The effect of body mass index on stroke prognosis: a systematic review and meta-analysis of 32 cohort studies with 330353 patients

BACKGROUND

Many studies have explored the impact of body mass index (BMI) on stroke prognosis, yet findings remain inconsistent.

AIMS

The aims of this study were to conduct a systematic review and meta-analyses to summarize the existing evidence on BMI and stroke outcomes.

METHODS

PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, Wanfang Database and VIP Database were systematically searched from inception to Jan.1st, 2023. Cohort studies were included if they reported on a population of patients with stroke, evaluated BMI on stroke outcomes (mortality/recurrence/score of mRs) and reported original data. Data extraction and quality assessment were independently undertaken by two reviewers. Stata 16.0 software was used for meta-analysis.

RESULTS

32 studies involving 330,353 patients (5 Chinese language articles) were included in the analysis. The proportion of underweight, overweight, and obese patients was 1.85%, 18.2%, and 15.6%, respectively. Compared with normal weight, being underweight was associated with an increased risk of mortality (RR 1.78, 95% CI 1.60-1.96), poor functional outcomes defined as modified Rankin scale ≥3 (RR 1.33, 95% CI 1.22-1.45), and stroke recurrence (RR 1.19, 95% CI 1.04-1.37). Being overweight but not obese was associated with reduced mortality (RR 0.81, 95% CI 0.74-0.89) and better functional outcomes (RR 0.92, 95% CI 0.89-0.96), but did not alter the risk of stroke recurrence (RR 1.03, 95% CI 0.90-1.17). Obesity was associated with lower risk of mortality (RR 0.76, 95% CI 0.72-0.81), and better functional outcomes (RR 0.89, 95% CI 0.84-0.94).

CONCLUSIONS

Our findings indicate that in patients with stroke, being underweight is associated with an increased risk of mortality, poor functional outcomes, and stroke recurrence. In contrast, being overweight but not obese, or being obese, was associated with a decreased risk of mortality and better functional outcomes. This are consistent with the obesity paradox in stroke, whereby obesity increases stroke risk in the general population but is associated with improved outcome in patients suffering stroke.Key Words body mass index; stroke; prognosis; meta-analysis.

Comparison of endoscopic and open surgery in life-threatening large spontaneous supratentorial intracerebral hemorrhage: a propensity-matched analysis

BACKGROUND

Conventionally, open surgery (OS), including standard craniotomy (SC) and decompressive craniectomy (DC) with hematoma evacuation, is adopted to treat life-threatening large spontaneous supratentorial intracerebral hemorrhage (ICH). Recently, a minimally invasive surgical treatment, endoscopic surgery (ES) has gained increased popularity. However, the safety and efficacy of ES for life-threatening large ICH is uncertain.

AIM

The aim of this study was to evaluate the effectiveness and safety of ES for life-threatening large ICH and compare it with traditional OS.

METHODS

We retrospectively analyzed the clinical and imaging data of consecutive supratentorial ICH patients with preoperative Glasgow Coma Scale (GCS) score ≤ 8, who underwent ES or OS between May 2015 and October 2021. To minimize bias in case selection, propensity score matching was performed (ratio 1:2, caliper o.2). The primary outcome was a prognosis-based dichotomized (favorable or unfavorable) outcome of the 5-point Glasgow Outcome Scale (GOS) at 6 months. Favorable outcome was defined as a GOS-score of 4-5 at 6 months. Sensitivity analysis was also performed to ensure the robustness of the findings.

RESULTS

Of 695 patients who underwent surgical treatment for spontaneous ICH, 191 patients were identified to be eligible, with 58 patients in the ES group and 133 patients in the OS group. Propensity score matching improved covariate balance and generated a comparable cohort (53 ES and 106 OS) for all analyses. The ES group had a higher incidence of the primary outcome of favorable outcome at 6 months (ES 20/53 (37.7%) vs. OS 22/106 (20.8); propensity score matched relative-risk (RR; 95%CI): 1.74 (1.13-2.68); P=0.013). Sensitivity analysis showed the result was stable.

CONCLUSION

ES is a safe treatment for life-threatening large spontaneous supratentorial ICH patients and may achieve better outcomes than OS.