title: Influence of body mass index on the prognosis of patients successfully resuscitated from out-of-hospital cardiac arrest treated by therapeutic hypothermia.
abstract: Obesity prevalence has dramatically increased over recent years and is associated with cardiovascular diseases, but data are lacking on its prognostic impact in out-of-hospital cardiac arrest (OHCA) patients.
  
  
  
  Data of all consecutive OHCA patients admitted in two cardiac arrest centers from Paris and suburbs between 2005 and 2012 were prospectively collected. Patients treated by therapeutic hypothermia (TH) were included in the analysis. Logistic and Cox regression analyses were used to quantify the association between body mass index (BMI) at hospital admission and day-30 and 1-year mortality respectively.
  
  
  
  818 patients were included in the study (median age 60.9 [50.8-72.7] year, 70.2% male). Obese patients (BMI>30kgm-2) were older, more frequently male and evidenced more frequently cardiovascular risk factors than normally (18.5<BMI<25kgm-2) or overweight patients (25<BMI<30kgm-2). Post-resuscitation shock and therapeutic hypothermia failure were more frequent in obese patients. Overall mortality at day-30 and one-year was 63.8 and 67.2%, respectively. After multivariate adjustment, BMI>30kgm-2was independently associated with day-30 mortality (Odds ratio [OR] in comparison with normally weight patients 2.45; 95% confidence interval [95%CI: 1.32-4.56; p<0.01]). Obesity was not associated with one-year mortality (Hazard ratio [HR] 0.99, 95%CI 0.21,4.67; p=0.99) while underweight was associated with one-year mortality in this subgroup of patients (Hazard ratio [HR] 3.94, 95%CI 1.11,14.01; p=0.03).
  
  
  
  In the present study, obesity was independently associated with day-30 mortality in successfully resuscitated ICU TH OHCA patients. Further studies are needed to understand the mechanisms that underpin this finding.
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France; Paris Descartes University, France; Sudden Death Expertise Center, Paris Cardiovascular Research Centre, INSERM U970, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.affiliation: Intensive Care Unit, CH Versailles, Le Chesnay (78), France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Savary
authors.affiliation: Intensive Care Unit, CH Versailles, Le Chesnay (78), France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Legriel
authors.affiliation: Paris Descartes University, France; Sudden Death Expertise Center, Paris Cardiovascular Research Centre, INSERM U970, France; Emergency Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.affiliation: Intensive Care Unit, CH Versailles, Le Chesnay (78), France.
authors.forename: Sybille
authors.initials: S
authors.lastname: Merceron
authors.affiliation: Paris Descartes University, France; Cardiology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
authors.affiliation: Cardiology Department, CH Versailles, Le Chesnay (78), France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Livarek
authors.affiliation: Service d'Aide Médicale Urgente (SAMU 78) Department, CH Versailles, Le Chesnay (78), France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Richard
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France; Paris Descartes University, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.affiliation: Intensive Care Unit, CH Versailles, Le Chesnay (78), France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bedos
authors.affiliation: Sudden Death Expertise Center, Paris Cardiovascular Research Centre, INSERM U970, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Empana
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France; Paris Descartes University, France; Sudden Death Expertise Center, Paris Cardiovascular Research Centre, INSERM U970, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.affiliation: Intensive Care Unit, CH Versailles, Le Chesnay (78), France. Electronic address: david.grimaldi@erasme.ulb.ac.be.
authors.forename: David
authors.initials: D
authors.lastname: Grimaldi
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality*; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
keywords: Cardiac arrest; Obesity; Outcome; Overweight; Prognosis