Obesity and mortality in critically ill COVID-19 patients with respiratory failure

Abstract

Background Patients with obesity are at increased risk of severe COVID-19, requiring mechanical ventilation due to acute respiratory failure. However, conflicting data are obtained for intensive care unit (ICU) mortality. Objective To analyze the relationship between obesity and in-hospital mortality of ICU patients with COVID-19. Subjects/methods Patients admitted to the ICU for COVID-19 acute respiratory distress syndrome (ARDS) were included retrospectively. The following data were collected: comorbidities, body mass index (BMI), the severity of ARDS assessed with PaO 2 /FiO 2 (P/F) ratios, disease severity measured by the Simplified Acute Physiology Score II (SAPS II), management and outcomes. Results For a total of 222 patients, there were 34 patients (15.3%) with normal BMI, 92 patients (41.4%) who were overweight, 80 patients (36%) with moderate obesity (BMI:30–39.9 kg/m 2 ), and 16 patients (7.2%) with severe obesity (BMI ≥ 40 kg/m 2 ). Overall in-hospital mortality was 20.3%. Patients with moderate obesity had a lower mortality rate (13.8%) than patients with normal weight, overweight or severe obesity (17.6%, 21.7%, and 50%, respectively; P = 0.011. Logistic regression showed that patients with a BMI ≤ 29 kg/m 2 (odds ratio [OR] 3.64, 95% CI 1.38–9.60) and those with a BMI > 39 kg/m 2 (OR 10.04, 95% CI 2.45–41.09) had a higher risk of mortality than those with a BMI from 29 to 39 kg/m 2 . The number of comorbidities (≥2), SAPS II score, and P/F < 100 mmHg were also independent predictors for in-hospital mortality. Conclusions COVID-19 patients admitted to the ICU with moderate obesity had a lower risk of death than the other patients, suggesting a possible obesity paradox.

The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU

“…Interestingly, multifactorial analysis indicated a paradoxical relationship between the category of BMI and mortality. Patients whose BMI was ≤29 kg/m 2 (OR = 3.64) and those whose BMI was >39 kg/m 2 (OR = 10.45) were more at risk of death compared to those with a BMI of 29-39 kg/m 2 [26]. Researchers point out that the risk of a severe COVID-19 disease course and invasive ventilation in the ICU is higher in patients being overweight or with obesity [27,28].…”

Association between obesity and hospital mortality in critical COVID-19: a retrospective cohort study

“…A recent systematic review of predictors of in-hospital mortality in COVID-19 concluded that obesity was only associated with mortality in studies that included fewer critically-ill patients [24]. However, these studies used ill-specified multivariable models that did not focus on the association between obesity and hospital mortality and used heterogeneous obesity categorizations [14,18,25,[30][31][32]. Thus, the association between obesity, defined as a high body mass index (BMI), and hospital mortality specifically in critical COVID-19 patients is not yet well-defined.…”

“…RESULTS: We included 94 patients. Median [q1, q3] body mass index (BMI) was 29 [26][27][28][29][30][31][32] kg/m 2 and 37% of patients were obese (defined as BMI > 30 kg/m 2 ). Hospital mortality for the entire cohort was 33%.…”

Previous Vitamin D Supplementation and Morbidity and Mortality Outcomes in People Hospitalised for COVID19: A Cross-Sectional Study

“…The PaO 2 /FIO 2 ratio has been reported as an independent factor related to death in COVID-19 subjects receiving intensive care (22). In addition, obesity has been associated with substantially increased risks of severe outcomes in patients with COVID-19 (23). Therefore, it is perhaps surprising that in the logistic regression models, we found that the obesity was negatively associated with the study outcomes.…”

“…This could be due to the J-shaped association between BMI and the mortality curve. It was already reported that survival rates of subjects with moderate obesity were higher than for those with normal body mass index (BMI), overweight or severe obesity subjects (23). However, a clear limitation of our study is that data on BMI were not available and the analyses were only based on a clinical recorded diagnosis of obesity in the clinical records, which is not a solid variable to analyse the contribution of adiposity on the outcomes.…”