The association between body mass index class and coronavirus disease 2019 outcomes

Abstract

Background/Objectives A growing body of data suggests that obesity influences coronavirus disease 2019 (COVID-19). Our study's primary objective was to assess the association between body mass index (BMI) categories and critical forms of COVID-19. Subjects/Methods Data on consecutive adult patients hospitalized with laboratory-confirmed COVID-19 at Amiens University Hospital (Amiens, France) were extracted retrospectively. The association between BMI categories and the composite primary endpoint (admission to the intensive care unit or death) was probed in a logistic regression analysis. Results In total, 433 patients were included, and BMI data were available for 329: 20 were underweight (6.1%), 95 have a normal weight (28.9%), 90 were overweight (27.4%), and 124 were obese (37.7%). The BMI category was associated with the primary endpoint in the fully adjusted model; the odds ratio (OR) [95% confidence interval (CI)] for overweight and obesity were respectively 1.58 [0.77-3.24] and 2.58 [1.28-5.31]. The ORs [95% CI] for ICU admission were similar for overweight (3.16 [1.29-8.06]) and obesity (3.05 [1.25-7.82]) in the fully adjusted model. The unadjusted ORs for death were similar in all BMI categories while obesity only was associated with higher risk after adjustment. Conclusions Our results suggest that overweight (and not only obesity) is associated with ICU admission, but overweight is not associated with death.

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

“…Possible explanations for this survival benefit are that obese patients might present a higher fraction of atelectasis than nonobese patients for the same degree of hypoxia (offering more 'treatable' profile), and that there might be a bias toward early ICU admission of obese ARDS patients, due to clinicians' fear of an unfavorable evolution [4]. Such a potential bias toward improved Hospital LOS 26 [11,47] 25 [13,44] 26 [8,53] ICU LOS 13 [6,29] 12 [6,24] 14 [3,35] Organ support on the day of hospital admission survival from preemptive admission in obese patients may come from more aggressive and earlier interventions and monitoring in these patients compared with nonobese patients [2]. These potential advantages for obese patients may have been lost during the first wave of the COVID-19 pandemic, since an early ICU admission policy was applied to all patients requiring relatively low levels of oxygen supplementation (~5 L/min or estimated FiO 2 > 40%).…”

“…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%.…”

Risk Factors of In-Hospital Mortality in Non-Specialized Tertiary Center Repurposed for Medical Care to COVID-19 Patients in Russia

“…This can be explained by the fact that a high BMI is associated with a higher risk of hospitalization, and during selection, our in-hospital study included overweight patients with a higher frequency. In addition, an increase in intrahospital mortality was observed with a BMI of more than 30 kg/m 2 [ 50 ] or 35 kg/m 2 [ 51 ], that is, in different classes of obesity, but there is evidence that being overweight (and not obese) does not affect the mortality of patients with coronavirus [ 52 ]. There is also the “obesity paradox”, which shows that obese individuals have a lower mortality rate for various diseases, including pneumonia [ 53 ], which may be caused by both a higher level of attention from the medical staff and some other factors.…”

Safety and Efficacy of Autologous Non-Hematopoietic Enriched Stem Cell Nebulization in Covid-19 Patients. A Randomized Clinical Trial, Abu Dhabi 2020.

“…Age, gender, nationalities, and other demographic and clinical information obtained at the time of recruitment were similar between both groups, and the only significant difference was found in a portion of body mass index (BMI) categories, such as normal weight and overweight. For both of these factors, the control group exhibited better values, and a smaller number of patients with these disadvantages were included in the stem cell-treated group because some reports have noted a poor prognosis for overweight patients [26]. Patients in the trial represent 15 nationalities, which is similar to that noted in the UAE population, giving strong meaning to the study.…”