Introduction: Obesity is a known risk factor for cardiovascular disease and stroke. However, an obesity paradox - improved outcomes in obese patients, has been reported in coronary artery disease, cardiac surgery and ischemic stroke. We report a possible obesity paradox in patients with intracerebral hemorrhage (ICH).
Methods: We retrospectively reviewed our prospectively collected database of patients diagnosed with ICH in our institution between November 2012 and March 2016. Trauma, malignancy, postoperative, vascular malformations associated hemorrhages and hemorrhagic conversion of ischemic strokes were excluded. Demographics, clinical, laboratory and imaging characteristics were collected. We defined obesity as body mass index (BMI) >30kg/m2; overweight 25-29.9kg/m2; normal weight 18.5-24.9kg/m2 and underweight <18.5kg/m2. Poor outcome was defined by hematoma expansion >30% increase in ICH volume or discharge to nursing home, long-term acute facility or death (‘poor-discharge’). Continuous variables were analyzed using an analysis of variance and a fisher exact test or chi-square test for categorical variables. A p value <0.05 was set for significance.
Results: 429 patients met criteria for our study. 50.1% were female, median age 64 years (SD 15.6) and BMI 27.4 (SD 7.9). There were 16 (3.7%) underweight; 131 (30.8%) normal weight; 138 (32.2%) overweight and 144 (33.6%) obese patients. Bivariate analysis across groups showed female gender (75% vs 56.5% vs 57% vs 50% p=0.015), diabetes mellitus (13.3% vs 20.6% vs 32.1% vs 33.3% p=0.041), systolic pressure (SBP) (177.5 vs 168 vs 175 vs 185 p=0.003), HbA1c (5.7 vs 5.9 vs 6.2 vs 6.5 p=0.0002), discharge poor outcome (43.8% vs 54.2% vs 55.8% vs 36.8% p=0.005) were significant. There was no difference in ICH volume and hematoma expansion. On multivariate analysis, only age (OR 1.02, CI 1.01 - 1.04 p=0.0004) SBP ≥ 140mmhg (OR 0.49, CI0.25 - 0.95, p=0.035) Admission glucose ≥180 (OR 2.71, CI 1.58 - 4.4.67 p=0.0003) and BMI >30kg/m2 (OR 0.5, CI 0.29 - 0.87 p= 0.014) remained independent predictors of poor outcome.
Conclusion: In our cohort, obese patients were more likely to have a good outcome suggesting the presence of an obesity paradox in outcome following intracerebral hemorrhage.