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.
Highlights
Stroke and obesity are both characterized by increasing incidence worldwide, causing huge socio-economic costs [1]
Using uni- and multivariate modeling, we assessed the relationship of body mass index (BMI) with favorable outcome and mortality 3 months after stroke as well as the occurrence of symptomatic intracerebral hemorrhages
BMI was not related to clinical outcomes in stroke patients treated with intravenous thrombolysis (IVT)
Summary
Stroke and obesity are both characterized by increasing incidence worldwide, causing huge socio-economic costs [1]. Many studies suggest survival benefit and better clinical outcome in obese stroke patients as compared to their normal weight counterparts [2,3,4] This observation has already been described in many other conditions such as heart failure, and is termed as “obesity paradox” [4]. The relationship between obesity and stroke outcome after intravenous thrombolysis (IVT) is less clear due to scarce number of studies with small sample size and contradictory results. This issue is of clinical relevance, as obesity especially affects younger people with increase of stroke risk and higher probability for IVT. We aimed to assess the relationship between body weight and stroke outcome after IV thrombolysis in a large cohort study
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