Association of Obesity with Disease Severity Among Patients with Coronavirus Disease 2019

Kalligeros, Markos; Shehadeh, Fadi; Mylona, Evangelia K.; Benitez, Gregorio; Beckwith, Curt G.; Chan, Philip A.; Mylonakis, Eleftherios

doi:10.1002/oby.22859

Cited by 379 publications

(427 citation statements)

References 17 publications

(20 reference statements)

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“…Preliminary reports on SARS-CoV-2 spread showed that obese subjects are at greater risk for ICU admission and invasive mechanical ventilation [23], but the potential mechanisms that explain why obesity is associated with increased COVID-19 severity have not been determined.…”

Section: Discussionmentioning

confidence: 99%

Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid-19 related respiratory failure: clinical relevance and potential pathophysiological mechanism.

Rossi

Gottin

Donadello

et al. 2020

Preprint

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Abstract Background/Objectives: Recent studies show that obesity is a risk factor for hospital admission and for critical care need in patients with coronavirus disease 2019 (COVID-19).The aim was to determine whether obesity is a risk factor for unfavourable health outcomes in patients affected by COVID-19 admitted to ICU and to compare the observed trend of C-Reactive Protein (CRP) and Creatine Phosphokinase (CPK), as potential pathophysiological mechanisms linking disease severity with Body Mass Index (BMI).Subjects/Methods: 95 consecutive patients with COVID-19 (78 males and 18 females) were admitted to ICU and included in the study. Height, weight, BMI, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, CRP, CPK, as well as ICU and hospital length of stay and comorbidities were evaluated. Results: Participants with obesity had a lower 28 day survival rate from ICU admission than normal weight subjects. Cox proportional hazard model-derived estimates, adjusted for age, gender and comorbidity, confirmed the results of the survival analysis (HR:5.30,95%C.I.1.26-22.34). In the full adjusted model, age was independently associated with mortality (HR:1.13,95%C.I:1.05-1.21).Obese subjects showed longer hospital and ICU stay as compared with normal weight counterpart.Subjects with obesity showed significantly higher CRP and CPK levels than normal weight subjects.Conclusions: Our study shows that in COVID-19 subjects admitted to ICU obesity is a risk factor for unfavourable health outcomes with higher mortality and longer hospital stay. The increase in CRP and CPK levels observed in this population could at least in part explain the unfavourable outcomes observed in individuals with obesity. In those subjects, careful management of any medical signs or symptoms and prompt intervention in case of suspected SARS-CoV-2 infection is necessary to prevent the progression of the disease towards severe outcomes and the increase of hospital treatment costs.

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Section: Discussionmentioning

confidence: 99%

Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid-19 related respiratory failure: clinical relevance and potential pathophysiological mechanism.

Rossi

Gottin

Donadello

et al. 2020

Preprint

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“…Chronic conditions such as underlying lung disease, cardiovascular disease, diabetes mellitus, and hypertension also seem to increase the risk for severe COVID-19 2,4 . Otherwise, we found only hyperlipidemia was strongly associated with risk of death, and not extubation failure.…”

Section: Discussionmentioning

confidence: 99%

“…In early December 2019, a group of acute respiratory illness, now known as Coronavirus Disease 2019 (COVID-19) emerged in Wuhan district of Hubei province in China 1 . Clinical presentation of the viral disease ranges from asymptomatic carriers to severe hypoxemic respiratory failure leading to severe acute respiratory distress syndrome (ARDS) 2 , labeling the disease as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)…”

Section: Introductionmentioning

confidence: 99%

Mortality Data in Mechanically Ventilated COVID-19 patients admitted to ICU: A Retrospective Study in Brooklyn

Patti

Duarte

Dalsania

et al. 2020

Preprint

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Background: High mortality rates are predominant even in COVID-19 patients requiring minimal supportive therapy, with a short-coming of data on COVID-19 patients requiring mechanical ventilation.Objectives/Design: We performed a single-center, retrospective, cohort study at a tertiary care, community-based teaching hospital with patient who required invasive mechanical ventilatory support and were COVID-19 positive. All patients were treated according to the ARDSnet protocol. The primary outcome was overall mortality, and secondary outcome was successful extubation.Results: A total of 72 COVID-19 positive intubated patients were included. Twenty-six (66.6%) patients died within the first 15 days of hospital admission; thirty-eight (52.7%) died within 28 days, and thirty-nine (54.2%) died within 29 days. A total of 22 patients (30.5%) were successfully extubated. 15 patients (20.8%) who required reintubation or could not be extubated further underwent tracheostomy.Conclusions: Mortality of critically ill COVID-19 patients requiring mechanical ventilatory support is high, our observed mortality rate (54.2%) was significantly lower than currently published reports. We believe our rate to be a consequence of early intubation in conjunction with adherence to ARDSnet protocol. We also observed patients with hyperlipidemia, higher CRP, renal failure, or those requiring vasopressor use had worse outcomes.

