The Effect of Morbid Obesity on Subarachnoid Hemorrhage Prognosis in the United States

Elliott, Ross-Jordon; Godoy, Daniel Agustín; Michalek, Joel E.; Behrouz, Réza; Elsehety, Marwah A.; Hafeez, Shaheryar; Rios, Denise; Seifi, Ali

doi:10.1016/j.wneu.2017.06.068

Cited by 12 publications

(29 citation statements)

References 37 publications

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“…The search yielded 175 articles, and 1 article [36] was found through reference list screening of the 175 articles. Of the 176 publications, 5 [8,11,18,36,46] fulfilled the eligibility criteria. Additionally, one study [27] outside of our literature search fulfilled the criteria and thus was added to further qualitative analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Study characteristics varied considerably (Table 1). Three studies [27,36,46] recruited cohorts and measured BMI values years before SAHs, whereas three [8,11,18] were based on hospital admission registers with BMI values measured upon admission.…”

Section: Resultsmentioning

confidence: 99%

“…In another study based on the NIS, Elliott et al [11] determined the impact of morbid obesity (BMI ≥ 40) on non-traumatic SAH outcomes. In-hospital mortality analyses were based on 224,561 (40% male; mean age 59 years) SAH patients diagnosed between years 2008 and 2013.…”

Section: Studymentioning

confidence: 99%

“…Additionally, in hospital-based studies (reference mortality 25%), the minimum cohort sizes were 1094, 466, and 250, respectively. Based on these criteria, only two [8,11] of the six studies consisted of an adequate sample size to reach sufficient statistical power (Table 2).…”

Section: Studymentioning

confidence: 99%

“…However, contrary to Lindbohm et al [27], no separate association analyses for outside hospital deaths were performed. Three [8,11,18] studies, all conducted in the USA, started the follow-up from hospital admission. All these studies assessed in-hospital mortality rates and associations, but one study also included deaths until 30 days post-discharge.…”

Section: Studymentioning

confidence: 99%

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Obesity paradox in subarachnoid hemorrhage: a systematic review

2019

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As the number of obese people is globally increasing, reports about the putative protective effect of obesity in life-threatening diseases, such as subarachnoid hemorrhage (SAH), are gaining more interest. This theory-the obesity paradox-is challenging to study, and the impact of obesity has remained unclear in survival of several critical illnesses, including SAH. Thus, we performed a systematic review to clarify the relation of obesity and SAH mortality. Our study protocol included systematic literature search in PubMed, Scopus, and Cochrane library databases, whereas risk-of-bias estimation and quality of each selected study were evaluated by the Critical Appraisal Skills Program and Cochrane Collaboration guidelines. A directional power analysis was performed to estimate sufficient sample size for significant results. From 176 reviewed studies, six fulfilled our eligibility criteria for qualitative analysis. One study found paradoxical effect (odds ratio, OR = 0.83 (0.74-0.92)) between morbid obesity (body mass index (BMI) > 40) and in-hospital SAH mortality, and another study found the effect between continuously increasing BMI and both short-term (OR = 0.90 (0.82-0.99)) and long-term SAH mortalities (OR = 0.92 (0.85-0.98)). However, according to our quality assessment, methodological shortcomings expose all reviewed studies to a high-risk-of-bias. Even though two studies suggest that obesity may protect SAH patients from death in the acute phase, all reviewed studies suffered from methodological shortcomings that have been typical in the research field of obesity paradox. Therefore, no definite conclusions could be drawn.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Studymentioning

confidence: 99%

Section: Studymentioning

confidence: 99%

Section: Studymentioning

confidence: 99%

See 3 more Smart Citations

Obesity paradox in subarachnoid hemorrhage: a systematic review

2019

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Machine learning prediction of the adverse outcome for nontraumatic subarachnoid hemorrhage patients

Williams

Aguilar

et al. 2020

Ann Clin Transl Neurol

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Objective: Subarachnoid hemorrhage (SAH) is often devastating with increased early mortality, particularly in those with presumed delayed cerebral ischemia (DCI). The ability to accurately predict survival for SAH patients during the hospital course would provide valuable information for healthcare providers, patients, and families. This study aims to utilize electronic health record (EHR) data and machine learning approaches to predict the adverse outcome for nontraumatic SAH adult patients. Methods: The cohort included nontraumatic SAH patients treated with vasopressors for presumed DCI from a large EHR database, the Cerner Health Facts â EMR database (2000-2014). The outcome of interest was the adverse outcome, defined as death in hospital or discharged to hospice. Machine learning-based models were developed and primarily assessed by area under the receiver operating characteristic curve (AUC). Results: A total of 2467 nontraumatic SAH patients (64% female; median age [interquartile range]: 56 [47-66]) who were treated with vasopressors for presumed DCI were included in the study. 934 (38%) patients died or were discharged to hospice. The model achieved an AUC of 0.88 (95% CI, 0.84-0.92) with only the initial 24 h EHR data, and 0.94 (95% CI, 0.92-0.96) after the next 24 h. Interpretation: EHR data and machine learning models can accurately predict the risk of the adverse outcome for critically ill nontraumatic SAH patients. It is possible to use EHR data and machine learning techniques to help with clinical decision-making.

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Body mass index and leptin levels in serum and cerebrospinal fluid in relation to delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

et al. 2021

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Aneurysmal subarachnoid hemorrhage (SAH) is associated with a high mortality rate and may leave surviving patients severely disabled. After the initial hemorrhage, clinical outcome is further compromised by the occurrence of delayed cerebral ischemia (DCI). Overweight and obesity have previously been associated with protective effects in the post-bleeding phase. The aim of this study was to assess the effects of a patient’s body mass index (BMI) and leptin levels on the occurrence of DCI, DCI-related cerebral infarction, and clinical outcome. In total, 263 SAH patients were included of which leptin levels were assessed in 24 cases. BMI was recorded along disease severity documented by the Hunt and Hess and modified Fisher scales. The occurrence of clinical or functional DCI (neuromonitoring, CT Perfusion) was assessed. Long-term clinical outcome was documented after 12 months (extended Glasgow outcome scale). A total of 136 (51.7%) patients developed DCI of which 72 (27.4%) developed DCI-related cerebral infarctions. No association between BMI and DCI occurrence (P = .410) or better clinical outcome (P = .643) was identified. Early leptin concentration in serum (P = .258) and CSF (P = .159) showed no predictive value in identifying patients at risk of unfavorable outcomes. However, a significant increase of leptin levels in CSF occurred from 326.0 pg/ml IQR 171.9 prior to DCI development to 579.2 pg/ml IQR 211.9 during ongoing DCI (P = .049). In our data, no association between obesity and clinical outcome was detected. After DCI development, leptin levels in CSF increased either by an upsurge of active transport or disruption of the blood-CSF barrier. This trial has been registered at ClinicalTrials.gov (NCT02142166) as part of a larger-scale prospective data collection. BioSAB: https://clinicaltrials.gov/ct2/show/NCT02142166

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The Effect of Morbid Obesity on Subarachnoid Hemorrhage Prognosis in the United States

Cited by 12 publications

References 37 publications

Obesity paradox in subarachnoid hemorrhage: a systematic review

Obesity paradox in subarachnoid hemorrhage: a systematic review

Machine learning prediction of the adverse outcome for nontraumatic subarachnoid hemorrhage patients

Body mass index and leptin levels in serum and cerebrospinal fluid in relation to delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

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