So you described something, when the fuck are you going to do the research that will still get these people 100% recovered? Or are you incompetent in that also?
Association Between Body Mass Index and Functional Outcomes in Patients With Intracerebral Hemorrhage
Abstract
Background and Objectives
Evidence
of the so-called “obesity paradox,” which refers to the protective
effect and survival benefit of obesity in patients with spontaneous
intracerebral hemorrhage (ICH), remains controversial. This study aims
to determine the association between body mass index (BMI) and
functional outcomes in patients with ICH and whether it is modified by
race/ethnicity.
Methods
Included
individuals were derived from the Ethnic/Racial Variations of
Intracerebral Hemorrhage study, which prospectively recruited 1,000
non-Hispanic White, 1,000 non-Hispanic Black, and 1,000 Hispanic
patients with spontaneous ICH. Only patients with available BMI were
included. The primary outcome was 90-day mortality. Secondary outcomes
were mortality at discharge, modified Rankin Scale (mRS), Barthel Index,
and self-reported health status measures at 90 days. Associations
between BMI and ICH outcomes were assessed using univariable and
multivariable logistic, ordinal, and linear regression models, as
appropriate. Sensitivity analyses after excluding frail patients and by
patient race/ethnicity were performed.
Results
A
total of 2,841 patients with ICH were included. The median age was 60
years (interquartile range 51–73). Most patients were overweight (n =
943; 33.2%) or obese (n = 1,032; 36.3%). After adjusting for covariates,
90-day mortality was significantly lower among overweight and obese
patients than their normal weight counterparts (adjusted odds ratio
[aOR] = 0.71 [0.52–0.98] and aOR = 0.70 [0.50–0.97], respectively).
Compared with patients with BMI <25 kg/m2, those with BMI ≥25 kg/m2
had better 90-day mRS (aOR = 0.80 [CI 0.67–0.95]), EuroQoL Group
5-Dimension (EQ-5D) (aβ = 0.05 [0.01–0.08]), and EQ-5D VAS (aβ = 3.80
[0.80–6.98]) scores. These differences persisted after excluding
withdrawal of care patients. There was an inverse relationship between
BMI and 90-day mortality (aOR = 0.97 [0.96–0.99]). Although non-Hispanic
White patients had significantly higher 90-day mortality than
non-Hispanic Black and Hispanic (26.6% vs 19.5% vs 18.0%, respectively; p
< 0.001), no significant interactions were found between BMI and
race/ethnicity. No significant interactions between BMI and age or sex
for 90-day mortality were found, whereas for 90-day mRS, there was a
significant interaction with age (pinteraction = 0.004).
Conclusion
We
demonstrated that a higher BMI is associated with decreased mortality,
improved functional outcomes(NOT GOOD ENOUGH! Survivors want 100% recovery! GET THERE!), and better self-reported health status at
90 days, thus supporting the paradoxical role of obesity in patients
with ICH. The beneficial effect of high BMI does not seem to be modified
by race/ethnicity or sex, whereas age may play a significant role in
patient functional outcomes.
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