Background and Purpose The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented health crisis to the entire world. As reported, the body mass index (BMI) may play an important role in COVID-19; however, this still remains unclear. The aim of this study was to explore the association between BMI and COVID-19 severity and mortality. Methods The Medline, PubMed, Embase and Web of science were systematically searched until August 2020. Random-effects models and dose-response meta-analysis were used to synthesize the results. Combined odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated, and the effect of covariates were analyzed using subgroup analysis and meta-regression analyses. Results A total of 16 observational studies involving 109,881 patients with COVID-19 were included in the meta-analysis. The pooled results showed that patients with a BMI≥30kg/m 2 had a 2.35-fold risk(OR = 2.35, 95%CI = 1.64 − 3.38, P < 0.001) for critical COVID-19 and a 2.68-fold risk for COVID-19 mortality (OR = 2.68, 95%CI = 1.65 −4.37, P < 0.001 ) compared with patients with a BMI <30kg/m 2 . Subgroup analysis results showed that patients with obesity and age > 60 years was associated with a significantly increased risk of critical COVID-19(OR = 3.11, 95%CI = 1.73 − 5.61, P < 0.001) and COVID-19 mortality(OR = 3.93, 95%CI = 2.18 − 7.09, P < 0.001). Meta-regression analysis results also showed that age had a significant influence on the association between BMI and COVID-19 mortality(Coef.=0.036, p=0.048). Random-effects dose-response meta-analysis showed a linear association between BMI and both critical COVID-19(P non-linearity = 0.242) and mortality (P non-linearity = 0.116). The risk of critical COVID-19 and mortality increased by 9%(OR = 1.09, 95%CI = 1.04 −1.14, P < 0.001) and 6%(OR = 1.06, 95%CI = 1.02 −1.10, P = 0.002) for each 1 kg/m 2 increase in BMI, respectively. Conclusions Evidence from this meta-analysis suggested that a linear dose-response association between BMI and both COVID-19 severity and mortality. Further, obesity(BMI≥30kg/m 2 ) was associated with a significantly increased risk of critical COVID-19 and in-hospital mortality of COVID-19.

Aims: As reported, hypertension may play an important role in adverse outcomes of coronavirus disease-2019 , but it still had many confounding factors. The aim of this study was to explore whether hypertension is an independent risk factor for critical COVID-19 and mortality. Data synthesis: The Medline, PubMed, Embase, and Web of Science databases were systematically searched until November 2020. Combined odds ratios (ORs) with their 95% confidence interval (CIs) were calculated by using random-effect models, and the effect of covariates was analyzed using the subgroup analysis and meta-regression analysis. A total of 24 observational studies with 99,918 COVID-19 patients were included in the meta-analysis. The proportions of hypertension in critical COVID-19 were 37% (95% CI: 0.27 À0.47) when compared with 18% (95% CI: 0.14 À0.23) of noncritical COVID-19 patients, in those who died were 46% (95%CI: 0.37 À0.55) when compared with 22% (95% CI: 0.16 À0.28) of survivors. Pooled results based on the adjusted OR showed that patients with hypertension had a 1.82-fold higher risk for critical COVID-19 (aOR: 1.82; 95% CI: 1.19 À 2.77; P Z 0.005) and a 2.17-fold higher risk for COVID-19 mortality (aOR: 2.17; 95% CI: 1.67 À 2.82; P < 0.001). Subgroup analysis results showed that male patients had a higher risk of developing to the critical condition than female patients (OR: 3.04; 95%CI: 2.06 À 4.49; P < 0.001) and age >60 years was associated with a significantly increased risk of COVID-19 mortality (OR: 3.12; 95% CI: 1.93 À 5.05; P < 0.001). Meta-regression analysis results also showed that age (Coef. Z 2.3Â10 À2 , P Z 0.048) had a significant influence on the association between hypertension and COVID-19 mortality. Conclusions: Evidence from this meta-analysis suggested that hypertension was independently associated with a significantly increased risk of critical COVID-19 and inhospital mortality of COVID-19.

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