Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Abstract

OBJECTIVE It has been suggested that increased body mass index (BMI) may confer a protective effect on patients who suffer from aneurysmal subarachnoid hemorrhage (aSAH). Whether the modality of aneurysm occlusion influences the effect of BMI on patient outcomes is not well understood. The authors aimed to compare the effect of BMI on outcomes for patients with aSAH treated with surgical clipping versus endovascular coiling. METHODS The authors retrospectively reviewed the outcomes for patients admitted to their institution for the management of aSAH treated with either clipping or coiling. BMI at the time of admission was recorded and used to assign patients to a group according to low or high BMI. Cutoff values for BMI were determined by classification and regression tree analysis. Predictors of poor functional outcome (defined as modified Rankin Scale score > 2 measured ≥ 90 days after the ictus) and posttreatment cerebral hypodensities detected during admission were then determined separately for patients treated with clipping or coiling using stepwise multivariate logistic regression analysis. RESULTS Of the 469 patients admitted to the authors' institution with aSAH who met the study's inclusion criteria, 144 were treated with clipping and 325 were treated with coiling. In the clipping group, the frequency of poor functional outcome was higher in patients with BMI ≥ 32.3 kg/m (47.6% vs 19.0%; p = 0.007). In contrast, in the coiling group, patients with BMI ≥ 32.3 kg/m had a lower frequency of poor functional outcome at ≥ 90 days (5.8% vs 30.9%; p < 0.001). On multivariate analysis, high BMI was independently associated with an increased (OR 3.92, 95% CI 1.20-13.41; p = 0.024) and decreased (OR 0.13, 95% CI 0.03-0.40; p < 0.001) likelihood of poor functional outcome for patients treated with clipping and coiling, respectively. For patients in the surgical group, BMI ≥ 28.4 kg/m was independently associated with incidence of cerebral hypodensities during admission (OR 2.44, 95% CI 1.16-5.25; p = 0.018) on multivariate analysis. For patients treated with coiling, BMI ≥ 33.2 kg/m was independently associated with reduced odds of hypodensities (OR 0.45, 95% CI 0.21-0.89; p = 0.021). CONCLUSIONS The results of this study suggest that BMI may differentially affect functional outcomes after aSAH, depending on treatment modality. These findings may aid in treatment selection for patients with aSAH.

New risk score of the early period after spontaneous subarachnoid hemorrhage: For the prediction of delayed cerebral ischemia

“…There would be some potential biases and known and unknown confounders in this study. The patients with WFNS 4‐5 (23.1%) and mFS 3‐4 (63.3%) were consistent with other studies (WFNS: 22.4%‐31.1%; mFS: 56.2%‐77.7%). Additionally, all CT grades were evaluated by two blinded senior neurologists.…”

“…12 Although VG was developed by two early predictors, and available for risk stratification at the time after SAH, the AUC was not large according to results from recent study. 15 mFS: 56.2%-77.7% 20,26,36 ). Additionally, all CT grades were evaluated by two blinded senior neurologists.…”

Obesity paradox in subarachnoid hemorrhage: a systematic review

“…For example, protective mechanisms might relate to an increased metabolic reserve of adipose or muscle mass, which could improve tolerance of major catabolic and inflammatory events among critically ill patients treated in ICUs. Supporting this theory, a few studies [3,8,34] have related obesity to more favorable outcomes, measured using the modified Rankin Scale (mRS), and milder overweight to lower complication rates as well. On the other hand, other studies have reported contradictory findings [33,37,44].…”

“…In contrast, other factors, such as SAH severity and rebleeding, have been associated with higher mortality rates; no evidence relates these findings to obesity groups. Furthermore, Rinaldo et al [34] found an effect of BMI on SAH outcome, and this effect varied depending on the treatment modality (clipping versus coiling). However, the study found no differences after using the validated WHO categories for BMI.…”

Anterior communicating artery aneurysm rupture and functional outcome in short-term: clipping versus coiling

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