The Obesity Paradox in Spontaneous Intracerebral Hemorrhage: Results from a Retrospective Analysis of the Nationwide Inpatient Sample.
Adolescent
Adult
Aged
Cerebral Hemorrhage
/ epidemiology
Comorbidity
Female
Gastrostomy
/ statistics & numerical data
Hospital Charges
/ statistics & numerical data
Hospital Mortality
Humans
Length of Stay
/ statistics & numerical data
Male
Middle Aged
Obesity
/ epidemiology
Obesity, Morbid
/ epidemiology
Patient Discharge
/ statistics & numerical data
Retrospective Studies
Tracheostomy
/ statistics & numerical data
United States
/ epidemiology
Young Adult
Cerebral hemorrhage
Obesity
Stroke
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
pubmed:
3
8
2019
medline:
8
6
2021
entrez:
3
8
2019
Statut:
ppublish
Résumé
Mild obesity is associated with a survival benefit in cardiovascular and cerebrovascular disease. Only a few studies have analyzed the effect of obesity on outcomes after spontaneous intracerebral hemorrhage (ICH), and none have used a national US database. We sought to determine whether or not obesity was associated with outcomes and in-hospital complications following ICH. The Nationwide Inpatient Sample was used to identify patients with ICH in the USA who were discharged between 2002 and 2011. The presence of obesity (body mass index [BMI] 30-39.9) or morbid obesity (BMI ≥ 40) was noted. The primary outcome of interest was in-hospital mortality, and secondary outcomes included non-routine discharge disposition, tracheostomy or gastrostomy placement, length of stay (LOS), inflation-adjusted hospital charges, and in-hospital complications. A total of 123,415 patients with ICH met the inclusion criteria, and the 10-year overall incidence of obesity was 4.5%. Between 2002 and 2011, the incidence of obesity increased from 1.9 to 4.4% and the incidence of morbid obesity increased from 0.7 to 3.2%. Both obese (OR 0.62, 95% CI 0.56-0.69) and morbidly obese (OR 0.76, 95% CI 0.66-0.88) patients had lower odds of inpatient mortality. Obese (OR 0.85, 95% CI 0.78-0.93) but not morbidly obese patients had lower odds of non-routine discharge. Morbidly obese patients were twice as likely to require a tracheostomy than non-obese patients (OR 2.07, 95% CI 1.62-2.66). Both obese and morbidly obese patients had higher total hospital charges and rates of pulmonary, renal, and venous thromboembolic complications. There was no difference in LOS according to body habitus. In patients with spontaneous ICH, obesity is associated with decreased in-hospital mortality but higher rates of in-hospital complications and greater total hospital charges. Non-morbid obesity carries lower odds of non-routine hospital discharge.
Sections du résumé
BACKGROUND/OBJECTIVE
Mild obesity is associated with a survival benefit in cardiovascular and cerebrovascular disease. Only a few studies have analyzed the effect of obesity on outcomes after spontaneous intracerebral hemorrhage (ICH), and none have used a national US database. We sought to determine whether or not obesity was associated with outcomes and in-hospital complications following ICH.
METHODS
The Nationwide Inpatient Sample was used to identify patients with ICH in the USA who were discharged between 2002 and 2011. The presence of obesity (body mass index [BMI] 30-39.9) or morbid obesity (BMI ≥ 40) was noted. The primary outcome of interest was in-hospital mortality, and secondary outcomes included non-routine discharge disposition, tracheostomy or gastrostomy placement, length of stay (LOS), inflation-adjusted hospital charges, and in-hospital complications.
RESULTS
A total of 123,415 patients with ICH met the inclusion criteria, and the 10-year overall incidence of obesity was 4.5%. Between 2002 and 2011, the incidence of obesity increased from 1.9 to 4.4% and the incidence of morbid obesity increased from 0.7 to 3.2%. Both obese (OR 0.62, 95% CI 0.56-0.69) and morbidly obese (OR 0.76, 95% CI 0.66-0.88) patients had lower odds of inpatient mortality. Obese (OR 0.85, 95% CI 0.78-0.93) but not morbidly obese patients had lower odds of non-routine discharge. Morbidly obese patients were twice as likely to require a tracheostomy than non-obese patients (OR 2.07, 95% CI 1.62-2.66). Both obese and morbidly obese patients had higher total hospital charges and rates of pulmonary, renal, and venous thromboembolic complications. There was no difference in LOS according to body habitus.
CONCLUSIONS
In patients with spontaneous ICH, obesity is associated with decreased in-hospital mortality but higher rates of in-hospital complications and greater total hospital charges. Non-morbid obesity carries lower odds of non-routine hospital discharge.
