Obesity paradox in subarachnoid hemorrhage : a systematic review

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Rautalin , I , Kaprio , J & Korja , M 2020 , ' Obesity paradox in subarachnoid hemorrhage : a systematic review ' , Neurosurgical Review , vol. 43 , no. 6 , pp. 1555-1563 . https://doi.org/10.1007/s10143-019-01182-5

Title: Obesity paradox in subarachnoid hemorrhage : a systematic review
Author: Rautalin, Ilari; Kaprio, Jaakko; Korja, Miikka
Contributor organization: Neurokirurgian yksikkö
HUS Neurocenter
University of Helsinki
Helsinki University Hospital Area
Department of Public Health
Institute for Molecular Medicine Finland
Genetic Epidemiology
Date: 2020-12
Language: eng
Number of pages: 9
Belongs to series: Neurosurgical Review
ISSN: 0344-5607
DOI: https://doi.org/10.1007/s10143-019-01182-5
URI: http://hdl.handle.net/10138/324009
Abstract: As the number of obese people is globally increasing, reports about the putative protective effect of obesity in life-threatening diseases, such as subarachnoid hemorrhage (SAH), are gaining more interest. This theory-the obesity paradox-is challenging to study, and the impact of obesity has remained unclear in survival of several critical illnesses, including SAH. Thus, we performed a systematic review to clarify the relation of obesity and SAH mortality. Our study protocol included systematic literature search in PubMed, Scopus, and Cochrane library databases, whereas risk-of-bias estimation and quality of each selected study were evaluated by the Critical Appraisal Skills Program and Cochrane Collaboration guidelines. A directional power analysis was performed to estimate sufficient sample size for significant results. From 176 reviewed studies, six fulfilled our eligibility criteria for qualitative analysis. One study found paradoxical effect (odds ratio, OR = 0.83 (0.74-0.92)) between morbid obesity (body mass index (BMI) > 40) and in-hospital SAH mortality, and another study found the effect between continuously increasing BMI and both short-term (OR = 0.90 (0.82-0.99)) and long-term SAH mortalities (OR = 0.92 (0.85-0.98)). However, according to our quality assessment, methodological shortcomings expose all reviewed studies to a high-risk-of-bias. Even though two studies suggest that obesity may protect SAH patients from death in the acute phase, all reviewed studies suffered from methodological shortcomings that have been typical in the research field of obesity paradox. Therefore, no definite conclusions could be drawn.
Subject: Obesity
Subarachnoid hemorrhage
Systematic review
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion

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