Movahed Mohammad Reza, Mahalleh Mehrdad, Sadin Zahra, Hashemzadeh Mehrtash
Department of Medicine, University of Arizona Sarver Heart Center, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ 85004, USA.
J Clin Med. 2025 Jul 25;14(15):5275. doi: 10.3390/jcm14155275.
The obesity paradox has been observed in patients with cardiovascular disease. The goal of this study was to evaluate whether obesity has a protective effect in patients presenting with cardiogenic shock. Using a large Nationwide Inpatient (NIS) sample database, we evaluated mortality in patients with cardiogenic shock based on weight categories in adults. A total of 843,020 patients over age 18 had a diagnosis of cardiogenic shock in the database. We found that overweight and obesity had the lowest mortality using univariate or multivariate analysis (overweight mortality of 20.66% vs. obesity mortality of 26.6% vs. 34.8% of normal weights). In contrast, cachexia was associated with the highest mortality in univariate analysis (cachexia 40.4%). Using multivariate analysis adjusting for age, baseline characteristics, and comorbidities, these relations remained unchanged (cachexia MVOR: 1.13; CI: 1.21-1.13; < 0.001; overweight MVOR: 0.52, CI: 0.43-0.65; < 0.001; obesity MVOR: 0.76, CI: 0.73-0.79; < 0.001). After multivariate adjustment, morbid obesity had similar mortality to patients with normal weight (morbid obesity MVOR: 0.99 CI 0.95-01.03; = 0.6) We observe a partial obesity paradox in patients with cardiogenic shock, showing that being overweight, followed by obesity, has the lowest mortality, whereas cachexia has the highest mortality despite multivariate adjustment.
肥胖悖论已在心血管疾病患者中被观察到。本研究的目的是评估肥胖在心源性休克患者中是否具有保护作用。利用一个大型的全国住院患者（NIS）样本数据库，我们根据成年人的体重类别评估了心源性休克患者的死亡率。该数据库中共有843020名18岁以上的患者被诊断为心源性休克。我们发现，使用单因素或多因素分析时，超重和肥胖患者的死亡率最低（超重患者死亡率为20.66%，肥胖患者死亡率为26.6%，正常体重患者死亡率为34.8%）。相比之下，在单因素分析中，恶病质与最高死亡率相关（恶病质为40.4%）。在对年龄、基线特征和合并症进行多因素分析调整后，这些关系保持不变（恶病质多因素调整风险比：1.13；可信区间：1.21 - 1.13；P < 0.001；超重多因素调整风险比：0.52，可信区间：0.43 - 0.65；P < 0.001；肥胖多因素调整风险比：0.76，可信区间：0.73 - 0.79；P < 0.001）。多因素调整后，病态肥胖患者的死亡率与正常体重患者相似（病态肥胖多因素调整风险比：0.99，可信区间：0.95 - 1.03；P = 0.6）。我们在心源性休克患者中观察到部分肥胖悖论，表明超重其次是肥胖的患者死亡率最低，而恶病质患者尽管经过多因素调整仍具有最高死亡率。
