Associations between Central Obesity and Outcomes of Adult In-hospital Cardiac Arrest: A Retrospective Cohort Study

Abstract

to investigate the association between central obesity and outcomes following in-hospital cardiac arrest (iHcA). A single-centred retrospective study was conducted. Adult patients that experienced IHCA during 2006-2015 were screened. Body mass index (BMI) was calculated at hospital admission. central obesity-related anthropometric parameters were measured by analysing computed tomography images. A total of 648 patients were included, with mean BMI of 23.0 kg/m 2. the proportions of BMI-defined obesity in this cohort were underweight (13.1%), normal weight (41.4%), overweight (31.5%) and obesity (14.0%). The mean waist circumference was 85.9 cm with mean waistto-height ratio (WHtR) of 0.53. The mean sagittal abdominal diameter was 21.2 cm with mean anterior and posterior abdominal subcutaneous adipose tissue (SAT) depths of 1.6 and 2.0 cm, respectively. Multivariate logistic regression analyses indicated BMI of 11.7-23.3 kg/m 2 (odds ratio [OR]: 2.53, 95% confidence interval [CI]: 1.10-5.85; p-value = 0.03), WHtR of 0.49-0.59 (OR: 3.45, 95% CI: 1.56-7.65; p-value = 0.002) and anterior abdominal SAT depth <1.9 cm (OR: 2.84, 95% CI: 1.05-7.74; p-value = 0.04) were positively associated with the favourable neurological outcome. Central obesity was associated with poor IHCA outcomes, after adjusting for the effects of BMI. Each year, approximately 209,000 American patients experience in-hospital cardiac arrest (IHCA) 1. About 24% of IHCA patients survive to hospital discharge; among them, 14% experience significant neurological disability 1. The prevalence of obesity has increased rapidly over the last few decades with 40% of the American population classified as obesity 2. Body mass index (BMI) has been demonstrated to be associated with IHCA outcomes 3,4. Jain et al 3. reported that for IHCA with shockable rhythms, patients with BMI < 18.5 kg/m 2 , BMI 18.5-24.9 kg/m 2 or BMI ≥ 35 kg/m 2 had lower survival rates compared with patients with BMI 25.0-29.9 kg/m 2 or BMI 30.0-34.9 kg/m2. However, for IHCA with non-shockable rhythms, patients with a moderately elevated BMI seemed to have better IHCA outcomes. This so-called "obesity paradox" was also observed in other cardiovascular diseases 5. However, using BMI as the sole obesity index does not consider body adipose distribution. In patients with coronary disease, Coutinho et al 6. noted that being overweight or obese per BMI criteria did not cause increased mortality in the absence of central obesity. When parameters defining central obesity were taken into account, the phenomenon of "obesity paradox" or "BMI paradox" was less obvious 6 .

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