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Zhang L, Tan D, Zhang Y, Ding Y, Liang H, Zhang G, Xie Z, Sun N, Wang C, Xiao B, Zhang H, Li L, Zhao X, Zeng Y. Ceramides and metabolic profiles of patients with acute coronary disease: a cross-sectional study. Front Physiol 2023; 14:1177765. [PMID: 38146506 PMCID: PMC10749667 DOI: 10.3389/fphys.2023.1177765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/19/2023] [Indexed: 12/27/2023] Open
Abstract
Metabolic Syndrome (MS) is a rapidly growing medical problem worldwide and is characterized by a cluster of age-related metabolic risk factors. The presence of MS increases the likelihood of developing atherosclerosis and significantly raises the morbidity/mortality rate of acute coronary syndrome (ACS) patients. Early detection of MS is crucial, and biomarkers, particularly blood-based, play a vital role in this process. This cross-sectional study focused on the investigation of certain plasma ceramides (Cer14:0, Cer16:0, Cer18:0, Cer20:0, Cer22:0, and Cer24:1) as potential blood biomarkers for MS due to their previously documented dysregulated function in MS patients. A total of 695 ACS patients were enrolled, with 286 diagnosed with MS (ACS-MS) and 409 without MS (ACS-nonMS) serving as the control group. Plasma ceramide concentrations were measured by LC-MS/MS assay and analyzed through various statistical methods. The results revealed that Cer18:0, Cer20:0, Cer22:0, and Cer24:1 were significantly correlated with the presence of MS risk factors. Upon further examination, Cer18:0 emerged as a promising biomarker for early MS detection and risk stratification, as its plasma concentration showed a significant sensitivity to minor changes in MS risk status in participants. This cross-sectional observational study was a secondary analysis of a multicenter prospective observational cohort study (Chinese Clinical Trial Registry, https://www.who.int/clinical-trials-registry-platform/network/primary-registries/chinese-clinical-trial-registry-(chictr), ChiCTR-2200056697), conducted from April 2021 to August 2022.
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Affiliation(s)
- Liang Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
- Heart Center, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Dawei Tan
- Department of Invasive Technology, Emergency General Hospital, Beijing, China
| | - Yang Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Yaodong Ding
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Huiqing Liang
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Gong Zhang
- Department of Cardiology, Beijing Daxing District People’s Hospital, Beijing, China
| | - Zhijiang Xie
- Department of Cardiology, Handan First Hospital, Handan, China
| | - Nian Sun
- Beijing Health Biotechnology Co., Ltd., Beijing, China
| | - Chunjing Wang
- Beijing Health Biotechnology Co., Ltd., Beijing, China
| | - Bingxin Xiao
- Beijing Health Biotechnology Co., Ltd., Beijing, China
| | - Hanzhong Zhang
- Beijing 21st Century International School, Beijing, China
| | - Lin Li
- Beijing Health Biotechnology Co., Ltd., Beijing, China
| | - Xiufeng Zhao
- Department of Cardiology, Handan First Hospital, Handan, China
| | - Yong Zeng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
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Zhao LH, Liu Y, Xiao JY, Wang JX, Li XW, Cui Z, Gao J. Prognostic Value of Metabolic Syndrome in Patients With Non-ST Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 9:912999. [PMID: 35811732 PMCID: PMC9260082 DOI: 10.3389/fcvm.2022.912999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/23/2022] [Indexed: 12/12/2022] Open
Abstract
Objective We aim to investigate the prognostic effects of metabolic syndrome (MS) on patients with non-ST elevated myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI). Methods Patients with NSTEMI undergoing PCI were consecutively collected. According to the presence or absence of MS, they were divided into two groups and followed up for 1 year. The endpoint was major adverse cardiovascular events (MACE), including all-cause death, unstable angina hospitalization, heart failure (HF) hospitalization, non-fatal recurrent myocardial infarction (MI), and target lesion revascularization. Also, six subgroups were made according to gender, age, left ventricular ejection fraction (LVEF), Global Registry of Acute Coronary Events (GRACE) score, hypersensitive troponin (hsTNT), and several diseased vessels. Cox proportional hazard model was adopted to analyze the effect of MS on MACE in all the patients and different subgroups. Results A total of 1,295 patients were included in the current analysis and 660 (50.97%) of them had MS. About 88 patients were lost to follow-up, and the overall average follow-up was 315 days. MS was an independent risk factor for MACE (HR 1.714, CI 1.265–2.322, p = 0.001), all-cause death, heart failure (HF) hospitalization, and non-fatal recurrent MI. In the MS component, BMI ≥28 kg/m2 was positively associated with MACE. Subgroup analysis indicated the prognostic value of MS was more striking for patients with the following: age of >60, LVEF of ≤40%, GRACE of >140, multivessel disease, or hsTNT of >0.1 ng/ml. Conclusions The MS was a robust adverse prognostic factor in patients diagnosed with NSTEMI, especially among those of older age and at higher ischemic risk. A BMI of ≥28 kg/m2 independently predicted the occurrence of MACE. Prognosis may be improved by controlling abdominal obesity.
