No Impact of Body Mass Index on Outcome in Stroke Patients Treated with IV Thrombolysis BMI and IV Thrombolysis Outcome.

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Version: Final published version
Serval ID
serval:BIB_E359D0E7BBE0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
No Impact of Body Mass Index on Outcome in Stroke Patients Treated with IV Thrombolysis BMI and IV Thrombolysis Outcome.
Journal
PloS one
Author(s)
Branscheidt M., Schneider J., Michel P., Eskioglou E., Kaegi G., Stark R., Fischer U., Jung S., Arnold M., Wertli M., Held U., Wegener S., Luft A., Sarikaya H.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
11
Number
10
Pages
e0164413
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Observational Study
Publication Status: epublish
Abstract
The 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.
In 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.
Among 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.
BMI 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.

Keywords
Aged, Aged, 80 and over, Body Mass Index, Body Weight, Female, Fibrinolytic Agents/therapeutic use, Humans, Intracranial Hemorrhages/etiology, Male, Middle Aged, Multivariate Analysis, Obesity/complications, Odds Ratio, Prognosis, Prospective Studies, Risk Factors, Stroke/drug therapy, Stroke/mortality, Stroke/pathology, Survival Analysis, Thrombolytic Therapy, Tissue Plasminogen Activator/therapeutic use
Pubmed
Open Access
Yes
Create date
19/10/2016 11:38
Last modification date
20/08/2019 16:07
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