Identifiants
pubmed: 31372928
doi: 10.1007/s12028-019-00796-3
pii: 10.1007/s12028-019-00796-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
765-774Références
Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke. 2009;40:394–9.
doi: 10.1161/STROKEAHA.108.523209
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8:355–69.
doi: 10.1016/S1474-4422(09)70025-0
Cadilhac DA, Dewey HM, Vos T, Carter R, Thrift AG. The health loss from ischemic stroke and intracerebral hemorrhage: evidence from the North East Melbourne Stroke Incidence Study (NEMESIS). Health Qual Life Outcomes. 2010;8:49.
doi: 10.1186/1477-7525-8-49
Hong KS, Bang OY, Kang DW, et al. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the Korean stroke society and clinical research center for stroke. J Stroke. 2013;15:2–20.
doi: 10.5853/jos.2013.15.1.2
An SJ, Kim TJ, Yoon BW. Epidemiology, Risk factors, and clinical features of intracerebral hemorrhage: an update. J Stroke. 2017;19:3–10.
doi: 10.5853/jos.2016.00864
Liebkind R, Gordin D, Strbian D, et al. Diabetes and intracerebral hemorrhage: baseline characteristics and mortality. Eur J Neurol. 2018;25:825–32.
doi: 10.1111/ene.13603
Øie LR, Madsbu MA, Solheim O, et al. Functional outcome and survival following spontaneous intracerebral hemorrhage: a retrospective population-based study. Brain Behav. 2018;8:e01113.
doi: 10.1002/brb3.1113
Burke GL, Bertoni AG, Shea S, et al. The impact of obesity on cardiovascular disease risk factors and subclinical vascular disease: the Multi-Ethnic Study of Atherosclerosis. Arch Intern Med. 2008;168:928–35.
doi: 10.1001/archinte.168.9.928
Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67:968–77.
doi: 10.1161/01.CIR.67.5.968
Hainer V, Aldhoon-Hainerova I. Obesity paradox does exist. Diabetes Care. 2013;36(Suppl 2):S276–81.
doi: 10.2337/dcS13-2023
Sun W, Xian Y, Huang Y, et al. Obesity is associated with better survival and functional outcome after acute intracerebral hemorrhage. J Neurol Sci. 2016;370:140–4.
doi: 10.1016/j.jns.2016.09.029
Dangayach NS, Grewal HS, De Marchis GM, et al. Does the obesity paradox predict functional outcome in intracerebral hemorrhage? J Neurosurg. 2018;129:1125–9.
doi: 10.3171/2017.5.JNS163266
Pezzini A, Grassi M, Paciaroni M, et al. Obesity and the risk of intracerebral hemorrhage: the multicenter study on cerebral hemorrhage in Italy. Stroke. 2013;44:1584–9.
doi: 10.1161/STROKEAHA.111.000069
Kwon HM, Park JH, Park JH, et al. Visceral fat is an independent predictor of cerebral microbleeds in neurologically healthy people. Cerebrovasc Dis. 2016;42:90–6.
doi: 10.1159/000445300
Dasenbrock HH, Nguyen MO, Frerichs KU, et al. The impact of body habitus on outcomes after aneurysmal subarachnoid hemorrhage: a Nationwide Inpatient Sample analysis. J Neurosurg. 2017;127:36–46.
doi: 10.3171/2016.4.JNS152562
Otite FO, Khandelwal P, Malik AM, Chaturvedi S, Sacco RL, Romano JG. Ten-year temporal trends in medical complications after acute intracerebral hemorrhage in the United States. Stroke. 2017;48:596–603.
doi: 10.1161/STROKEAHA.116.015746
Andrade SE, Harrold LR, Tjia J, et al. A systematic review of validated methods for identifying cerebrovascular accident or transient ischemic attack using administrative data. Pharmacoepidemiol Drug Saf. 2012;21:100–28.
doi: 10.1002/pds.2312
Ammann EM, Kalsekar I, Yoo A, Johnston SS. Validation of body mass index (BMI)-related ICD-9-CM and ICD-10-CM administrative diagnosis codes recorded in US claims data. Pharmacoepidemiol Drug Saf. 2018;27:1092–100.
doi: 10.1002/pds.4617
Edwards N, Honemann D, Burley D, Navarro M. Refinement of the medicare diagnosis-related groups to incorporate a measure of severity. Health Care Financ Rev. 1994;16:45–64.
pubmed: 10142374
pmcid: 4193498
Baram D, Daroowalla F, Garcia R, et al. Use of the all patient refined-diagnosis related group (APR-DRG) risk of mortality score as a severity adjustor in the medical ICU. Clin Med Circ Respira Pulm Med. 2008;18:19–25.
