Body mass index and outcomes of patients with cardiogenic shock: A systematic review and meta-analysis

Table 1 Details of included studies

Ref.	Location	Type	Primary diagnosis	Groups	Definition as per BMI (kg/m2)	Sample size	Age (yr)	Male gender (%)	Smokers (%)	DM (%)	HTN (%)	CKD (%)	DL (%)	PCI (%)	CABG (%)	MCS (%)	Follow-up
Sreenivasan et al[16], 2021	United States	R	AMI or HF	Severe obesity	> 40	8782	59.9	52.3	NR	64.4	72.2	41.3	NR	53.2	25.8	100	30-d
				Moderate obesity	35-39.9	6862	60.9	68.9		66	77.6	38.4		47.1	31	100
				Mild obesity	30-34.9	10880	62.9	71.2		59.1	75.4	33.1		54.4	32.2	100
				Normal	20-29.9	7111	65.9	71.6		45.4	65.5	39.8		47	27.5	100
				Underweight	< 19.9	1920	65.6	67.9		30.9	54	30.9		37.3	14.7	100
Patlolla et al[17], 2021	United States	R	AMI	Overweight/Obese	> 24.9	46675	63.8	60.3	NR	NR	NR	NR	NR	53.6	24.9	49	In-hospital
				Normal	19.9-24.9	290333	69	64.5						53.6	16.3	45.7
				Underweight	< 19.9	2356	73.7	49.4						39.8	12.2	27.8
Hermansen et al[18], 2021	Denmark	R	AMI	Moderate/Severe	≥ 35	42	63	69	68	43	75	NR	55	100	0	17	30-d
				Obesity	30-34.9	131	64	80	82	21	54		34	100	0	15
				Mild obesity	25-29.9	391	65.2	82	79	21	55		33	100	0	21
				Overweight	< 25	453	66.1	75	74	13	42		29	100	0	16
Hashmi et al[19], 2018	Pakistan	P	AMI	Obese	≥ 30	137	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	In-hospital
				Normal	< 30	214
Chatterjee et al[20], 2017	United States	R	AMI	Obese	≥ 30	25835	63.1	58.2	34.3	45.2	68.8	23.5	54.8	50.9	19.6	NR	In-hospital
				Normal	< 30	265059	69.4	62.3	24	24.4	50.6	18.9	33.8	47.9	13.6

AMI: Acute myocardial infarction; HF: Heart failure; BMI: Body mass index; DM: Diabetes mellitus; HTN: Hypertension; CKD: Chronic kidney disease; DL: Dyslipidemia; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass grafting; MCS: Mechanical circulatory support; NR: Not reported; R: Retrospective; P: Prospective.

Table 2 Sensitivity analysis for mortality rates

Excluded study	Odds ratio
Adjusted mortality rates
Sreenivasan et al[16], 2021	0.89 95%CI: 0.87, 0.91 I2 = 0%
Patlolla et al[17], 2021	1.15 95%CI: 0.67, 2.00 I2 = 93%
Chatterjee et al[20], 2017	1.15 95%CI: 0.67, 2.00 I2 = 93%
Crude mortality rates
Sreenivasan et al[16], 2021	0.79 95%CI: 0.70, 0.89 I2 = 95%
Patlolla et al[17], 2021	1.12 95%CI: 0.76, 1.67 I2 = 99%
Hermansen et al[18], 2021	0.98 95%CI: 0.80, 1.20 I2 = 99%
Hashmi et al[19], 2018	0.83 95%CI: 0.69, 1.00 I2 = 99%
Chatterjee et al[20], 2017	1.13 95%CI: 0.80, 1.60 I2 = 99%

Table 3 Subgroup analysis of mortality reported by included studies

Ref.	Subgroups	Result
Sreenivasan et al[16], 2021	Acute MI only	Significantly higher mortality in severely obese patients as compared to normal patients
	Acute HF only	Significantly higher mortality in severely obese patients as compared to normal patients
	Age < 60 years	Significantly higher mortality in severely obese patients as compared to normal patients
	Age ≥ 60 years	Significantly higher mortality in severely obese patients as compared to normal patients
Chatterjee et al[20], 2017	ST-elevated MI	No statistically significant difference in mortality between obese and normal patients
	Non-ST elevated MI	Significantly lower morality in obese as compared to normal patients
	Revascularization group	Significantly lower morality in obese as compared to normal patients
	Non-revascularization group	No statistically significant difference in mortality between obese and normal patients

MI: Myocardial infarction; HF: Heart failure.

Table 4 Risk of bias analysis based on Newcastle-Ottawa scale

Ref.	Selection				Comparability	Outcome			Total
	Representativeness of the exposed cohort	Selection of the non exposed cohort	Ascertainment of exposure	Demonstration that outcome of interest	Basis of the design or analysis	Assessment of outcome	Follow-up long enough for outcomes	Adequate follow up
Sreenivasan et al[16], 2021	1	1	1	1	2	1	0	0	7
Patlolla et al[17], 2021	1	1	1	1	2	1	0	0	7
Hermansen et al[18], 2021	1	1	1	1	0	1	0	0	5
Hashmi et al[19], 2018	1	1	1	1	2	1	0	0	7
Chatterjee et al[20], 2017	1	1	1	1	2	1	0	0	7