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Affiliation(s)
- Li-Hong Zhao
- Graduate School, Tianjin Medical University, Tianjin, China
- Cardiac Function Department, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ji-Xiang Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xiao-Wei Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Zhuang Cui
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jing Gao
- Tianjin Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
- *Correspondence: Jing Gao
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Mahdavi-Roshan M, Ghorbani Z, Gholipour M, Salari A, Savar Rakhsh A, Kheirkhah J. Evaluation of cardiometabolic risk markers linked to reduced left ventricular ejection fraction (LVEF) in patients with ST-elevation myocardial infarction (STEMI). BMC Cardiovasc Disord 2022; 22:224. [PMID: 35568801 PMCID: PMC9107768 DOI: 10.1186/s12872-022-02660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background It is well established that left ventricular systolic dysfunction (LVSD), as marked by reduced left ventricular ejection fraction (LVEF), notably worsens the prognosis of ST-elevation myocardial infarction (STEMI). However, the link between cardiometabolic risk markers and LVSD seems unclear. This study aimed to investigate the differences in variables affecting reduced LVEF in STEMI patients. Methods In the current retrospective study, 200 consecutive STEMI patients were enrolled between April 2016 to January 2017. Analysis of serum parameters, anthropometric evaluation, and echocardiography was performed after admission. The participants were categorized according to LVEF levels as follows: group1 (normal: 50–70%, n = 35), group2 (mildly reduced: 40–49%, n = 48); group3 (moderately reduced: 30–39%, n = 94) and group4 (severely reduced: < 30%, n = 23). Between-group comparisons were made using the Kruskal–Wallis test. Results Overall, of 200 STEMI patients with a mean age of 62 years, 27%(n = 54) were females. The median of BMI of patients in group4 (31.07 kg/m2) was significantly higher than group3 (26.35 kg/m2), group2 (25.91 kg/m2), and group1 (24.98 kg/m2; P value < 0.0001). Group4 patients showed significantly increased fasting blood sugar (FBS) than groups 1 (212.00, vs. 139.00 mg/dl; P value = 0.040). Patients in groups 1 and 2 exerted significantly elevated triglyceride levels than those in group4 (142.00, 142.50, and 95.00 mg/dl; P value = 0.001). WBC count, neutrophil%, and neutrophil to lymphocyte ratio among those in group1 (10,200/m3, 70.00%, and 2.92, respectively) were significantly lower than group4 (12,900/m3, 83.00%, and 5.47, respectively; P value < 0.05). Conclusion These findings highlight higher BMI, FBS, and leucocyte count linked to LVSD, probably through increasing the inflammation and reducing LVEF levels. More extensive studies are needed to clarify the clinical relevance of these results.
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Affiliation(s)
- Marjan Mahdavi-Roshan
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Department of Clinical Nutrition, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zeinab Ghorbani
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. .,Department of Clinical Nutrition, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mahboobeh Gholipour
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amir Savar Rakhsh
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Jalal Kheirkhah
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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De Paola L, Mehta A, Pana TA, Carter B, Soiza RL, Kafri MW, Potter JF, Mamas MA, Myint PK. Body Mass Index and Mortality, Recurrence and Readmission after Myocardial Infarction: Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11092581. [PMID: 35566707 PMCID: PMC9104293 DOI: 10.3390/jcm11092581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
The following study aimed to systematically review and meta-analyse the literature on the relations between markers of nutritional status and long-term mortality, recurrence and all-cause hospital readmission following myocardial infarction (MI). Medline, EMBASE and Web of Science were searched for prospective cohort studies reporting the relationship between anthropometric and biochemical markers of nutritional status and nutritional assessment tools on long-term mortality, recurrence and all-cause hospital readmission in adult patients with an MI. Two reviewers conducted screening, data extraction and critical appraisal independently. Random-effects meta-analysis was performed. Twenty-seven studies were included in the qualitative synthesis and twenty-four in the meta-analysis. All eligible studies analysed BMI as their exposure of interest. Relative to normal weight, mortality was highest in underweight patients (adjusted Hazard Ratio (95% confidence interval): 1.42 (1.24–1.62)) and lower in both overweight (0.85 (0.76–0.94)) and obese patients (0.86 (0.81–0.91)), over a mean follow-up ranging from 6 months to 17 years. No statistically significant associations were identified between different BMI categories for the outcomes of recurrence and hospital readmission. Patients with low BMI carried a significant mortality risk post-MI; however due to the known limitations associated with BMI measurement, further evidence regarding the prognostic utility of other nutritional markers is required.
