Obese cardiogenic arrest survivors with significant coronary artery disease had worse in-hospital mortality and neurological outcomes

Sung, Chih-Wei; Chen, Wen‐Jone; Chang, Wei‐Tien; Wang, Chih‐Hung; Wu, Yen‐Wen; Chen, Wei‐Ting; Chang, J. R.; Tsai, Min‐Shan

doi:10.1038/s41598-020-75752-9

Cited by 11 publications

(7 citation statements)

References 28 publications

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“…There were 18 studies 89,127–143 (1,415,697 participants) with critically ill populations (Table S3): 11 cohorts in North America, 3 each were in East Asia and in Europe, and 1 in the Pacific. Mean age of participants ranged from 41 to 87 years.…”

Section: Resultsmentioning

confidence: 99%

“…There were 18 studies 89,[127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143] (1,415,697 participants) with critically ill populations (Table S3): quadratic term for mean BMI with a linear term (Table 2) or when groups with mean BMIs <20 kg/m 2 were excluded. The interaction terms for Asian/non-Asian majority countries were non-significant.…”

Section: Critically Ill Populationsmentioning

confidence: 99%

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Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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SummaryFasting insulin and c‐reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non‐first order polynomials or splines. All‐cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid‐19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations. The associations for general, cancer, and non‐communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re‐examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

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Section: Resultsmentioning

confidence: 99%

Section: Critically Ill Populationsmentioning

confidence: 99%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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“…In a large registry study, patients with obesity did not have an increased risk of inpatient mortality after in-hospital arrest, but patients with BMI >35 kg/m 2 had lower rates of survival following arrest from shockable rhythms [18]. Cardiogenic arrest survivors with significant coronary artery disease who were obese had worse in-hospital mortality and neurological outcomes [19]. Our study findings are consistent with observations in other studies that patients with obesity have greater health care utilization but not increased mortality.…”

Section: Discussionmentioning

confidence: 98%

Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine

Lim

Rathnasekara

Kanumuri

et al. 2022

JCM

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Obesity is associated with long-term morbidity and mortality, but it is unclear if obesity affects goals of care determination and intensive care unit (ICU) resource utilization during hospitalization under a general medicine service. In a cohort of 5113 adult patients admitted under general medicine, 15.3% were obese. Patients with obesity were younger and had a different comorbidity profile than patients who were not obese. In age-adjusted regression analysis, the distribution of goals of care categories for patients with obesity was not different to patients who were not obese (odds ratio for a lower category with more limitations, 0.94; 95% confidence interval [CI]: 0.79–1.12). Patients with obesity were more likely to be directly admitted to ICU from the Emergency Department, require more ICU admissions, and stayed longer in ICU once admitted. Hypercapnic respiratory failure and heart failure were more common in patients with obesity, but they were less likely to receive mechanical ventilation in favor of non-invasive ventilation. The COVID-19 pandemic was associated with 16% higher odds of receiving a lower goals of care category, which was independent of obesity. Overall hospital length of stay was not affected by obesity. Patients with obesity had a crude mortality of 3.8 per 1000 bed-days, and age-adjusted mortality rate ratio of 0.75 (95% CI: 0.49–1.14) compared to patients who were not obese. In conclusion, there was no evidence to suggest biased goals of care determination in patients with obesity despite greater ICU resource utilization.

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“…Chavda et al did not link obesity with improved in-hospital survival outcome in patients who were admitted to the ICU after CA [ 32 ]. Other researchers have proven that subpar in-hospital mortality and neurological outcomes were the concomitant occurrences among obese CA patients [ 33 ]. Obesity is characterized by higher fat mass, which leads to chronic inflammation and a prothrombotic state [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Do Body Mass Index and Nutritional Risk Score 2002 Influence the In-Hospital Mortality of Patients Following Cardiac Arrest?

et al. 2023

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Background: Contemporarily, cardiac arrest (CA) remains one of the leading causes of death. Poor nutritional status can increase the post-CA mortality risk. The aim of this study was to determine the relationship between body mass index (BMI) and Nutritional Risk Score 2002 (NRS 2002) results and in-hospital mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest. Methods: A retrospective study and analysis of medical records of 161 patients admitted to the ICU of the University Clinical Hospital in Wrocław (Wrocław, Poland) was conducted. Results: No significant differences in body mass index (BMI) and nutritional risk score (NRS 2002) values were observed between non-survivors and survivors. Non-survivors had significantly lower albumin concentration (p = 0.017) and total cholesterol (TC) (p = 0.015). In multivariate analysis BMI and NRS 2002 scores were not, per se, associated with the in-hospital mortality defined as the odds of death (Model 1: p: 0.700, 0.430; Model 2: p: 0.576, 0.599). Univariate analysis revealed significant associations between the hazard ratio (HR) and TG (p ≈ 0.017, HR: 0.23) and hsCRP (p ≈ 0.018, HR: 0.34). In multivariate analysis, mortality risk over time was influenced by higher scores in parameters such as BMI (HR = 0.164; p = 0.048) and hsCRP (HR = 1.006, p = 0.002). Conclusions: BMI and NRS 2002, on their own (unconditionally – in the whole study group) did not alter the odds of mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest. The risk of in-hospital mortality (expressed as hazard ratio – the risk over the time period of the study) increased with an increase in BMI but not with NRS 2002.

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Obese cardiogenic arrest survivors with significant coronary artery disease had worse in-hospital mortality and neurological outcomes

Cited by 11 publications

References 28 publications

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine

Do Body Mass Index and Nutritional Risk Score 2002 Influence the In-Hospital Mortality of Patients Following Cardiac Arrest?

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