Joint effects of severe obesity and inflammation on mortality in critically ill non-ST-segment elevation myocardial infarction patients: a cohort study with external validation.

Authors

Yuqing Li, Yuhang Wang, Pengju Lu, Jiaxin Wang, Weiwei Tian, Ran Chu, Jingxi Chen, Lai Jiang, Changping Li, Yin Liu, Jing Gao

Published in

Frontiers in endocrinology. Volume 17. Pages 1850802. Epub Jun 24, 2026.

Abstract

To investigate the association between body mass index (BMI) and both in-hospital and 10-year all-cause mortality in critically ill non-ST-segment elevation myocardial infarction (NSTEMI) patients, and to evaluate the incremental value of C-reactive protein (CRP) in risk stratification.
This multinational study included 7,815 critically ill NSTEMI patients from three cohorts. We first analyzed an original discovery cohort (TAMI, n = 5,010) from a Chinese tertiary hospital, then externally validated the findings in two independent US cohorts (MIMIC-IV, n = 1,208; eICU-CRD, n = 1,597). BMI was categorized according to WHO criteria, and CRP was dichotomized at 2 mg/L. Multivariable Cox regression and restricted cubic splines were used to assess mortality risks.
In the TAMI cohort, severe obesity (BMI ≥ 35 kg/m²) was independently associated with increased risks of in-hospital (HR 1.69; 95% CI: 1.08-2.65; p = 0.022) and 10-year (HR 1.68; 95% CI: 1.31-2.15; p < 0.001) all-cause mortality. Overweight and obesity I were associated with lower mortality risk compared with normal weight. The absolute in-hospital mortality rate was 8.36% in the severe obesity group, compared with 1.55% in the overweight group. The coexistence of severe obesity and elevated CRP (≥ 2 mg/L) identified a high-risk clinical profile, with no significant interaction between these two factors for either outcome (p for interaction = 0.178 for in-hospital and 0.169 for 10-year all-cause mortality). Adding CRP to the base model (Model 3) significantly improved risk prediction, with an increase in AUC from 0.764 to 0.768 (p = 0.021) and significant improvements in reclassification and discrimination metrics (all p < 0.05). The pooled meta-analysis results across the three databases were consistent.
BMI exhibits a U-shaped association with mortality in critically ill NSTEMI patients. Severe obesity combined with elevated inflammation identifies a high-risk clinical profile, supporting integrated metabolic-inflammatory risk stratification.

PMID:
42422429
Bibliographic data and abstract were imported from PubMed on 09 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.