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“…These patients have also one or more risk factor(s) for aggravating the disease as described by the French High Council of Public Health [14]: 70 years of age or older, cardiovascular history (stroke, coronary artery disease, complicated hypertension, cardiac surgery, NYHA III or IV heart failure), insulin-dependent diabetes which is unbalanced or secondary complicated; respiratory disease likely to decompensate for viral infection, patients with chronic renal failure on dialysis, cancer patients under treatment. We have added BMI (BMI>30) as a risk criterion, based on the recent data from the literature [10][11][12][13]. Exclusion criteria arevulnerable populations and the contraindication of the use of doxycycline.…”

Section: Study Populationmentioning

confidence: 99%

“…The pandemic has shown that some patients may have risk factor(s) for adverse outcomes: 70 years of age and older, Body Mass Index (BMI) greater than 30 (obesity [10][11][12][13]), cardiovascular history, chronic respiratory disease that may decompensate with viral infection, respiratory failure, poorly controlled and/or complicated diabetes, patients with chronic renal failure on dialysis and cancer patients under treatment [14].…”

mentioning

confidence: 99%

Impact of Doxycycline on Covid-19 Patients With Risk Factors of Disease Degradation: Dynamic, A Randomised Controlled Double-blind Trial

Poinas

Boutoille

Vrignaud

et al. 2020

Preprint

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Background: The DYNAMIC study is based on three properties of tetracyclines. (1) Tetracyclines are known to chelate zinc from metalloproteases (MMPs). It is possible that their chelating activity may help to inhibit COVID-19 infection by limiting its ability to replicate in the host. (2) As seen with dengue virus, tetracyclines may also be able to inhibit the replication of positive polarity single-stranded RNA viruses, such as COVID-19. (3) In addition, tetracyclines are modulators of innate immunity (anti-inflammatory activity), a property that has been used to treat inflammatory skin diseases for many years. They could therefore participate in limiting the cytokine storm induced by COVID-19. The lipophilic nature of tetracyclines and their strong pulmonary penetration could allow them to inhibit viral replication at this level. Among tetracyclines, the advantages of doxycycline are triple: its long history of safety (infrequent side effects with no notable risks), the short duration of treatment and its low cost.Methods: By estimating the rate of patients presenting pulmonary signs requiring hospitalisation in at-risk patients infected with COVID-19 at 25%, we hypothesise that on doxycycline, this rate would decrease to 12%. The main objective involves 2 embedded hypotheses tested successively in case of rejection of the previous one: (i) Decrease the rate of patients requiring hospitalisation, (ii) Decrease the use of mechanical ventilatory assistance.Discussion: This study could have an impact on the management of COVID-19 risk factor patientsupstream of hospitals by general practitioners. These patients,if kept at home under experimental treatment, would participate in reducing the risk of dissemination of SAR-CoV-2in the population.Thus, this treatment would contribute to supporting the deconfinement strategy through blocking the viral infection early and reducing the contagious period.Trial Registration: On ClinicalTrials.gov, registration number NCT04371952, first published on 30 April 2020.

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Association of Obesity with Disease Severity Among Patients with Coronavirus Disease 2019

Abstract: Infectious Disease and EMS (PRIDEMS)*Authors contributed equally to this work.

Cited by 379 publications

References 17 publications

Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid-19 related respiratory failure: clinical relevance and potential pathophysiological mechanism.

Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid-19 related respiratory failure: clinical relevance and potential pathophysiological mechanism.

Mortality Data in Mechanically Ventilated COVID-19 patients admitted to ICU: A Retrospective Study in Brooklyn

Impact of Doxycycline on Covid-19 Patients With Risk Factors of Disease Degradation: Dynamic, A Randomised Controlled Double-blind Trial

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