Introduction:
Even though Obesity, as measured by BMI
>
30.00 kg/m
2
, is a established risk factor for ASCVD, it hasn’t been proven as a risk factor for adverse outcomes in patients with diagnosis of ischemic stroke. Our study sought to compare outcomes for ischemic stroke hospitalizations in patients with and without Obesity.
Methods:
A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 71,473,874who had ischemic stroke as primary diagnosis were enrolled and further stratified based on the presence or absence of Obesity as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, treatment with mechanical thrombectomy, treatment with tPA, and complications like respiratory failure requiring intubation, pulmonary embolism (PE), DVT, NSTEMI and sepsis. Multivariate regression analysis was done to adjust for confounders.
Results:
The in-hospital mortality for patients with ischemic stroke was 42 145 overall. Compared with patients without obesity, patients with Obesity had a lower odds of in- hospital mortality (aOR 0.85, 95% CI 0.79-0.93, p<0.001) when adjusted for patient and hospital characteristics. We found that patients with ischemic stroke and obesity had decreased length of hospital stay and higher odds ratio of treatment with mechanical thrombectomy, treatment with tPA, and higher odds ratio of complications like respiratory failure requiring intubation and pulmonary embolism (PE). No significant difference in other secondary outcomes (DVT, NSTEMI and sepsis).
Conclusion:
There is convincing evidence supporting the existence of the “obesity paradox” in patients with ischemic stroke. Several stroke-associated mechanisms, like autonomous nervous activation and pro-inflammatory cytokine release in addition to other factors like impaired feeding and inactivity cause accelerated tissue degradation and overall weight loss. It is thought that obese patients with better metabolic reserve may be less affected from this unfavorable metabolic dysregulation as compared to underweight patients. Nevertheless, further studies are needed in order to identify factors responsible for this paradox.
Risk Factor for Pulmonary Embolism
