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Impact of low body mass index on stroke outcomes: A propensity-matched analysis
1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Insights
Underweight patients (BMI < 19.9) face worse outcomes after ischemic stroke, including poor functional recovery and increased pneumonia risk. Nutritional status is crucial for stroke care planning and risk stratification.
Area of Science:
- Neurology
- Clinical Nutrition
- Public Health
Background:
- Body mass index (BMI) significantly impacts stroke outcomes.
- The specific effects of being underweight (BMI < 19.9) on post-stroke prognosis are not well-understood.
- This study investigates the association between underweight status and adverse outcomes following ischemic stroke.
Purpose of the Study:
- To evaluate functional and clinical outcomes in ischemic stroke patients with underweight BMI compared to those with ideal BMI (20-24.9).
- To determine if low BMI is a risk factor for poorer recovery and increased complications post-stroke.
Main Methods:
- Utilized TriNetX data from the Mount Sinai Health System for adult ischemic stroke patients.
- Cohorts were categorized by BMI: ideal weight (20-24.9) and underweight (<19.9).
- Propensity score matching balanced 1,600 patients per group for a 2-year outcome assessment including modified Rankin Scale (mRS), pneumonia, and survival.
Main Results:
- Underweight patients exhibited a higher incidence of poor functional outcome (mRS > 2: 18.1% vs 14.4%) and lower 2-year survival probability (79.3% vs 83.7%).
- Pneumonia occurred more frequently in the underweight group (8.8% vs 6.9%).
- No significant differences were found in repeat stroke, motor deficits, hemorrhagic transformation, or need for advanced interventions like thrombolytics or thrombectomy.
Conclusions:
- Underweight status is significantly associated with poorer functional outcomes, increased risk of pneumonia, and reduced survival after ischemic stroke.
- Nutritional status should be considered in the planning of post-stroke care.
- Identifying underweight patients can aid in stroke risk stratification and management.
Introduction:
Body mass index (BMI) influences stroke outcomes, but the impact of being underweight remains understudied. This analysis examines whether underweight status (BMI < 19.9) is associated with worse post-stroke outcomes compared to ideal BMI (20-24.9). We aim to evaluate functional and clinical outcomes in stroke patients with low BMI versus those with ideal weight.
Methods:
Using TriNetX data from the Mount Sinai Health System, we identified adult patients with ischemic stroke (ICD-10: I63) and categorized them based on BMI: ideal weight (BMI 20-24.9, n = 2,640) and underweight (BMI < 19.9, n = 1,610). Propensity score matching on demographics and comorbidities yielded two balanced cohorts of 1,600 patients each. We assessed outcomes over a 2-year follow-up, including modified Rankin Scale (mRS > 2), pneumonia, and survival probability using Kaplan-Meier analysis.
Results:
Underweight patients had a higher incidence of poor functional outcome (mRS > 2: 18.1 % vs 14.4 %; RR 1.26, p = 0.004), with a lower survival probability at 2 years (79.3 % vs 83.7 %; log-rank p = 0.002). Pneumonia occurred more frequently in the underweight group (8.8 % vs 6.9 %; p = 0.048). No significant differences were observed in rates of repeat stroke, motor deficits, or hemorrhagic transformation. Use of thrombolytics, thrombectomy, or need for intubation did not differ significantly.
Conclusion:
Underweight status is associated with poorer functional outcomes, increased pneumonia risk, and reduced survival following ischemic stroke compared to patients with ideal BMI. These findings support the consideration of nutritional status in post-stroke care planning and risk stratification.
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