Obesity Paradox in Intracerebral Hemorrhage

Abstract

Background and Purpose— Although obesity is an established risk factor for cardiovascular disease and stroke, studies have shown evidence of an obesity paradox—a protective effect of obesity in patients who already have these disease states. Data on the obesity paradox in intracerebral hemorrhage is limited. Methods— Clinical data for adult intracerebral hemorrhage patients were extracted from the National Inpatient Sample between 2007 and 2014. Multivariable logistic regression analyzed the association of body habitus with in-hospital mortality, discharge disposition, length of stay, tracheostomy or gastrostomy placement, and ventriculoperitoneal shunt placement. Results— There were 99 212 patients who were eligible. Patients with both obesity (OR=0.69; 95% CI=0.62–0.76; P <0.001) and morbid obesity (OR=0.85; 95% CI=0.74–0.97; P =0.02) were associated with decreased odds of in-hospital mortality. Morbid obesity was significantly associated with increased odds of a tracheostomy or gastrostomy placement (OR=1.42; 1.20–1.69; P <0.001) and decreased odds of a routine discharge disposition (OR=0.84; 0.74–0.97; P =0.014). Conclusions— Obesity and morbid obesity appear to protect against mortality in intracerebral hemorrhage.