Body mass index and aneurysmal subarachnoid hemorrhage

Decreasing mortality with increasing body mass index

Joshua D. Hughes, Milan Samarage, Anthony M. Burrows, Giuseppe Lanzino, Alejandro Rabinstein

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Labeled the "obesity paradox," obesity has been shown to provide a survival advantage in coronary artery disease, stroke, and intracerebral hemorrhage. Studies on body mass index (BMI) in aneurysmal subarachnoid hemorrhage (SAH) show conflicting results and none examined a North American population with long-term follow-up. Methods A total of 305 consecutive SAH patients (2002 to 2011) were retrospectively reviewed to collect demographics, BMI (kg/m2), comorbidities, Glascow Coma Scale, World Federation of Neurologic Surgeons Scale, aneurysm treatment, delayed cerebral ischemia, radiographic infarction, and short-term and long-term (>24 months) morbidity, and mortality. Patients were stratified by BMI into category 1, <25 kg/m2; category 2, 25-<30 kg/m2; and category 3, ≥30 kg/m2. Results Categories 1, 2, and 3 had 93, 100, and 87 patients with mean BMIs of 22.4 ± 1.8, 27.6 ± 1.4, and 35.7 ± 4.6 (P< 0.05), respectively. By category, 24-month follow-up was available in 92%, 85%, and 85%. Category 3 had more hypertension, diabetes mellitus, and clipping than category 1. Short-term mortality rates were 17%, 12%, and 8%; long-term mortality rates were 34%, 26%, and 19% (P> 0.05 at all points between categories 1 vs. 3, but not 1 vs. 2 or 2 vs. 3). On univariate analysis, BMI was inversely associated with short-term (odds ratio, 0.91; 95% confidence interval 0.84-0.98; P = 0.009) and long-term (odds ratio, 0.92; 95% confidence interval 0.87-0.97; P = 0.001) mortality. On multivariate analysis including age, World Federation of Neurologic Surgeons Scale, delayed cerebral ischemia, and radiographic infarction, BMI remained significant for short-term (odds ratio, 0.91; 95% confidence interval 0.81-0.99; P = 0.047) and long-term (odds ratio, 0.92; 95% confidence interval 0.85-0.98; P = 0.021) mortality. On Kaplan-Meier survival analysis, P > 0.05 for categories 1 versus 2 and 2 versus 3, but P = 0.005 for categories 1 versus 3. Conclusions In our SAH population, higher BMI resulted in less short-term and long-term mortality, but no difference in functional outcome.

Original languageEnglish (US)
Pages (from-to)1598-1604
Number of pages7
JournalWorld Neurosurgery
Volume84
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Subarachnoid Hemorrhage
Body Mass Index
Mortality
Odds Ratio
Confidence Intervals
Brain Ischemia
Infarction
Nervous System
Obesity
Cerebral Hemorrhage
Kaplan-Meier Estimate
Survival Analysis
Coma
Population
Aneurysm
Comorbidity
Coronary Artery Disease
Multivariate Analysis
Stroke
Demography

Keywords

  • Body mass index (BMI)
  • Mortality
  • Obesity paradox
  • Subarachnoid hemorrhage (SAH)

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Body mass index and aneurysmal subarachnoid hemorrhage : Decreasing mortality with increasing body mass index. / Hughes, Joshua D.; Samarage, Milan; Burrows, Anthony M.; Lanzino, Giuseppe; Rabinstein, Alejandro.

In: World Neurosurgery, Vol. 84, No. 6, 01.12.2015, p. 1598-1604.

