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

9 Scopus citations

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

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Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

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