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Published on: June 12, 2021
Body mass index and outcomes of patients with cardiogenic shock: A systematic review and meta-analysis
Wen-Xia Tao1, Guo-Ying Qian1, Hong-Dan Li1
1Department of Cardiovascular Medicine, Huzhou Cent Hospital, Affiliated Cent Hospital Huzhou University, Huzhou 313000, Zhejiang Province, China.
Insights
Higher body mass index (BMI) may reduce mortality risk in cardiogenic shock patients, but evidence is conflicting. Further research is needed to understand this obesity paradox and its potential confounders.
Area of Science:
- Cardiology
- Metabolic Health
- Critical Care Medicine
Background:
- Cardiogenic shock is a severe complication of acute myocardial infarction and heart failure, carrying high mortality rates.
- Obesity is a global health epidemic, necessitating an understanding of its impact on various critical conditions.
Purpose of the Study:
- To investigate the relationship between elevated body mass index (BMI) and patient outcomes in cardiogenic shock.
- To analyze existing literature for evidence of an obesity paradox in cardiogenic shock.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, ScienceDirect, CENTRAL, Google Scholar).
- Studies comparing mortality in cardiogenic shock patients based on World Health Organization BMI criteria were included.
- Data extraction and analysis were performed using Reference Citation Analysis.
Main Results:
- Pooled analysis of multivariable-adjusted data suggested a statistically significant reduction in mortality risk for overweight/obese patients compared to normal BMI patients (OR = 0.92).
- However, meta-analysis of crude mortality rates showed no significant difference between BMI groups (OR = 0.95).
- Sensitivity analyses revealed unstable results and substantial heterogeneity, indicating limitations in the current evidence.
Conclusions:
- The association between overweight/obesity and mortality in cardiogenic shock is currently unclear and contradictory.
- A potential obesity paradox may exist, but it could be influenced by factors like mechanical circulatory support.
- More robust studies are required to definitively elucidate the relationship between BMI and cardiogenic shock outcomes.
Background:
Cardiogenic shock continues to be a highly morbid complication that affects around 7%-10% of patients with acute myocardial infarction or heart failure. Similarly, obesity has become a worldwide epidemic.
Aim:
To analyze the impact of higher body mass index (BMI) on outcomes of patients with cardiogenic shock.
Methods:
A systematic and comprehensive search was undertaken on the electronic databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar for all types of studies comparing mortality outcomes of patients with cardiogenic shock based on BMI. All studies defined overweight or obese patients based on the World Health Organization BMI criteria. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).
Results:
Five studies were included. On pooled analysis of multivariable-adjusted ratios, we noted a statistically significantly reduced risk of mortality in overweight/obese vs normal patients (three studies; odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.85-0.98, I 2 = 85%). On meta-analysis, we noted that crude mortality rates did not significantly differ between overweight/obese and normal patients after cardiogenic shock (OR = 0.95, 95%CI: 0.79-1.15, I 2 = 99%). The results were not stable on sensitivity analysis and were associated with substantial heterogeneity.
Conclusion:
Current evidence on the association between overweight/obesity and mortality after cardiogenic shock is scarce and conflicting. The obesity paradox might exist in patients with cardiogenic shock but could be confounded by the use of mechanical circulatory support. There is a need for further studies to clarify this relationship.
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