{"title":"体重指数对缺血性和出血性脑卒中预后的临床影响。","authors":"Kaori Miwa, Michikazu Nakai, Sohei Yoshimura, Yusuke Sasahara, Shinichi Wada, Junpei Koge, Akiko Ishigami, Yoshiki Yagita, Kenji Kamiyama, Yoshihiro Miyamoto, Shotai Kobayashi, Kazuo Minematsu, Kazunori Toyoda, Masatoshi Koga","doi":"10.1177/17474930241249370","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aim: </strong>To investigate the prognostic implication of body mass index (BMI) on clinical outcomes after acute ischemic and hemorrhagic stroke.</p><p><strong>Methods: </strong>The subjects of the study included adult patients with available baseline body weight and height data who had suffered an acute stroke and were registered in the Japan Stroke Data Bank-a hospital-based, multicenter stroke registration database-between January 2006 and December 2020. The outcome measures included unfavorable outcomes defined as a modified Rankin Scale (mRS) score of 5-6 and favorable outcomes (mRS 0-2) at discharge, and in-hospital mortality. Mixed effects logistic regression analysis was conducted to determine the relationship between BMI categories (underweight, normal weight, overweight, class I obesity, class II obesity; <18.5, 18.5-23.0, 23.0-25.0, 25-30, ⩾30 kg/m<sup>2</sup>) and the outcomes, after adjustment for covariates.</p><p><strong>Results: </strong>A total of 56,230 patients were assigned to one of the following groups: ischemic stroke (IS, n = 43,668), intracerebral hemorrhage (ICH, n = 9741), and subarachnoid hemorrhage (SAH, n = 2821). In the IS group, being underweight was associated with an increased likelihood of unfavorable outcomes (odds ratio, 1.47 (95% confidence interval (CI):1.31-1.65)) and in-hospital mortality (1.55 (1.31-1.83)) compared to outcomes in those with normal weight. Being overweight was associated with an increased likelihood of favorable outcomes (1.09 (1.01-1.18)). Similar associations were observed between underweight and these outcomes in specific IS subtypes (cardioembolic stroke, large artery stroke, and small-vessel occlusion). Patients with a BMI ⩾30.0 kg/m<sup>2</sup> was associated with an increased likelihood of unfavorable outcomes (1.44 (1.01-2.17)) and in-hospital mortality (2.42 (1.26-4.65)) in large artery stroke. In patients with ICH, but not those with SAH, being underweight was associated with an increased likelihood of unfavorable outcomes (1.41 (1.01-1.99)).</p><p><strong>Conclusions: </strong>BMI substantially impacts functional outcomes following IS and ICH. Lower BMI consistently affected post-stroke disability and mortality, while higher BMI values similarly affected these outcomes after large artery stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11408962/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical impact of body mass index on outcomes of ischemic and hemorrhagic strokes.\",\"authors\":\"Kaori Miwa, Michikazu Nakai, Sohei Yoshimura, Yusuke Sasahara, Shinichi Wada, Junpei Koge, Akiko Ishigami, Yoshiki Yagita, Kenji Kamiyama, Yoshihiro Miyamoto, Shotai Kobayashi, Kazuo Minematsu, Kazunori Toyoda, Masatoshi Koga\",\"doi\":\"10.1177/17474930241249370\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aim: </strong>To investigate the prognostic implication of body mass index (BMI) on clinical outcomes after acute ischemic and hemorrhagic stroke.</p><p><strong>Methods: </strong>The subjects of the study included adult patients with available baseline body weight and height data who had suffered an acute stroke and were registered in the Japan Stroke Data Bank-a hospital-based, multicenter stroke registration database-between January 2006 and December 2020. The outcome measures included unfavorable outcomes defined as a modified Rankin Scale (mRS) score of 5-6 and favorable outcomes (mRS 0-2) at discharge, and in-hospital mortality. Mixed effects logistic regression analysis was conducted to determine the relationship between BMI categories (underweight, normal weight, overweight, class I obesity, class II obesity; <18.5, 18.5-23.0, 23.0-25.0, 25-30, ⩾30 kg/m<sup>2</sup>) and the outcomes, after adjustment for covariates.