Effects of Body Mass Index on Functional Outcomes in Patients with Acute Cerebral Large Vessel Occlusion
Yu Kinoshita1,2, Fumihiro Sakakibara1,3, Shinichi Yoshimura4
1Department of Data Science, Hyogo Medical University, Nishinomiya, Japan.
Introduction:
The effect of body mass index (BMI) on the outcome of acute cerebral large vessel occlusion (LVO) was uncertain in the era of endovascular therapy (EVT). We investigated the association between BMI and functional outcomes in patients with acute cerebral LVO.
Methods:
We performed a post hoc analysis of the RESCUE-Japan Registry 2 including 2,408 LVO patients among 46 stroke centers in Japan. The patients were categorized into 3 groups depending on their BMI (kg/m2): Low-BMI group: BMI <18.5, Normal-BMI group: 18.5≤ BMI <25, and High-BMI group: BMI ≥25. We estimated the effect of the Low-BMI and High-BMI groups relative to the Normal-BMI group. The primary outcome was a modified Rankin Scale (mRS) score of 5 or 6 at 90 days from the onset. The secondary outcomes consisted of an mRS score of 0-2 at 90 days, symptomatic intracranial hemorrhage (ICH), and any ICH within 72 h from the onset.
Results:
Among a total of 2,234 analyzed patients, Low-BMI, Normal-BMI, and High-BMI groups accounted for 14.5%, 63.7%, and 21.9%, respectively. The patients in the Low-BMI group were older, more female, poorer premorbid status, severe symptom presentation, and more dominant of occlusion of the internal carotid artery or M1 segment of the middle cerebral artery. The Low-BMI group used less recombinant tissue plasminogen activator and EVT. The primary outcome occurred 46.4%, 31.2%, and 23.7% in the Low-BMI, Normal-BMI, and High-BMI groups, respectively. The adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of the primary outcome of the Low-BMI and High-BMI groups relative to the Normal-BMI group were 1.59 (1.18-2.13) and 0.80 (0.60-1.07), respectively. The mRS score of 0-2 in the Low-BMI, Normal-BMI, and High-BMI groups consisted of 26.3%, 38.8%, and 41.9%, respectively. The adjusted OR (95% CIs) of an mRS score of 0-2 for the Low-BMI and High-BMI groups relative to the Normal-BMI group were 0.72 (0.53-0.99) and 0.83 (0.64-1.06), respectively. The adjusted OR (95% CIs) of symptomatic ICH of the Low-BMI and High-BMI groups relative to the Normal-BMI group were 1.57 (0.84-2.95) and 1.31 (0.75-2.29), respectively.
Conclusion:
The low BMI was associated with a severity and poorer functional outcomes in patients with acute cerebral LVO.
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