Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Neurological Surgery, University of California San Francisco, Fresno, California, USA.
Neurosurgery. 2022 Jun 1;90(6):816-822. doi: 10.1227/neu.0000000000001931. Epub 2022 Mar 24.
Heterogeneity among study populations and treatment procedures has led to conflicting results on outcome predictors for patients with aneurysmal subarachnoid hemorrhage (aSAH). One such conflicting predictor is body mass index (BMI).
To clarify whether high BMI values protect patients from poor outcome after aSAH, as previously suggested.
We surveyed 6 prospective studies conducted in 14 different countries (93 healthcare units) between 1985 and 2016 and pooled the data on surgically treated patients with good-grade (Glasgow Coma Scale 13-15 on admission) aSAH. We calculated BMI for each patient and created 4 balanced categories based on the BMI quartiles of each cohort. We calculated adjusted odds ratios (ORs) with 95% CIs for the 3-month poor outcome (Glasgow Outcome Scale 1-3) by BMI.
The pooled study cohort included 1692 patients with good-grade aSAH (mean age 51 years; 64% female). At 3 months, 288 (17%) had poor outcomes. The risk for poor outcomes increased with increasing BMI values (OR = 1.15 [1.02-1.31] per each standard deviation increase of BMI). The risk for poor outcome was over 1.6 times higher (OR = 1.66 [1.13-2.43]) in the highest BMI category (range 27.1-69.2) compared with the lowest BMI category (range 14.4-23.8). These associations were found in each of the 6 study cohorts in both men and women, regardless of age.
Because higher BMI values seem to associate with poor outcomes in surgically treated patients with good-grade aSAH, it seems unlikely that obesity protects patients with aSAH from poor outcomes.
研究人群和治疗方法的异质性导致了动脉瘤性蛛网膜下腔出血（aSAH）患者预后预测因素的结果相互矛盾。其中一个相互矛盾的预测因素是体重指数（BMI）。
阐明高 BMI 值是否像之前所建议的那样，保护 aSAH 患者免受不良预后。
我们调查了 1985 年至 2016 年间在 14 个不同国家进行的 6 项前瞻性研究，并对接受手术治疗的良好分级（入院时格拉斯哥昏迷量表 13-15 分）aSAH 患者的数据进行了汇总。我们为每位患者计算了 BMI，并根据每个队列的 BMI 四分位间距创建了 4 个平衡类别。我们计算了 BMI 与 3 个月不良预后（格拉斯哥预后量表 1-3）的调整比值比（OR）及其 95%置信区间。
汇总的研究队列包括 1692 名良好分级 aSAH 患者（平均年龄 51 岁，64%为女性）。3 个月时，288 例（17%）预后不良。不良预后的风险随着 BMI 值的增加而增加（OR=1.15[1.02-1.31]，BMI 每增加一个标准差）。与最低 BMI 类别（范围 14.4-23.8）相比，最高 BMI 类别（范围 27.1-69.2）不良预后的风险高出 1.6 倍以上（OR=1.66[1.13-2.43]）。这些关联在 6 项研究队列中的男性和女性中均存在，且与年龄无关。
由于较高的 BMI 值似乎与接受手术治疗的良好分级 aSAH 患者的不良预后相关，因此肥胖不太可能保护 aSAH 患者免受不良预后的影响。
