In Cardiogenic Shock, Overweight and Obesity Have the Lowest, Whereas Cachexia Has the Highest Mortality

<b>Introduction:</b> The obesity paradox has been observed in patients with cardiovascular disease. The goal of this study was to evaluate whether obesity has a protective effect in patients presenting with cardiogenic shock. <b>Method:</b> Using a large Nationwide Inpatient (NIS) sample database, we evaluated mortality in patients with cardiogenic shock based on weight categories in adults. <b>Results:</b> A total of 843,020 patients over age 18 had a diagnosis of cardiogenic shock in the database. We found that overweight and obesity had the lowest mortality using univariate or multivariate analysis (overweight mortality of 20.66% vs. obesity mortality of 26.6% vs. 34.8% of normal weights). In contrast, cachexia was associated with the highest mortality in univariate analysis (cachexia 40.4%). Using multivariate analysis adjusting for age, baseline characteristics, and comorbidities, these relations remained unchanged (cachexia MVOR: 1.13; CI: 1.21-1.13; <i>p</i> < 0.001; overweight MVOR: 0.52, CI: 0.43-0.65; <i>p</i> < 0.001; obesity MVOR: 0.76, CI: 0.73-0.79; <i>p</i> < 0.001). After multivariate adjustment, morbid obesity had similar mortality to patients with normal weight (morbid obesity MVOR: 0.99 CI 0.95-01.03; <i>p</i> = 0.6) <b>Conclusions:</b> We observe a partial obesity paradox in patients with cardiogenic shock, showing that being overweight, followed by obesity, has the lowest mortality, whereas cachexia has the highest mortality despite multivariate adjustment.