Systematic Reviews
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World J Clin Cases. Oct 26, 2022; 10(30): 10956-10966
Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.10956
Body mass index and outcomes of patients with cardiogenic shock: A systematic review and meta-analysis
Wen-Xia Tao, Guo-Ying Qian, Hong-Dan Li, Feng Su, Zhou Wang
Wen-Xia Tao, Guo-Ying Qian, Hong-Dan Li, Feng Su, Zhou Wang, Department of Cardiovascular Medicine, Huzhou Cent Hospital, Affiliated Cent Hospital Huzhou University, Huzhou 313000, Zhejiang Province, China
Author contributions: Tao WX conceived and designed the study; Qian GY, Li HD, and Su F were involved in literature search and data collection; Tao WX, Qian GY, and Li HD analyzed the data; Tao WX and Wang Z wrote the paper; Wang Z reviewed and edited the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors provided the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhou Wang, BPhty, Nurse, Department of Cardiovascular Medicine, Huzhou Cent Hospital, Affiliated Cent Hospital Huzhou University, No. 1558 Sanhuan North Road, Wuxing District, Huzhou 313000, Zhejiang Province, China. twx18703678@163.com
Received: May 5, 2022
Peer-review started: May 5, 2022
First decision: July 29, 2022
Revised: August 9, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: October 26, 2022
Processing time: 168 Days and 6.5 Hours
Abstract
BACKGROUND

Cardiogenic shock continues to be a highly morbid complication that affects around 7%-10% of patients with acute myocardial infarction or heart failure. Similarly, obesity has become a worldwide epidemic.

AIM

To analyze the impact of higher body mass index (BMI) on outcomes of patients with cardiogenic shock.

METHODS

A systematic and comprehensive search was undertaken on the electronic databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar for all types of studies comparing mortality outcomes of patients with cardiogenic shock based on BMI. All studies defined overweight or obese patients based on the World Health Organization BMI criteria. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).

RESULTS

Five studies were included. On pooled analysis of multivariable-adjusted ratios, we noted a statistically significantly reduced risk of mortality in overweight/ obese vs normal patients (three studies; odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.85-0.98, I2 = 85%). On meta-analysis, we noted that crude mortality rates did not significantly differ between overweight/obese and normal patients after cardiogenic shock (OR = 0.95, 95%CI: 0.79-1.15, I2 = 99%). The results were not stable on sensitivity analysis and were associated with substantial heterogeneity.

CONCLUSION

Current evidence on the association between overweight/obesity and mortality after cardiogenic shock is scarce and conflicting. The obesity paradox might exist in patients with cardiogenic shock but could be confounded by the use of mechanical circulatory support. There is a need for further studies to clarify this relationship.

Keywords: Obese; Overweight; Myocardial infarction; Shock; Mortality

Core Tip: Cardiogenic shock continues to be a highly morbid complication that affects around 7%-10% of patients and similarly, obesity is now prevalent around the globe. We reviewed data from five studies to assess the impact of obesity on outcomes of cardiogenic shock. Pooled analysis of adjusted data indicated that overweight/obese was associated with a reduced risk of mortality vs normal patients but the same relationship was not noted in the analysis of crude mortality rates. Thus, current evidence on the association between overweight/obesity and mortality after cardiogenic shock is scarce and conflicting and there is a need for further studies.