Differences in mortality rate among patients hospitalized with severe COVID‐19 according to their body mass index

Abstract

Background Obesity has been described as a risk factor for COVID‐19 severity and mortality. Previous studies report a linear association between BMI and adverse outcomes, meanwhile in other critical illness, excessive fat tissue is related to improved survival. Whether different BMI is related with the survival of patients with severe COVID‐19 deserves further analysis. Objective To determine the mortality rate among hospitalized patients with severe COVID‐19 stratified according to BMI. Methods The clinical files of all patients hospitalized from March to December 2020 with a positive PCR test for SARS‐CoV‐2 discharged due to improvement or death, were analyzed. A mixed effects logistic regression was carried out to determine which clinical and biochemical characteristics and comorbidities were associated with in‐hospital mortality. Results The cohort consisted of 608 patients with a median age of 59 years (interquartile ranges, IQR 46–69 years), median BMI of 28.7 kg/m 2 (IQR 25.4–32.4 kg/m 2 ), 65.5% were male. In‐hospital mortality rate was 43.4%. Of the cohort 0.8% had low weight, 20.9% normal weight, 36.0% overweight, 26.5% obesity grade I, 10.2% obesity grade II and 5.6% obesity grade III. Mortality rate was highest in patients with low weight (80%), followed by patients with obesity grade III (58.8%) and grade II (50.0%). Overweight and underweight/obesity grade III were associated with higher mortality (OR of 9.75 [1.01–1.10] and OR 4.08 [1.64–10.14]), after adjusting by sex and age. Conclusions The patients in the underweight/overweight and grade 3 obesity categories are at higher risk of COVID‐19 related mortality, compared to those with grade I or II obesity.

Role of body mass index in outcomes of patients hospitalized with COVID‐19 illness

“…17 A more recent study showed that patients with underweight, overweight, and grade 3 obesity were at higher risk of COVID-19 related mortality compared to patients with grade I or grade II obesity. 18 On the other hand a French study of 1461 critically ill patients with COVID-19 showed mortality was higher in patients with obesity class III (BMI ≥ 40 kg/m 2 ). 19 In this study, we examined the association between the BMI classes (patients with underweight [BMI < 18.5 kg/m 2 ], patients with normal weight [BMI 18.5-24.9 kg/m 2 ], patients with overweight [BMI 25-29.9 kg/m 2 ], and patients with obesity [BMI ≥ 30 kg/m 2 ]) and outcomes among patients hospitalized with COVID-19 in our innercity patient population.…”

“…A retrospective study showed the patients with underweight are at risk of mechanical ventilation and death from COVID‐19 16 whereas another study did not show any association of patients with underweight and severity of illness 17 . A more recent study showed that patients with underweight, overweight, and grade 3 obesity were at higher risk of COVID‐19 related mortality compared to patients with grade I or grade II obesity 18 . On the other hand a French study of 1461 critically ill patients with COVID‐19 showed mortality was higher in patients with obesity class III (BMI ≥ 40 kg/m 2 ) 19 …”

“… 17 A more recent study showed that patients with underweight, overweight, and grade 3 obesity were at higher risk of COVID‐19 related mortality compared to patients with grade I or grade II obesity. 18 On the other hand a French study of 1461 critically ill patients with COVID‐19 showed mortality was higher in patients with obesity class III (BMI ≥ 40 kg/m 2 ). 19 …”

Risk Factors Associated with Mortality among Patients with COVID-19: Analysis of a Cohort of 1213 Patients in a Tertiary Healthcare Center

“…The SARS-CoV-2 infection was mainly characterized by acute respiratory symptoms and related systemic complications. The presence of cardio-metabolic (diabetes, hypertension, and obesity) and respiratory (asthma and chronic obstructive pulmonary disease) comorbidities, immunosuppression, and chronic kidney disease (CKD) were all aggravating factors in the evolution and possible triggers for increased mortality in Mexico [ 1 , 2 , 3 , 4 , 5 ].…”

Influência da composição corporal durante a hospitalização sobre a função pulmonar e força da musculatura inspiratória em pacientes com COVID-19: estudo transversal

“…Impaired body composition through weight Fisioterapia Brasil 2023;2491): [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] loss impacts the course of the disease and affects muscles and adipose tissues, making patients even more fragile and worsening these symptoms [2,3]. Among hospitalized patients, underweight patients have higher mortality rates [4]. Within 60 days after hospital discharge 9.1% of patients died, especially older adults [5].…”