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Body Mass Index and Mortality in Cardiogenic Shock
Maya Guglin1, Elric Zweck2,3, Manreet Kanwar4
1From Department of Cardiology, the Indiana University Health, Indianapolis, Indiana.
Insights
Body mass index (BMI) impacts mortality in cardiogenic shock (CS). Normal weight patients had lower CS mortality than obese or severely obese individuals. This association varied between heart failure-related CS and acute myocardial infarction-related CS.
Area of Science:
- Cardiology
- Public Health
- Obesity Research
Background:
- Cardiogenic shock (CS) is a life-threatening condition with high mortality.
- The role of body mass index (BMI) in CS outcomes is not fully understood.
- Obesity is a growing public health concern, and its impact on critical illnesses needs investigation.
Purpose of the Study:
- To investigate the association between body mass index (BMI) and mortality in patients with cardiogenic shock (CS).
- To analyze mortality rates across different BMI categories in CS patients.
- To explore potential differences in BMI-mortality relationships based on the underlying cause of CS, specifically heart failure (HF-CS) and acute myocardial infarction (AMI-CS).
Main Methods:
- Utilized data from the Cardiogenic Shock Working Group registry, including 3,492 patients.
- Employed multivariable logistic regression with restricted cubic splines to assess BMI's impact on mortality, adjusting for covariates.
- Categorized patients into underweight, normal, overweight, obese, and severely obese groups to compare mortality, device use, and complications.
Main Results:
- Body mass index was a significant predictor of mortality in the overall CS cohort (p < 0.0001).
- Patients with normal BMI exhibited lower mortality (29.0%) compared to obese (35.1%) and severely obese (36.7%) individuals.
- In the heart failure-related CS subgroup, normal weight patients had the lowest mortality (21.7%), while underweight, obese, and severely obese patients had higher rates. No significant difference in mortality among BMI categories was observed in the acute myocardial infarction-related CS subgroup.
Conclusions:
- Body mass index is a significant factor influencing mortality in cardiogenic shock.
- A normal BMI is associated with better survival in CS, particularly in cases related to heart failure.
- Further research is warranted to understand the complex interplay between BMI, CS etiology, and patient outcomes.
Abstract:
We explored the association of body mass index (BMI) with mortality in cardiogenic shock (CS). Using the Cardiogenic Shock Working Group registry, we assessed the impact of BMI on mortality using restricted cubic splines in a multivariable logistic regression model adjusting for age, gender, and race. We also assessed mortality, device use, and complications in BMI categories, defined as underweight (<18.5 kg/m 2 ), normal (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), obese (30-39.9 kg/m 2 ), and severely obese (>40 kg/m 2 ) using univariable logistic regression models. Our cohort had 3,492 patients with CS (mean age = 62.1 ± 14 years, 69% male), 58.0% HF-related CS (HF-CS), and 27.8% acute myocardial infarction (AMI) related CS. Body mass index was a significant predictor of mortality in multivariable regression using restricted cubic splines ( p < 0.0001, p = 0.194 for nonlinearity). When stratified by categories, patients with healthy weight had lower mortality (29.0%) than obese (35.1%, p = 0.003) or severely obese (36.7%, p = 0.01). In HF-CS cohort, the healthy weight patients had the lowest mortality (21.7%), whereas it was higher in the underweight (37.5%, p = 0.012), obese (29.2%, p = 0.003), and severely obese (29.9%, p = 0.019). There was no difference in mortality among BMI categories in AMI-CS.
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