Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

Abstract

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

Non-linear association between body weight and functional outcome after acute ischemic stroke

“…Some studies showed a beneficial association of overweight or obesity with survival after stroke 22 , 25 , 26 , 36 , which supports the presence of an obesity paradox. However, other studies showed no association 14 – 16 , 23 , 27 or a detrimental association 17 of overweight or obesity with the risk of death after stroke. Regarding underweight, some studies are in agreement with its disadvantageous effects on death after stroke 15 , 16 , 27 .…”

“…However, other studies showed no association 14 – 16 , 23 , 27 or a detrimental association 17 of overweight or obesity with the risk of death after stroke. Regarding underweight, some studies are in agreement with its disadvantageous effects on death after stroke 15 , 16 , 27 . However, other studies reported no association of underweight with the risk of death after intracerebral hemorrhage 14 or after mechanical thrombectomy 23 .…”

“…Although a higher BMI is associated with a higher risk of ischemic stroke 13 , how BMI affects clinical outcomes after acute ischemic stroke is still unknown. Previous studies have reported inconsistent findings regarding the association between BMI and clinical outcomes in the short term after stroke 14 – 27 . Recent systematic reviews have pointed out several methodological issues in previous studies, such as insufficient consideration for multivariable adjustment, stroke subtypes, definitions of an abnormal body weight and clinical outcomes, and the follow-up period after onset 28 – 30 .…”

The obesity paradox in intracerebral hemorrhage: a systematic review and meta-analysis

“…Cao et al. ( 23 ) evaluated the associations between BMI and in-hospital mortality, complications, and discharge disposition in ICH using data derived from the China Stroke Center Alliance, a national, hospital-based, multicenter, voluntary, quality assessment and improvement initiative performed in China. A total of 82,789 patients were involved from August 2015–July 2019.…”

Risk factors for and outcomes of poststroke pneumonia in patients with acute ischemic stroke treated with mechanical thrombectomy

“…Interestingly, we found that BMI was also an independent predictor of PSP. One study reported that obesity was a predictor of an increased risk of in-hospital complications in patients with cerebral hemorrhage ( 16 ). Another study reported that for patients treated with MT, a high BMI was independently associated with lower rates of functional independence among recanalized patients ( 17 ).…”