</p><p><strong>Results: </strong>A total of 56,230 patients were assigned to one of the following groups: ischemic stroke (IS, n = 43,668), intracerebral hemorrhage (ICH, n = 9741), and subarachnoid hemorrhage (SAH, n = 2821). In the IS group, being underweight was associated with an increased likelihood of unfavorable outcomes (odds ratio, 1.47 (95% confidence interval (CI):1.31-1.65)) and in-hospital mortality (1.55 (1.31-1.83)) compared to outcomes in those with normal weight. Being overweight was associated with an increased likelihood of favorable outcomes (1.09 (1.01-1.18)). Similar associations were observed between underweight and these outcomes in specific IS subtypes (cardioembolic stroke, large artery stroke, and small-vessel occlusion). Patients with a BMI ⩾30.0 kg/m<sup>2</sup> was associated with an increased likelihood of unfavorable outcomes (1.44 (1.01-2.17)) and in-hospital mortality (2.42 (1.26-4.65)) in large artery stroke. In patients with ICH, but not those with SAH, being underweight was associated with an increased likelihood of unfavorable outcomes (1.41 (1.01-1.99)).</p><p><strong>Conclusions: </strong>BMI substantially impacts functional outcomes following IS and ICH. 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引用次数: 0
摘要
背景和目的:研究体重指数(BMI)对急性缺血性和出血性脑卒中临床预后的影响:研究对象包括 2006 年 1 月至 2020 年 12 月期间在日本脑卒中数据库(Japan Stroke Data Bank)--一个基于医院的多中心脑卒中登记数据库--登记的急性脑卒中成年患者,这些患者均有体重和身高基线数据。结果测量包括出院时的不利结果(定义为改良Rankin量表(mRS)5-6分)、有利结果(mRS 0-2)和院内死亡率。在对协变量进行调整后,进行了混合效应逻辑回归分析,以确定体重指数类别(体重不足、正常体重、超重、I 级肥胖、II 级肥胖;2)与结果之间的关系:共有 56230 名患者被分配到以下组别:缺血性中风(IS,n = 43668)、脑内出血(ICH,n = 9741)和蛛网膜下腔出血(SAH,n = 2821)。在IS组中,与体重正常者的结果相比,体重过轻与不利结果(几率比1.47(95%置信区间(CI):1.31-1.65))和院内死亡率(1.55(1.31-1.83))的可能性增加有关。超重与有利结果的可能性增加有关(1.09 (1.01-1.18))。在特定的 IS 亚型(心栓塞性中风、大动脉中风和小血管闭塞)中,也观察到体重不足与这些结果之间存在类似的关联。在大动脉卒中中,BMI ⩾30.0 kg/m2 的患者出现不良预后(1.44 (1.01-2.17))和院内死亡率(2.42 (1.26-4.65))的可能性增加。在 ICH 患者中,体重过轻与不良预后的可能性增加(1.41 (1.01-1.99))相关,但与 SAH 患者无关:结论:体重指数对IS和ICH后的功能预后有很大影响。结论:体重指数对 IS 和 ICH 后的功能预后有很大影响。体重指数越低,中风后的残疾率和死亡率越高,而体重指数越高,大动脉中风后的这些预后也会受到类似影响。
Clinical impact of body mass index on outcomes of ischemic and hemorrhagic strokes.
Background and aim: To investigate the prognostic implication of body mass index (BMI) on clinical outcomes after acute ischemic and hemorrhagic stroke.
Methods: The subjects of the study included adult patients with available baseline body weight and height data who had suffered an acute stroke and were registered in the Japan Stroke Data Bank-a hospital-based, multicenter stroke registration database-between January 2006 and December 2020. The outcome measures included unfavorable outcomes defined as a modified Rankin Scale (mRS) score of 5-6 and favorable outcomes (mRS 0-2) at discharge, and in-hospital mortality. Mixed effects logistic regression analysis was conducted to determine the relationship between BMI categories (underweight, normal weight, overweight, class I obesity, class II obesity; <18.5, 18.5-23.0, 23.0-25.0, 25-30, ⩾30 kg/m2) and the outcomes, after adjustment for covariates.
Results: A total of 56,230 patients were assigned to one of the following groups: ischemic stroke (IS, n = 43,668), intracerebral hemorrhage (ICH, n = 9741), and subarachnoid hemorrhage (SAH, n = 2821). In the IS group, being underweight was associated with an increased likelihood of unfavorable outcomes (odds ratio, 1.47 (95% confidence interval (CI):1.31-1.65)) and in-hospital mortality (1.55 (1.31-1.83)) compared to outcomes in those with normal weight. Being overweight was associated with an increased likelihood of favorable outcomes (1.09 (1.01-1.18)). Similar associations were observed between underweight and these outcomes in specific IS subtypes (cardioembolic stroke, large artery stroke, and small-vessel occlusion). Patients with a BMI ⩾30.0 kg/m2 was associated with an increased likelihood of unfavorable outcomes (1.44 (1.01-2.17)) and in-hospital mortality (2.42 (1.26-4.65)) in large artery stroke. In patients with ICH, but not those with SAH, being underweight was associated with an increased likelihood of unfavorable outcomes (1.41 (1.01-1.99)).
Conclusions: BMI substantially impacts functional outcomes following IS and ICH. Lower BMI consistently affected post-stroke disability and mortality, while higher BMI values similarly affected these outcomes after large artery stroke.
期刊介绍:
The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.