Nov 2018
Externally published	Yes

Keywords

Functional recovery
Intensive care unit
Intracerebral hemorrhage
Obesity
Vascular disorders

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10.3171/2017.5.JNS163266

Cite this

@article{13fc88428b1749259819e07038963329,

title = "Does the obesity paradox predict functional outcome in intracerebral hemorrhage?",

abstract = "Objective: Being overweight or mildly obese has been associated with a decreased risk of death or hospitalization in patients with cardiovascular disease. Similarly, overweight patients admitted to an intensive care unit (ICU) have improved survival up to 1 year after admission. These counterintuitive observations are examples of the {"}obesity paradox.{"} Does the obesity paradox exist in patients with intracerebral hemorrhage (ICH)? In this study the authors examined whether there was an association between obesity and functional outcome in patients with ICH. Methods: The authors analyzed 202 patients admitted to the neurological ICU (NICU) who were prospectively enrolled in the Columbia University ICH Outcomes Project between September 2009 and December 2012. Patients were categorized into 2 groups: overweight (body mass index [BMI] ≥ 25 kg/m2) and not overweight (BMI < 25 kg/m2). The primary outcome was defined as survival with favorable outcome (modified Rankin Scale [mRS] score 0.3) versus death or severe disability (mRS score 4.6) at 3 months. Results: The mean age of the patients in the study was 61 years. The mean BMI was 28 ± 6 kg/m2. The mean Glasgow Coma Scale score was 10 ± 4 and the mean ICH score was 1.9 ± 1.3. The overall 90-day mortality rate was 41\%. Among patients with a BMI < 25 kg/m2, 24\% (17/70) had a good outcome, compared with 39\% (52/132) among those with a BMI ≥ 25 kg/m2 (p = 0.03). After adjusting for ICH score, sex, do-not-resuscitate code status, and history of hypertension, being overweight or obese (BMI ≥ 25 kg/m2) was associated with twice the odds of having a good outcome compared with patients with BMI < 25 kg/m2 (adjusted odds ratio 2.05, 95\% confidence interval 1.03.4.06, p = 0.04). Conclusions: In patients with ICH admitted to the NICU, being overweight or obese (BMI ≥ 25 kg/m2) was associated with favorable outcome after adjustment for established predictors. The reason for this finding requires further study.",

keywords = "Functional recovery, Intensive care unit, Intracerebral hemorrhage, Obesity, Vascular disorders",

author = "Dangayach, \{Neha S.\} and Grewal, \{Harpreet Singh\} and \{De Marchis\}, \{Gian Marco\} and Sefcik, \{Roberta K.\} and Rachel Bruce and Aarti Chhatlani and Connolly, \{E. Sander\} and Falo, \{M. Cristina\} and Sachin Agarwal and Jan Claassen and Schmidt, \{J. Michael\} and Mayer, \{Stephan A.\}",

note = "Publisher Copyright: {\textcopyright} AANS 2018.",

year = "2018",

month = nov,

doi = "10.3171/2017.5.JNS163266",

language = "English",

volume = "129",

pages = "1125--1129",

journal = "Journal of Neurosurgery",

issn = "0022-3085",