Kang Jin Kook, Feng Shi Nan, Liu Winnie L, Kim Jiah, Kalra Andrew, Brown Patricia, Wilcox Christopher J, Brodie Daniel, Keller Steven P, Kim Bo Soo, Whitman Glenn J R, Cho Sung-Min
Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
J Clin Med. 2025 Mar 24;14(7):2202. doi: 10.3390/jcm14072202.
We aimed to characterize the impact of body mass index (BMI) on stroke in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). We queried the Extracorporeal Life Support Organization registry for patients receiving ECPR (2020-2024). Patients were categorized into five BMI groups: underweight (<18.5 kg/m), normal weight (18.5-24.9 kg/m), overweight (25-29.9 kg/m), class 1 obesity (30-34.9 kg/m), and class 2 obesity or above (≥35 kg/m). A generalized additive model (GAM) analysis was used to identify the BMI range with the greatest stroke risk. Multivariable regression was used to compare odds of stroke between standard BMI groups and normal weight. Propensity score matching was used to compare stroke and mortality between normal weight and the BMI group with the highest predicted stroke risk. Of 6390 patients (median age = 57.5, 68.6% male), 470 (7.4%) had a stroke during ECMO support (4.5% ischemic; 3.4% hemorrhagic). A total of 9.6% ( = 131) of class 1 obesity patients experienced stroke compared with 6.6% ( = 111) of normal weight, 6.9% ( = 79) of class 2 obesity or above, 6.9% ( = 143) of overweight, and 5.4% ( = 6) of underweight patients ( = 0.01). The GAM analysis showed a highest predicted stroke risk for class 1 obesity patients ( = 1366), which was confirmed by multivariable regression (adjusted odds ratio (aOR) = 1.63, 95%CI = 1.01-2.62, = 0.045). After propensity matching ( = 357 each), class 1 obesity was associated with ischemic (aOR = 2.01, 95%CI = 1.02-4.08, = 0.047) but not hemorrhagic stroke. Odds of hospital mortality were higher in both class 1 and 2 obesity patients compared with normal weight. Class 1 obesity was associated with increased odds of ischemic but not hemorrhagic stroke compared with normal weight patients.
我们旨在描述体重指数（BMI）对接受体外心肺复苏（ECPR）患者中风的影响。我们查询了体外生命支持组织登记处中接受ECPR的患者（2020 - 2024年）。患者被分为五个BMI组：体重过轻（<18.5 kg/m²）、正常体重（18.5 - 24.9 kg/m²）、超重（25 - 29.9 kg/m²）、1级肥胖（30 - 34.9 kg/m²）以及2级及以上肥胖（≥35 kg/m²）。采用广义相加模型（GAM）分析来确定中风风险最高的BMI范围。使用多变量回归比较标准BMI组与正常体重组之间中风的几率。采用倾向得分匹配来比较正常体重组与预测中风风险最高的BMI组之间的中风和死亡率。在6390例患者（中位年龄 = 57.5岁，68.6%为男性）中，470例（7.4%）在体外膜肺氧合（ECMO）支持期间发生了中风（4.5%为缺血性；3.4%为出血性）。1级肥胖患者中有9.6%（n = 131）发生中风，而正常体重患者为6.6%（n = 111），2级及以上肥胖患者为6.9%（n = 79），超重患者为6.9%（n = 143），体重过轻患者为5.4%（n = 6）（P = 0.01）。GAM分析显示1级肥胖患者的预测中风风险最高（n = 1366），多变量回归证实了这一点（调整优势比（aOR） = 1.63，95%置信区间 = 1.01 - 2.62，P = 0.045）。倾向匹配后（每组n = 357），1级肥胖与缺血性中风相关（aOR = 2.01，95%置信区间 = 1.02 - 4.08，P = 0.047），但与出血性中风无关。与正常体重相比，1级和2级肥胖患者的医院死亡率几率更高。与正常体重患者相比，1级肥胖与缺血性中风几率增加相关，但与出血性中风无关。