Research output: Contribution to journalArticle

Hughes, Joshua D. ; Samarage, Milan ; Burrows, Anthony M. ; Lanzino, Giuseppe ; Rabinstein, Alejandro. / Body mass index and aneurysmal subarachnoid hemorrhage : Decreasing mortality with increasing body mass index. In: World Neurosurgery. 2015 ; Vol. 84, No. 6. pp. 1598-1604.
@article{1fca94209f13440f9164cbc54cdcbcb0,
title = "Body mass index and aneurysmal subarachnoid hemorrhage: Decreasing mortality with increasing body mass index",
abstract = "Background Labeled the {"}obesity paradox,{"} obesity has been shown to provide a survival advantage in coronary artery disease, stroke, and intracerebral hemorrhage. Studies on body mass index (BMI) in aneurysmal subarachnoid hemorrhage (SAH) show conflicting results and none examined a North American population with long-term follow-up. Methods A total of 305 consecutive SAH patients (2002 to 2011) were retrospectively reviewed to collect demographics, BMI (kg/m2), comorbidities, Glascow Coma Scale, World Federation of Neurologic Surgeons Scale, aneurysm treatment, delayed cerebral ischemia, radiographic infarction, and short-term and long-term (>24 months) morbidity, and mortality. Patients were stratified by BMI into category 1, <25 kg/m2; category 2, 25-<30 kg/m2; and category 3, ≥30 kg/m2. Results Categories 1, 2, and 3 had 93, 100, and 87 patients with mean BMIs of 22.4 ± 1.8, 27.6 ± 1.4, and 35.7 ± 4.6 (P< 0.05), respectively. By category, 24-month follow-up was available in 92{\%}, 85{\%}, and 85{\%}. Category 3 had more hypertension, diabetes mellitus, and clipping than category 1. Short-term mortality rates were 17{\%}, 12{\%}, and 8{\%}; long-term mortality rates were 34{\%}, 26{\%}, and 19{\%} (P> 0.05 at all points between categories 1 vs. 3, but not 1 vs. 2 or 2 vs. 3). On univariate analysis, BMI was inversely associated with short-term (odds ratio, 0.91; 95{\%} confidence interval 0.84-0.98; P = 0.009) and long-term (odds ratio, 0.92; 95{\%} confidence interval 0.87-0.97; P = 0.001) mortality. On multivariate analysis including age, World Federation of Neurologic Surgeons Scale, delayed cerebral ischemia, and radiographic infarction, BMI remained significant for short-term (odds ratio, 0.91; 95{\%} confidence interval 0.81-0.99; P = 0.047) and long-term (odds ratio, 0.92; 95{\%} confidence interval 0.85-0.98; P = 0.021) mortality. On Kaplan-Meier survival analysis, P > 0.05 for categories 1 versus 2 and 2 versus 3, but P = 0.005 for categories 1 versus 3. Conclusions In our SAH population, higher BMI resulted in less short-term and long-term mortality, but no difference in functional outcome.",
keywords = "Body mass index (BMI), Mortality, Obesity paradox, Subarachnoid hemorrhage (SAH)",
author = "Hughes, {Joshua D.} and Milan Samarage and Burrows, {Anthony M.} and Giuseppe Lanzino and Alejandro Rabinstein",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.wneu.2015.07.019",
language = "English (US)",
volume = "84",
pages = "1598--1604",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Body mass index and aneurysmal subarachnoid hemorrhage

T2 - Decreasing mortality with increasing body mass index

AU - Hughes, Joshua D.

AU - Samarage, Milan

AU - Burrows, Anthony M.

