Obesity, inflammatory and thrombotic markers, and major clinical outcomes in critically ill patients with COVID‐19 in the US

Abstract

Objective This study aimed to determine whether obesity is independently associated with major adverse clinical outcomes and inflammatory and thrombotic markers in critically ill patients with COVID‐19. Methods The primary outcome was in‐hospital mortality in adults with COVID‐19 admitted to intensive care units across the US. Secondary outcomes were acute respiratory distress syndrome (ARDS), acute kidney injury requiring renal replacement therapy (AKI‐RRT), thrombotic events, and seven blood markers of inflammation and thrombosis. Unadjusted and multivariable‐adjusted models were used. Results Among the 4,908 study patients, mean (SD) age was 60.9 (14.7) years, 3,095 (62.8%) were male, and 2,552 (52.0%) had obesity. In multivariable models, BMI was not associated with mortality. Higher BMI beginning at 25 kg/m2 was associated with a greater risk of ARDS and AKI‐RRT but not thrombosis. There was no clinically significant association between BMI and inflammatory or thrombotic markers. Conclusions In critically ill patients with COVID‐19, higher BMI was not associated with death or thrombotic events but was associated with a greater risk of ARDS and AKI‐RRT. The lack of an association between BMI and circulating biomarkers calls into question the paradigm that obesity contributes to poor outcomes in critically ill patients with COVID‐19 by upregulating systemic inflammatory and prothrombotic pathways.

Overweight and Obesity Are Associated With Acute Kidney Injury and Acute Respiratory Distress Syndrome, but Not With Increased Mortality in Hospitalized COVID-19 Patients: A Retrospective Cohort Study

“…Moreover, in patients admitted to the ICU an increased BMI has previously been described to be an independent risk factor for developing AKI (69,70). A finding which more recently has also been reported in patients with COVID-19 (71). This retrospective study has several strengths and limitations.…”

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

“…Few studies measured the association between obesity and hospital mortality in this patient population, and among those who did, most included both critically ill and hospitalized patients with a less severe form of the disease [11,[20][21][22]. Among studies that focused on critically-ill patients, a significant harmful association between obesity and hospital mortality has not been observed consistently [18,[23][24][25][26][27][28][29]. 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].…”

“…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%.…”

Therapeutic Target Analysis and Molecular Mechanism of Melatonin - Treated Leptin Resistance Induced Obesity: A Systematic Study of Network Pharmacology

“…Elevated serum cytokine levels, particularly IL-6 and TNFa, were observed in obese subjects (59,60). The obesity patients with increased BMI had abnormal circulation of inflammatory cytokines and are strongly associated in developing severe respiratory failure in COVID-19 (61,62). Leptin is a cytokine belonging to the family of proinflammatory cytokines and structurally similar to IL-6.…”