One of the ending slides is linked to your karmic status. That and the thing you mentioned are the only thing that karma influences I think.
I find it a bit silly that it's so hard to be bad in NV. No matter how many conundrums you solve in a morally grey/black fashion, you'll shoot right up to being a saint after offing a few ghouls or fiends.
The karma system is wonk in New Vegas and only used in a few of the ending slides and to keep Cass around. The reputation system replaces it completely in functionality and the karma system could have been ditched.