No Impact of Body Mass Index on Outcome in Stroke Patients Treated with IV Thrombolysis BMI and IV Thrombolysis Outcome

Abstract

Background and PurposeThe impact of excess body weight on prognosis after stroke is controversial. Many studies report higher survival rates in obese patients (“obesity paradox”). Recently, obesity has been linked to worse outcomes after intravenous (IV) thrombolysis, but the number and sample size of these studies were small. Here, we aimed to assess the relationship between body weight and stroke outcome after IV thrombolysis in a large cohort study.MethodsIn a prospective observational multicenter study, we analyzed baseline and outcome data of 896 ischemic stroke patients who underwent IV thrombolysis. Patients were categorized according to body mass index (BMI) as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2) or severely obese (>35 kg/m2). Using uni- and multivariate modeling, we assessed the relationship of BMI with favorable outcome (defined as modified Rankin Scale 0 or 1) and mortality 3 months after stroke as well as the occurrence of symptomatic intracerebral hemorrhages (sICH). We also measured the incidence of patients that had an early neurological improvement of >40% on the National Institutes of Health Stroke Scale (NIHSS) after 24 hours.ResultsAmong 896 patients, 321 were normal weight (35.8%), 22 underweight (2.5%), 378 overweight (42.2%), 123 obese (13.7%) and 52 severely obese (5.8%). Three-month mortality was comparable in obese vs. non-obese patients (8.1% vs. 8.3%) and did not differ significantly among different BMI groups. This was also true for favorable clinical outcome, risk of sICH and early neurological improvement on NIHSS at 24 hours. These results remained unchanged after adjusting for potential confounding factors in the multivariate analyses.ConclusionBMI was not related to clinical outcomes in stroke patients treated with IVT. Our data suggest that the current weight-adapted dosage scheme of IV alteplase is appropriate for different body weight groups, and challenge the existence of the obesity paradox after stroke.

<p>Metabolic Syndrome Predicts Poor Outcome in Acute Ischemic Stroke Patients After Endovascular Thrombectomy</p>

“…A post hoc analysis of the MR CLEAN trial demonstrated that a shift toward a better functional outcome with higher body mass index, and mortality was inversely related to body mass index; 25 while some other studies showed no significant favorable effect, or negative effect of obesity on outcome after recanalization treatment. 26 , 27 Similarly, our present study did not find a significant association between increased waist circumference and clinical outcomes after EVT. This discrepancy might be due to the differences in study populations and study methods, especially in the definition of obesity.…”

Prior Stroke in PFO Patients Is Associated With Both PFO-Related and -Unrelated Factors

“…Several observational studies point to a lower rate of stroke recurrence in overweight or obese patients (41)(42)(43)(44). However, recent studies in stroke patients receiving intravenous thrombolysis or patients with mild symptoms did not detect this relationship, thus challenging the "obesity paradox" (45,46). Obesity was more common among patients with multiple CS and PFO in a single study, though the recurrence risk was not independently associated with BMI (18).…”

Body mass index is a risk factor for hemorrhagic transformation in older ischemic stroke patients after intravenous thrombolysis: a single center retrospective study

“…Moreover, Diedler J et al reported that the risk of sICH significantly increased in patients weighing > 100 kg who accepted intravenous r-tPA thrombolysis compared to those weighing ≤ 100 kg [13]. However, a meta-analysis across three studies in Europe reported that obesity (BMI ≥ 30 kg/m 2 vs. BMI < 30 kg/m 2 ) was not related to sICH risk with 3-month follow-up [8,9], while others found inverse associations that may be related to obese patients receiving an intravenous r-tPA dose < 0.9 mg/kg [11]. These seemingly discrepant observations might be explained by differences in race, length of follow-up, sample size, or definition and subtype of HT.…”

“…BMI was calculated as weight in kilograms divided by height squared in meters. Body weight and height were measured by nurses or obtained from the patient or relatives or -if not available -from estimates made by the attending stroke physician [8][9][10].…”

“…However, the relationship between BMI and the risk of HT remains unclear. Some studies showed no associations between BMI and the risk of HT [8][9][10]. while others found inverse associations [11] or positive associations between body weight and HT in ischemic stroke with thrombolysis [12,13].…”