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Affiliation(s)
- Lorenzo De Paola
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB24 3FX, UK; (L.D.P.); (A.M.); (T.A.P.); (R.L.S.)
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK;
| | - Arnav Mehta
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB24 3FX, UK; (L.D.P.); (A.M.); (T.A.P.); (R.L.S.)
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK;
| | - Tiberiu A. Pana
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB24 3FX, UK; (L.D.P.); (A.M.); (T.A.P.); (R.L.S.)
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK;
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK;
| | - Roy L. Soiza
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB24 3FX, UK; (L.D.P.); (A.M.); (T.A.P.); (R.L.S.)
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK;
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB24 3FX, UK
| | - Mohannad W. Kafri
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK;
- Department of Nutrition & Dietetics, Birzeit University, Birzeit P627, Palestine
| | - John F. Potter
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK;
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent ST5 5BG, UK;
| | - Phyo K. Myint
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB24 3FX, UK; (L.D.P.); (A.M.); (T.A.P.); (R.L.S.)
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK;
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB24 3FX, UK
- Correspondence: ; Tel.: +44-(0)-1224-437841
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Wang Y, Wang W, Jia S, Gao M, Zheng S, Wang J, Dang Y, Li Y, Qi X. Development of a nomogram for the prediction of in-hospital mortality in patients with acute ST-elevation myocardial infarction after primary percutaneous coronary intervention: a multicentre, retrospective, observational study in Hebei province, China. BMJ Open 2022; 12:e056101. [PMID: 35110324 PMCID: PMC8811571 DOI: 10.1136/bmjopen-2021-056101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To establish a clinical prognostic nomogram for predicting in-hospital mortality after primary percutaneous coronary intervention (PCI) among patients with ST-elevation myocardial infarction (STEMI). DESIGN Retrospective, multicentre, observational study. SETTING Thirty-nine hospitals in Hebei province. PARTICIPANTS Patients with STEMI who underwent PCI from January 2018 to December 2019. INTERVENTIONS A multivariable logistic regression model was used to identify the factors associated with in-hospital mortality, and a nomogram was established using these factors. The performance of the nomogram was evaluated by the discrimination, calibration and clinical usefulness. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome was the factors associated with in-hospital mortality. RESULTS This study included 855 patients, among whom 223 died in hospital. Age, body mass index, systolic pressure on admission, haemoglobin, random blood glucose on admission, ejection fraction after PCI, use aspirin before admission, long lesions, thrombolysis in myocardial infarction flow grade and neutrophils/lymphocytes ratio were independently associated with in-hospital mortality (all p<0.05). In the training set, the nomogram showed a C-index of 0.947, goodness-of-fit of 0.683 and area under the receiver operating characteristic curve (AUC) of 0.947 (95% CI 0.927 to 0.967). In the testing set, the C-index was 0.891, goodness-of-fit was 0.462 and AUC was 0.891 (95% CI 0.844 to 0.939). The results indicate that the nomogram had good discrimination and good prediction accuracy and could achieve a good net benefit. CONCLUSIONS A nomogram to predict in-hospital mortality in patients with STEMI after PCI was developed and validated in Hebei, China and showed a satisfactory performance. Prospective studies will be necessary to confirm the performance and clinical applicability and practicality of the nomogram.
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Affiliation(s)
- Yudan Wang
- School of Graduate, Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wenjing Wang
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Shengqi Jia
- School of Graduate, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Man Gao
- School of Graduate, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shihang Zheng
- School of Graduate, Hebei North University, Zhangjiakou, Hebei, China
| | - Jiaqi Wang
- School of Graduate, Hebei North University, Zhangjiakou, Hebei, China
| | - Yi Dang
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yingxiao Li
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xiaoyong Qi
- School of Graduate, Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
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Wang J, Wang C, Zeng Z, Zuo H. Impact of BMI on Long-Term Outcomes in Patients with ST-Segment Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention. Int J Clin Pract 2022; 2022:6210204. [PMID: 35685592 PMCID: PMC9159228 DOI: 10.1155/2022/6210204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
AIM Obesity paradox remains a point of debate in ST-segment elevation myocardial infarction (STEMI) patients. The aim of this study was to examine the relationship between body mass index (BMI) and clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). METHODS Outcomes were assessed in 1429 STEMI patients undergoing PPCI between January 2009 and January 2010 in Beijing. Patients were classified into 6 groups according to age (the younger and elderly groups consisting of patients ≤65 and > 65 years old) and baseline BMI (normal weight, BMI < 24 kg/m2; overweight, 24 kg/m2 ≤BMI < 28 kg/m2; obese, BMI ≥ 28 kg/m2). The primary outcome was death, acute myocardial infarction (AMI), or revascularization. RESULTS On long-term follow-up (mean follow-up of 59 months), 13.9% of patients experienced the adverse event. Multivariate logistic regression analyses showed that low BMI was a significant predictor of the primary outcome only in the younger group. The odds ratio for overweight in comparison with normal weight was 0.741 (95% CI: 0.413-0.979; p = 0.038), the odds radio for obesity in comparison with normal-weight patients was 0.508 (95% CI: 0.344-0.750; p = 0.016) in the younger group. In the elderly group, diabetes, hypertension, triple disease, regular exercise, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARBs) use after discharge, and bleeding complication were associated with primary outcome. CONCLUSION The obesity paradox was recognized only in the younger age group in STEMI patients undergoing PPCI.
