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

Q: What are the key findings of this study?

Severe obesity was independently associated with a 68% increased risk of 10-year all-cause mortality compared to normal weight in critically ill NSTEMI patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Critically ill non-ST-segment elevation myocardial infarction (NSTEMI) (n=7815). Intervention: Severe obesity (BMI ≥ 35 kg/m2) vs. Normal weight (BMI 18.5-24.9 kg/m2). Primary outcome: 10-year all-cause mortality (HR 1.68, 95% CI 1.31-2.15, p=<0.001).

Q: What does this research mean for the field?

In critically ill NSTEMI patients, severe obesity is independently associated with a 68% increased risk of 10-year all-cause mortality compared to normal weight. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the association of body mass index with in-hospital and 10-year all-cause mortality in critically ill NSTEMI patients, and assess the incremental prognostic value of C-reactive protein for risk stratification.

Y Q Li; Yuhang Wang; Pengju Lu; Jiaxin Wang; Weiwei Tian; Ran Chu; Jingxi Chen; Lai Jiang; Changping Li; Yin Liu; Jing Gao

doi:10.3389/fendo.2026.1850802

June 24, 2026Frontiers in EndocrinologyOpen Access

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

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Key result

Severe obesity is linked to ~68% higher 10-year mortality vs normal weight in critically ill NSTEMI.

HR 1.68
95% CI 1.31-2.15
P<0.001
n=7,815

Figures

Graphical abstract published by Frontiers in Endocrinology — Graphical abstract · Published by Frontiers in Endocrinology · CC BY

Why the study?

To evaluate the association between BMI and both in-hospital and 10-year all-cause mortality in critically ill NSTEMI patients, and assess the incremental value of CRP for risk stratification.

Does severe obesity combined with elevated inflammation increase mortality in critically ill NSTEMI patients?

Key Points

To investigate the association of body mass index with in-hospital and 10-year all-cause mortality in critically ill NSTEMI patients, and assess the incremental prognostic value of C-reactive protein for risk stratification.
Analyzed an original discovery cohort (TAMI, n = 5,010) from a Chinese tertiary hospital and externally validated findings in two independent US cohorts (MIMIC-IV, n = 1,208; eICU-CRD, n = 1,597), totaling 7,815 critically ill NSTEMI patients.
Categorized BMI according to WHO criteria and dichotomized CRP at 2 mg/L, evaluating mortality risk through multivariable Cox proportional hazards regression and restricted cubic splines.
In the TAMI cohort, severe obesity (BMI ≥ 35 kg/m2) independently increased the risk 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.
BMI displayed a U-shaped association with mortality: absolute in-hospital mortality was 8.36% in severe obesity compared with 1.55% in overweight patients, with overweight and class I obesity exhibiting lower mortality risk than normal weight.
Adding CRP (≥ 2 mg/L) to the base model improved AUC from 0.764 to 0.768 (p = 0.021) without significant interaction between severe obesity and CRP (p for interaction = 0.178 for in-hospital, 0.169 for 10-year mortality).

Study Design

Type

Cohort (n=7,815)

Multicenter

Yes

Structured PICO

Does severe obesity combined with elevated inflammation increase mortality in critically ill NSTEMI patients?

P

Population

7,815 critically ill adults with non-ST-segment elevation myocardial infarction across three multinational cohorts, followed for up to 10 years.

E

Exposure

Severe obesity (BMI ≥ 35 kg/m2) and elevated C-reactive protein (≥ 2 mg/L)

C

Comparator

Normal weight (BMI 18.5-24.9 kg/m2) and low C-reactive protein (< 2 mg/L)

O

Outcome

In-hospital and 10-year all-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.68 (95% CI 1.31–2.15)

Absolute Event Rate: 27.86% vs 14.8%

p-value: p=<0.001

Severe obesity combined with elevated CRP identifies a high-risk clinical profile for mortality in critically ill NSTEMI patients, highlighting the need for integrated metabolic-inflammatory risk stratification.

Limitations

Retrospective observational design limits causal inference
Timing of laboratory measurements varied between days 1 and 3 post-admission
Lack of data on long-term changes in BMI during the follow-up period
Missing data for key variables required multiple imputation

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Severe obesity may signal higher mortality risk warranting monitoring; leaves open causality and risk-model refinement in AMI cohorts.

Abstract

Background 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. Methods 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. Results In the TAMI cohort, severe obesity (BMI ≥ 35 kg/m 2 ) 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. Conclusions 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.

Discussion

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Cite This Study

Li et al. (2026) conducted a cohort in Critically ill non-ST-segment elevation myocardial infarction (NSTEMI) (n=7,815). Severe obesity (BMI ≥ 35 kg/m2) vs. Normal weight (BMI 18.5-24.9 kg/m2) was evaluated on 10-year all-cause mortality (HR 1.68, 95% CI 1.31-2.15, p=<0.001). Severe obesity was independently associated with a 68% increased risk of 10-year all-cause mortality compared to normal weight in critically ill NSTEMI patients.

synapsesocial.com/papers/6a3f9785125782b61d86574f https://doi.org/10.3389/fendo.2026.1850802

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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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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