J. Pharm. Pharmacogn. Res., vol. 14, no. 4, Article ID 2858, Jul-Aug 2026.
DOI: https://doi.org/10.56499/jppres_14.4.2858
Original Article
Association of body mass index with complications and outcomes among intensive care unit stroke patients
[Asociación del índice de masa corporal con desenlaces en pacientes con ictus en cuidados intensivos]
Retnaningsih Retnaningsih, Widhy A. Wardhani, Dodik T. Pramukarso*
Neurology Department, Faculty of Medicine, Diponegoro University, Prof. Mr. Sunario Street, Tembalang, Semarang 50275, Indonesia.
*E-mail: dodiktugasworo@lecturer.undip.ac.id, dodiktugasworo152314@gmail.com
Abstract
Context: Obesity is a recognized risk factor for stroke, but its association with complications and outcomes among critically ill stroke patients remains uncertain.
Aims: To evaluate the association between obesity and clinical characteristics, vascular risk factors, intensive care unit complications, and survival among stroke patients.
Methods: A retrospective cohort study was conducted using medical records of 101 patients with computed tomography-confirmed ischemic or hemorrhagic stroke admitted to the intensive care unit of Dr. Kariadi General Hospital, Semarang, from January 2022 to December 2023. Obesity was defined as body mass index ≥30 kg/m². Demographic characteristics, stroke type, vascular risk factors, comorbidities, stroke severity, albumin level, length of stay, infectious complications, and survival status were analyzed. Associations were assessed using appropriate statistical tests. Adjusted regression models were not performed because of extreme mortality imbalance.
Results: Obesity was identified in 58 patients. Obesity was more frequent among male patients and patients with ischemic stroke, diabetes mellitus, and dyslipidemia. No significant unadjusted association was observed between obesity and stroke severity, albumin level, length of stay, pneumonia, urinary tract infection, sepsis, septic shock, or survival.
Conclusions: Obesity was associated with a higher burden of metabolic risk factors but was not significantly associated with intensive care unit complications or survival. Because only unadjusted analyses were performed, these findings should be interpreted as exploratory.
Keywords: critical care; intensive care units; nutritional status; obesity paradox; treatment outcome.
Resumen
Contexto: La obesidad es un factor de riesgo para el ictus, pero su asociación con las complicaciones en cuidados intensivos sigue siendo incierta.
Objetivos: Evaluar la asociación entre la obesidad y las características clínicas, complicaciones en cuidados intensivos y supervivencia en pacientes con ictus.
Métodos: Estudio de cohorte retrospectivo con 101 pacientes con ictus isquémico o hemorrágico ingresados en cuidados intensivos del Hospital Dr. Kariadi, Semarang (2022-2023). La obesidad se definió como índice de masa corporal ≥30 kg/m². Se analizaron características, comorbilidades, complicaciones infecciosas y supervivencia. No se realizaron modelos ajustados debido al desequilibrio en la mortalidad.
Resultados: Se identificó obesidad en 58 pacientes, siendo más frecuente en hombres y en casos con ictus isquémico, diabetes y dislipidemia. No se observó asociación no ajustada significativa entre obesidad y gravedad del ictus, neumonía, sepsis o supervivencia.
Conclusiones: La obesidad se asoció con mayor riesgo metabólico, pero no con complicaciones o supervivencia en cuidados intensivos. Al ser análisis no ajustados, los hallazgos son exploratorios.
Palabras Clave: cuidados críticos; estado nutricional; obesidad paradójica; resultado del tratamiento; unidades de cuidados intensivos.
