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Joint effects of severe obesity and inflammation on mortality in critically ill non-ST-segment elevation myocardial
Yuqing Li1, Yuhang Wang1, Pengju Lu1,2
1Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
Background:
To investigate the association between body mass index (BMI) and both in-hospital and 10-year all-cause mortality in critically ill non-ST-segment elevation myocardial infarction (NSTEMI) patients, and to evaluate the incremental value of C-reactive protein (CRP) in risk stratification.
Methods:
This multinational study included 7,815 critically ill NSTEMI patients from three cohorts. We first analyzed an original discovery cohort (TAMI, n = 5,010) from a Chinese tertiary hospital, then externally validated the findings in two independent US cohorts (MIMIC-IV, n = 1,208; eICU-CRD, n = 1,597). BMI was categorized according to WHO criteria, and CRP was dichotomized at 2 mg/L. Multivariable Cox regression and restricted cubic splines were used to assess mortality risks.
Results:
In the TAMI cohort, severe obesity (BMI ≥ 35 kg/m2) was independently associated with increased risks of in-hospital (HR 1.69; 95% CI: 1.08-2.65; p = 0.022) and 10-year (HR 1.68; 95% CI: 1.31-2.15; p < 0.001) all-cause mortality. Overweight and obesity I were associated with lower mortality risk compared with normal weight. The absolute in-hospital mortality rate was 8.36% in the severe obesity group, compared with 1.55% in the overweight group. The coexistence of severe obesity and elevated CRP (≥ 2 mg/L) identified a high-risk clinical profile, with no significant interaction between these two factors for either outcome (p for interaction = 0.178 for in-hospital and 0.169 for 10-year all-cause mortality). Adding CRP to the base model (Model 3) significantly improved risk prediction, with an increase in AUC from 0.764 to 0.768 (p = 0.021) and significant improvements in reclassification and discrimination metrics (all p < 0.05). The pooled meta-analysis results across the three databases were consistent.
Conclusions:
BMI exhibits a U-shaped association with mortality in critically ill NSTEMI patients. Severe obesity combined with elevated inflammation identifies a high-risk clinical profile, supporting integrated metabolic-inflammatory risk stratification.
