School of Medicine, New York Medical College, Valhalla, New York, USA.
Chicago Medical School at Rosalind Franklin University, North Chicago, Illinois, USA.
Cerebrovasc Dis. 2022;51(5):565-569. doi: 10.1159/000521513. Epub 2022 Feb 14.
Previous literature has identified a survival advantage in acute ischemic stroke (AIS) patients with elevated body mass indices (BMIs), a phenomenon termed the "obesity paradox."
The aim of this study was to evaluate the independent association between obesity and clinical outcomes following AIS.
Weighted discharge data from the National Inpatient Sample were queried to identify AIS patients from 2015 to 2018. Multivariable logistic regression and Cox proportional hazards modeling were performed to evaluate associations between obesity (BMI ≥ 30) and clinical endpoints following adjustment for acute stroke severity and comorbidity burden.
Among 1,687,805 AIS patients, 216,775 (12.8%) were obese. Compared to nonobese individuals, these patients were younger (64 vs. 72 mean years), had lower baseline NIHSS scores (6.9 vs. 7.9 mean score), and a higher comorbidity burden. Multivariable analysis demonstrated independent associations between obesity and lower likelihood of mortality (adjusted odds ratio [aOR] 0.76, 95% confidence interval [CI]: 0.71, 0.82, p < 0.001; hazard ratio 0.84, 95% CI: 0.73, 0.97, p = 0.015), intracranial hemorrhage (aOR 0.87, 95% CI: 0.82, 0.93, p < 0.001), and routine discharge to home (aOR 0.97, 95% CI: 0.95, 0.99; p = 0.015). Mortality rates between obese and nonobese patients were significantly lower across stroke severity thresholds, but this difference was attenuated among high severity (NIHSS > 20) strokes (21.6% vs. 23.2%, p = 0.358). Further stratification of the cohort into BMI categories demonstrated a "U-shaped" association with mortality (underweight aOR 1.58, 95% CI: 1.39, 1.79; p < 0.001, overweight aOR 0.64, 95% CI: 0.42, 0.99; p = 0.046, obese aOR 0.77, 95% CI: 0.71, 0.83; p < 0.001, severely obese aOR 1.18, 95% CI: 0.74, 1.87; p = 0.485). Sub-cohort assessment of thrombectomy-treated patients demonstrated an independent association of obesity (BMI 30-40) with lower mortality (aOR 0.79, 95% CI: 0.65, 0.96; p = 0.015), but not with routine discharge.
This cross-sectional analysis demonstrates a lower likelihood of discharge to home as well as in-hospital mortality in obese patients following AIS, suggestive of a protective effect of obesity against mortality but not against all poststroke neurological deficits in the short term which would necessitate placement in acute rehabilitation and long-term care facilities.
先前的文献表明，体质量指数（BMI）升高的急性缺血性脑卒中（AIS）患者具有生存优势，这种现象被称为“肥胖悖论”。
本研究旨在评估肥胖与 AIS 后临床结局之间的独立相关性。
从 2015 年至 2018 年，从国家住院患者样本中查询加权出院数据，以确定 AIS 患者。采用多变量逻辑回归和 Cox 比例风险模型，在调整急性脑卒中严重程度和合并症负担后，评估肥胖（BMI≥30）与临床终点之间的相关性。
在 1687805 例 AIS 患者中，216775 例（12.8%）为肥胖。与非肥胖患者相比，这些患者年龄较小（64 岁 vs. 72 岁），基线 NIHSS 评分较低（6.9 分 vs. 7.9 分），合并症负担较重。多变量分析显示，肥胖与死亡率降低独立相关（调整后的优势比[aOR]0.76，95%置信区间[CI]：0.71，0.82，p<0.001；风险比[HR]0.84，95%CI：0.73，0.97，p=0.015）、颅内出血（aOR 0.87，95%CI：0.82，0.93，p<0.001）和常规出院回家（aOR 0.97，95%CI：0.95，0.99；p=0.015）的可能性降低。在脑卒中严重程度的各个阈值下，肥胖患者与非肥胖患者的死亡率均显著降低，但在高严重程度（NIHSS>20）脑卒中患者中，这种差异减弱（21.6% vs. 23.2%，p=0.358）。进一步对队列进行 BMI 分类分层分析显示，死亡率呈“U 形”相关（体重不足 aOR 1.58，95%CI：1.39，1.79；p<0.001，超重 aOR 0.64，95%CI：0.42，0.99；p=0.046，肥胖 aOR 0.77，95%CI：0.71，0.83；p<0.001，重度肥胖 aOR 1.18，95%CI：0.74，1.87；p=0.485）。血栓切除术治疗患者的亚组评估显示，肥胖（BMI 30-40）与死亡率降低独立相关（aOR 0.79，95%CI：0.65，0.96；p=0.015），但与常规出院无关。
本横断面分析表明，AIS 后肥胖患者出院回家以及住院期间死亡率较低，提示肥胖对死亡率具有保护作用，但对短期内在脑卒中后出现的所有神经功能缺损没有保护作用，这些患者需要入住急性康复和长期护理机构。
