Impact of the obesity paradox on 28-day mortality in elderly patients critically ill with cardiogenic shock: a retrospective cohort study

Abstract

Abstract Background Previous studies have shown that the obesity paradox exists in cardiovascular disease (CVD), giving patients a survival advantage, but controversy remains as to whether it applies to patients with cardiogenic shock (CS), especially in the elderly. We therefore aimed to determine whether obesity affects 28-day prognosis in elderly patients with CS. Methods We used clinical data from the Medical Information Market in Critical Care IV (MIMIC-IV) database. Critical patients with CS were categorized into two groups based on age; age 30 kg/m2 was not a 28-day risk factor for death in elderly patients critically ill with CS (Overweight OR 1.28, P = 0.221; Obesity OR 1.15, P = 0.709; Severe obesity OR 1.46, P = 0.521; using normal weight as a reference). In contrast, underweight was a risk factor (OR 2.42, P = 0.039). Kaplan–Meier curves showed that in the older age group, 28-day survival was significantly higher in patients with BMI ≥ 30 kg/m2 compared to those with BMI < 30 kg/m2 [261 (66.75%) vs. 522 (60.35%), P = 0.024]. Conclusion Underweight affects the 28-day prognosis of critically ill elderly patients with CS. In contrast, overweight and or obesity do not appear to have a significant impact on the prognosis of these patients.

Keywords

• Body mass index
• Cardiogenic shock
• Critical care
• Mortality
• Obesity
• Prognosis