Barba R, Marco J, Ruiz J, et al. The obesity paradox in stroke: impact on mortality and short-term readmission. J Stroke Cerebrovasc Dis. 2015;24:766–70.
doi: 10.1016/j.jstrokecerebrovasdis.2014.11.002
Andersen KK, Olsen TS. The obesity paradox in stroke: lower mortality and lower risk of readmission for recurrent stroke in obese stroke patients. Int J Stroke. 2015;10:99–104.
doi: 10.1111/ijs.12016
Kim BJ, Lee SH, Ryu WS, Kim CK, Lee J, Yoon BW. Paradoxical longevity in obese patients with intracerebral hemorrhage. Neurology. 2011;76:567–73.
doi: 10.1212/WNL.0b013e31820b7667
Eckel RH, York DA, Rössner S, et al. Prevention conference VII: obesity, a worldwide epidemic related to heart disease and stroke: executive summary. Circulation. 2004;110:2968–75.
doi: 10.1161/01.CIR.0000140086.88453.9A
Broderick JP, Brott T, Tomsick T, Miller R, Huster G. Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg. 1993;78:188–91.
doi: 10.3171/jns.1993.78.2.0188
Stein M, Misselwitz B, Hamann GF, Scharbrodt W, Schummer DI, Oertel MF. Intracerebral hemorrhage in the very old: future demographic trends of an aging population. Stroke. 2012;43:1126–8.
doi: 10.1161/STROKEAHA.111.644716
Khaodhiar L, McCowen KC, Blackburn GL. Obesity and its comorbid conditions. Clin Cornerstone. 1999;2:17–31.
doi: 10.1016/S1098-3597(99)90002-9
Camacho E, LoPresti MA, Bruce S, et al. The role of age in intracerebral hemorrhages. J Clin Neurosci. 2015;22:1867–70.
doi: 10.1016/j.jocn.2015.04.020
Howard VJ. Reasons underlying racial differences in stroke incidence and mortality. Stroke. 2013;44:S126–8.
doi: 10.1161/STROKEAHA.111.000691
Iwuchukwu I, Mahale N, Ryder J, et al. Racial differences in intracerebral haemorrhage outcomes in patients with obesity. Obes Sci Pract. 2018;4:268–75.
doi: 10.1002/osp4.167
Chang HW, Li YH, Hsieh CH, Liu PY, Lin GM. Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis. Cardiovasc Diagn Ther. 2016;6:109–19.
doi: 10.21037/cdt.2015.12.06
Piper A. Obesity hypoventilation syndrome: weighing in on therapy options. Chest. 2016;149:856–68.
doi: 10.1378/chest.15-0681
Steidl C, Bösel J, Suntrup-Krueger S, et al. Tracheostomy, extubation, reintubation: airway management decisions in intubated stroke patients. Cerebrovasc Dis. 2017;44:1–9.
doi: 10.1159/000471892
Samad F, Ruf W. Inflammation, obesity, and thrombosis. Blood. 2013;122:3415–22.
doi: 10.1182/blood-2013-05-427708
Lee CG, Fujimoto WY, Brunzell JD, et al. Intra-abdominal fat accumulation is greatest at younger ages in Japanese-American adults. Diabetes Res Clin Pract. 2010;89:58–64.
doi: 10.1016/j.diabres.2010.03.006
Biasucci LM, Graziani F, Rizzello V, et al. Paradoxical preservation of vascular function in severe obesity. Am J Med. 2010;123:727–34.
doi: 10.1016/j.amjmed.2010.02.016
Cushman M, Yanez D, Psaty BM, et al. Association of fibrinogen and coagulation factors VII and VIII with cardiovascular risk factors in the elderly: the Cardiovascular Health Study. Cardiovascular Health Study Investigators. Am J Epidemiol. 1996;143:665–76.
doi: 10.1093/oxfordjournals.aje.a008799
Scherbakov N, Dirnagl U, Doehner W. Body weight after stroke: lessons from the obesity paradox. Stroke. 2011;42:3646–50.
doi: 10.1161/STROKEAHA.111.619163
Abhyankar S, Leishear K, Callaghan FM, Demner-Fushman D, McDonald CJ. Lower short- and long-term mortality associated with overweight and obesity in a large cohort study of adult intensive care unit patients. Crit Care. 2012;16:R235.
doi: 10.1186/cc11903
Bundhun PK, Li N, Chen MH. Does an obesity paradox really exist after cardiovascular intervention? A systematic review and meta-analysis of randomized controlled trials and observational studies. Medicine (Baltimore). 2015;94:e1910.
doi: 10.1097/MD.0000000000001910