Citation Format: Retnaningsih R, Wardhani WA, Pramukarso DT (2026) Association of body mass index with complications and outcomes among intensive care unit stroke patients. J Pharm Pharmacogn Res 14(4): 2858. https://doi.org/10.56499/jppres_14.4.2858
References
Boehme AK, Esenwa C, Elkind MSV (2017) Stroke risk factors, genetics, and prevention. Circ Res 120(3): 472–495. https://doi.org/10.1161/CIRCRESAHA.116.308398
Caleyachetty R, Thomas GN, Toulis KA, Mohammed N, Gokhale KM, Balachandran K, Nirantharakumar K (2017) Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women. J Am Coll Cardiol 70(12): 1429–1437. https://doi.org/10.1016/j.jacc.2017.07.763
Coupland AP, Thapar A, Qureshi MI, Jenkins H, Davies AH (2017) The definition of stroke. J R Soc Med 110(1): 9–12. https://doi.org/10.1177/0141076816680121
Gao L, Liu JJ, Fan QC, Ling LT, Ding HB (2023) Association of obesity and mortality in sepsis patients: A meta-analysis from observational evidence. Heliyon 9(9): e19556. https://doi.org/10.1016/j.heliyon.2023.e19556
Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36(5): 309–332. https://doi.org/10.1016/j.ajic.2008.03.002
Horn JW, Feng T, Mørkedal B, Strand LB, Horn J, Mukamal K, Janszky I (2021) Obesity and risk for first ischemic stroke depends on metabolic syndrome: The HUNT study. Stroke 52(11): 3555–3561. https://doi.org/10.1161/STROKEAHA.120.033016
Horwich TB, Fonarow GC, Clark AL (2018) Obesity and the obesity paradox in heart failure. Prog Cardiovasc Dis 61(2): 151–156. https://doi.org/10.1016/j.pcad.2018.05.005
Hu G, Tuomilehto J, Silventoinen K, Sarti C, Männistö S, Jousilahti P (2007) Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke. Arch Intern Med 167(13): 1420–1427. https://doi.org/10.1001/archinte.167.13.1420
Isaman DJM, Herman WH, Ye W (2021) Prediction of transient ischemic attack and minor stroke in people with type 2 diabetes mellitus. J Diabetes Complications 35(7): 107911. https://doi.org/10.1016/j.jdiacomp.2021.107911
Lau LH, Lew J, Borschmann K, Thijs V, Ekinci EI (2019) Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review. J Diabetes Investig 10(3): 780–792. https://doi.org/10.1111/jdi.12932
Li S, Fu Z, Zhang W, Liu H (2024) Impact of obesity on intensive care unit outcomes in older patients with critical illness: A cohort study. PLoS One 19(2): e0297635. https://doi.org/10.1371/journal.pone.0297635
Nauli AM, Matin S (2019) Why do men accumulate abdominal visceral fat? Front Physiol 10: 1486. https://doi.org/10.3389/fphys.2019.01486
Ovbiagele B, Goldstein LB, Higashida RT, Howard VJ, Johnston SC, Khavjou OA, Lackland DT, Lichtman JH, Mohl S, Sacco RL, Saver JL, Turgiss D (2013) Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association. Stroke 44(8): 2361–2375. https://doi.org/10.1161/STR.0b013e31829734f2
Quiñones-Ossa GA, Lobo C, Garcia-Ballestas E, Florez WA, Moscote-Salazar LR, Agrawal A (2021) Obesity and stroke: Does the paradox apply for stroke? Neurointervention 16(1): 9–19. https://doi.org/10.5469/neuroint.2020.00108
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 315(8): 801–810. https://doi.org/10.1001/jama.2016.0287
Song DK, Hong YS, Sung YA, Lee H (2022) Body mass index and stroke risk among patients with diabetes mellitus in Korea. PLoS One 17(9): e0275393. https://doi.org/10.1371/journal.pone.0275393
Towfighi A, Ovbiagele B (2009) The impact of body mass index on mortality after stroke. Stroke 40(8): 2704–2708. https://doi.org/10.1161/STROKEAHA.109.550228
Vemmos K, Ntaios G, Spengos K, Savvari P, Vemmou A, Pappa T, Manios E, Georgiopoulos G, Alevizaki M (2011) Association between obesity and mortality after acute first-ever stroke: The obesity-stroke paradox. Stroke 42(1): 30–36. https://doi.org/10.1161/STROKEAHA.110.593434
WHO Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363(9403): 157–163. https://doi.org/10.1016/S0140-6736(03)15268-3
Winter Y, Rohrmann S, Linseisen J, Lanczik O, Ringleb PA, Hebebrand J, Back T (2008) Contribution of obesity and abdominal fat mass to risk of stroke and transient ischemic attacks. Stroke 39(12): 3145–3151. https://doi.org/10.1161/STROKEAHA.108.523001
Yatsuya H, Yamagishi K, North KE, Brancati FL, Stevens J, Folsom AR (2010) Associations of obesity measures with subtypes of ischemic stroke in the ARIC Study. J Epidemiol 20(5): 347–354. https://doi.org/10.2188/jea.JE20090186
Zainuddin AA, Kadir RRA, Kuswanto H, Tammasse J, Qalby N, Abdullah AA, Junaidi AA, Asyary A (2025) The major risk factor of stroke across Indonesia; a nationwide geospatial analysis of universal health coverage program. Arch Public Health 83: 169. https://doi.org/10.1186/s13690-025-01613-4
Zhou D, Li Z, Shi G, Zhou J (2020) Obesity paradox for critically ill patients may be modified by age: A retrospective observational study from one large database. Crit Care 24: 425. https://doi.org/10.1186/s13054-020-03157-1
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