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Affiliation(s)
- Jinwen Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
| | - Changhua Wang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhechun Zeng
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
| | - Huijuan Zuo
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
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Body mass index and in-hospital outcomes in patient's ≥80 years with ST Elevation Myocardial Infarction. Results from low income country without coronary intervention. Int J Cardiol 2020; 306:11-14. [PMID: 32111357 DOI: 10.1016/j.ijcard.2020.02.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/13/2020] [Accepted: 02/18/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND In most scenarios from low/middle income countries, pharmacological approach for ST elevation Myocardial Infarction is still use. In these setting and increase proportion of elderly patients is awaited. So it is also expected to have older patients with suboptimal treatment and risk stratification. OBJECTIVE To investigate the impact of the body mass index (BMI) on in-hospital outcomes in a cohort of elderly (≥80 years) patients, from a center without coronary intervention. METHODS Patient's ≥80 years of age admitted to our institution between June 2014 and May 2019 with STEMI, were divided according BMI tertiles (BMI tertile 1: ≪22.36 kg/m2, BMI tertile2: 22.36-25.71 kg/m2, and BMI tertile 3: ≫25.71 kg/m2). The primary endpoint was all-cause in-hospital mortality RESULTS: Out of 118 patients, 41 (34.74%) were women. Median age was 84.4 ± 3.5 years and median BMI 24.1 ± 3.7 kg/m2. Women had a higher BMI than men (24.4 ± 4.0 vs 24.0 ± 3.6; p: 0.535). All-cause mortality was 33.3%, 2.5%, and 15% for lower, middle, and higher BMI tertiles (p=0.002). To belong to BMI tertile 1 was associated with an increased all-cause mortality (OR: 5.15, 95% CI 1.84-14.28, p = 0.001); and in patients without administration of streptokinase (OR: 9.52, 95% CI 2.34-38.45, p = 0.001). CONCLUSION This study reports association between lower BMI values and increased mortality in elderly patients with and without pharmacological reperfusion with streptokinase.
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Schiffl H. Obesity and the Survival of Critically Ill Patients with Acute Kidney Injury: A Paradox within the Paradox? KIDNEY DISEASES (BASEL, SWITZERLAND) 2020; 6:13-21. [PMID: 32021870 PMCID: PMC6995946 DOI: 10.1159/000502209] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/17/2019] [Indexed: 12/30/2022]
Abstract
The obesity epidemic is reflected by the rising number of obese patients requiring intensive care. Obesity is a recognized risk factor for the development of acute kidney injury (AKI) in critically ill patients. Both acute critical illness and AKI are associated with higher in-hospital mortality rates, and intensive care unit (ICU) patients suffering from AKI have an elevated risk of death. The relationships between obesity and mortality in critically ill paediatric and adult patients with or without AKI are less clear. Conflicting evidence exists regarding the potential impact of body mass index on the mortality of ICU patients with AKI. Some studies looking at the ICU outcomes of critically ill obese patients with AKI show reduced mortality and others show either no association or elevated mortality. Despite a high biologic plausibility of the proposed causal mechanisms, such as a greater haemodynamic stability and the protective cytokine, adipokine, and lipoprotein defence profiles associated with obesity, the inconsistency of the data suggests that the obesity paradox is a statistical fallacy and the result of chance, bias, and residual confounding variables in retrospective cohort analyses. Further prospective randomized trials are essential to elucidate the role of obesity and the mechanisms underlying a potential survival benefit of obesity in critically ill patients with AKI.
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Affiliation(s)
- Helmut Schiffl
- Department of Internal Medicine IV, University of Munich, Munich, Germany
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