Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Sci Rep. 2023 May 29;13(1):8697. doi: 10.1038/s41598-023-35894-y.
This study aimed to determine whether body weight is associated with functional outcome after acute ischemic stroke. We measured the body mass index (BMI) and assessed clinical outcomes in patients with acute ischemic stroke. The BMI was categorized into underweight (< 18.5 kg/m), normal weight (18.5-22.9 kg/m), overweight (23.0-24.9 kg/m), and obesity (≥ 25.0 kg/m). The association between BMI and a poor functional outcome (modified Rankin Scale [mRS] score: 3-6) was evaluated. We included 11,749 patients with acute ischemic stroke (70.3 ± 12.2 years, 36.1% women). The risk of a 3-month poor functional outcome was higher for underweight, lower for overweight, and did not change for obesity in reference to a normal weight even after adjusting for covariates by logistic regression analysis. Restricted cubic splines and SHapley Additive exPlanation values in eXtreme Gradient Boosting model also showed non-linear relationships. Associations between BMI and a poor functional outcome were maintained even after excluding death (mRS score: 3-5) or including mild disability (mRS score: 2-6) as the outcome. The associations were strong in older patients, non-diabetic patients, and patients with mild stroke. Body weight has a non-linear relationship with the risk of a poor functional outcome after acute ischemic stroke.
本研究旨在确定体重是否与急性缺血性脑卒中后的功能结局相关。我们测量了身体质量指数（BMI）并评估了急性缺血性脑卒中患者的临床结局。BMI 分为消瘦（<18.5kg/m²）、正常体重（18.5-22.9kg/m²）、超重（23.0-24.9kg/m²）和肥胖（≥25.0kg/m²）。评估了 BMI 与不良功能结局（改良 Rankin 量表[mRS]评分：3-6）之间的关系。我们纳入了 11749 例急性缺血性脑卒中患者（70.3±12.2 岁，36.1%为女性）。与正常体重相比，消瘦患者发生 3 个月不良功能结局的风险较高，超重患者的风险较低，肥胖患者的风险没有变化。即使在校正了协变量后，逻辑回归分析也显示了这种非线性关系。受限立方样条和极端梯度提升模型中的 SHapley Additive exPlanation 值也显示了非线性关系。即使将死亡（mRS 评分：3-5）排除在外或将轻度残疾（mRS 评分：2-6）作为结局纳入在内，BMI 与不良功能结局之间的关联仍然存在。在老年患者、非糖尿病患者和轻度脑卒中患者中，这种关联更强。体重与急性缺血性脑卒中后不良功能结局的风险之间存在非线性关系。
