Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

Despite intense research on the outcomes of cardiogenic shock, it is still unclear how obesity affects the outcomes of patients with cardiogenic shock.

Research objectives

We aimed to compare mortality outcomes of patients with cardiogenic shock based on body mass index (BMI).

Research methods

A systematic search of the literature was conducted on the 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.

Research results

Five studies were eligible for inclusion. On pooled analysis of multivariable-adjusted ratios, we noted a statistically significantly reduced risk of mortality in overweight/obese vs normal patients with cardiogenic shock (three studies; OR = 0.92, 95%CI: 0.85-0.98, I2 = 85%). In meta-analysis, we also 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.

Research conclusions

Based on the current review, we found that 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.

Research perspectives

Given the scarce number of studies available, there is a need for further research on the impact of obesity on outcomes of cardiogenic shock. Future studies should be prospective with a large sample size and also assess the impact of mechanical circulatory support on the outcomes.