AU - Lanzino, Giuseppe

AU - Rabinstein, Alejandro

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background Labeled the "obesity paradox," obesity has been shown to provide a survival advantage in coronary artery disease, stroke, and intracerebral hemorrhage. Studies on body mass index (BMI) in aneurysmal subarachnoid hemorrhage (SAH) show conflicting results and none examined a North American population with long-term follow-up. Methods A total of 305 consecutive SAH patients (2002 to 2011) were retrospectively reviewed to collect demographics, BMI (kg/m2), comorbidities, Glascow Coma Scale, World Federation of Neurologic Surgeons Scale, aneurysm treatment, delayed cerebral ischemia, radiographic infarction, and short-term and long-term (>24 months) morbidity, and mortality. Patients were stratified by BMI into category 1, <25 kg/m2; category 2, 25-<30 kg/m2; and category 3, ≥30 kg/m2. Results Categories 1, 2, and 3 had 93, 100, and 87 patients with mean BMIs of 22.4 ± 1.8, 27.6 ± 1.4, and 35.7 ± 4.6 (P< 0.05), respectively. By category, 24-month follow-up was available in 92%, 85%, and 85%. Category 3 had more hypertension, diabetes mellitus, and clipping than category 1. Short-term mortality rates were 17%, 12%, and 8%; long-term mortality rates were 34%, 26%, and 19% (P> 0.05 at all points between categories 1 vs. 3, but not 1 vs. 2 or 2 vs. 3). On univariate analysis, BMI was inversely associated with short-term (odds ratio, 0.91; 95% confidence interval 0.84-0.98; P = 0.009) and long-term (odds ratio, 0.92; 95% confidence interval 0.87-0.97; P = 0.001) mortality. On multivariate analysis including age, World Federation of Neurologic Surgeons Scale, delayed cerebral ischemia, and radiographic infarction, BMI remained significant for short-term (odds ratio, 0.91; 95% confidence interval 0.81-0.99; P = 0.047) and long-term (odds ratio, 0.92; 95% confidence interval 0.85-0.98; P = 0.021) mortality. On Kaplan-Meier survival analysis, P > 0.05 for categories 1 versus 2 and 2 versus 3, but P = 0.005 for categories 1 versus 3. Conclusions In our SAH population, higher BMI resulted in less short-term and long-term mortality, but no difference in functional outcome.

AB - Background Labeled the "obesity paradox," obesity has been shown to provide a survival advantage in coronary artery disease, stroke, and intracerebral hemorrhage. Studies on body mass index (BMI) in aneurysmal subarachnoid hemorrhage (SAH) show conflicting results and none examined a North American population with long-term follow-up. Methods A total of 305 consecutive SAH patients (2002 to 2011) were retrospectively reviewed to collect demographics, BMI (kg/m2), comorbidities, Glascow Coma Scale, World Federation of Neurologic Surgeons Scale, aneurysm treatment, delayed cerebral ischemia, radiographic infarction, and short-term and long-term (>24 months) morbidity, and mortality. Patients were stratified by BMI into category 1, <25 kg/m2; category 2, 25-<30 kg/m2; and category 3, ≥30 kg/m2. Results Categories 1, 2, and 3 had 93, 100, and 87 patients with mean BMIs of 22.4 ± 1.8, 27.6 ± 1.4, and 35.7 ± 4.6 (P< 0.05), respectively. By category, 24-month follow-up was available in 92%, 85%, and 85%. Category 3 had more hypertension, diabetes mellitus, and clipping than category 1. Short-term mortality rates were 17%, 12%, and 8%; long-term mortality rates were 34%, 26%, and 19% (P> 0.05 at all points between categories 1 vs. 3, but not 1 vs. 2 or 2 vs. 3). On univariate analysis, BMI was inversely associated with short-term (odds ratio, 0.91; 95% confidence interval 0.84-0.98; P = 0.009) and long-term (odds ratio, 0.92; 95% confidence interval 0.87-0.97; P = 0.001) mortality. On multivariate analysis including age, World Federation of Neurologic Surgeons Scale, delayed cerebral ischemia, and radiographic infarction, BMI remained significant for short-term (odds ratio, 0.91; 95% confidence interval 0.81-0.99; P = 0.047) and long-term (odds ratio, 0.92; 95% confidence interval 0.85-0.98; P = 0.021) mortality. On Kaplan-Meier survival analysis, P > 0.05 for categories 1 versus 2 and 2 versus 3, but P = 0.005 for categories 1 versus 3. Conclusions In our SAH population, higher BMI resulted in less short-term and long-term mortality, but no difference in functional outcome.

KW - Body mass index (BMI)

KW - Mortality

KW - Obesity paradox

KW - Subarachnoid hemorrhage (SAH)

UR - http://www.scopus.com/inward/record.url?scp=84951762104&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84951762104&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2015.07.019

DO - 10.1016/j.wneu.2015.07.019

M3 - Article

VL - 84

SP - 1598

EP - 1604

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

IS - 6

ER -