Obesity paradox seen in cardiogenic shock with overweight and obesity having the lowest, whereas cachexia has the highest mortality using the large Nationwide Inpatient Sample (NIS) database

IntroductionThe obesity paradox has been observed in patients with cardiovascular disease. The goal of this study was to evaluate if obesity has a protective effect in patients presenting with cardiogenic shock. MethodUsing a large Nationwide Inpatient sample (NIS) database, we evaluated mortality in patients with cardiogenic shock based on weight categories in adults. ResultsA total of 843,020 patients had a diagnosis of cardiogenic shock in the database over age 18. We found that overweight and obesity had the lowest mortality using univariate or multivariate analysis (overweight mortality of 20.66% vs obesity mortality of 26.6 % vs 34,3% of normal weights). In contrast, cachexia was associated with the highest mortality in univariate analysis (cachexia 40.4%). Using multivariate analysis adjusting for baseline characteristics and comorbidities, these relations remained unchanged (cachexia MVOR; 1.13, CI: 1.21-1.13, p <0.001, overweight MVOR: 0.52, CI; 0.43-0.65, p<0.001, obesity MVOR: 0.76, CI: 0.73-0.79, p<0.001). After multivariate adjustment, morbid obesity had similar mortality to patients with normal weight (morbid obesity MVOR: 0.99, CI 0.95-01.03, p=0.6) ConclusionWe observe a partial obesity paradox in patients with cardiogenic shock, showing that overweight followed by obesity has the lowest mortality whereas cachexia has the highest mortality despite multivariate adjustment.