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Sena GR, de Lima TPF, de Carvalho Silva ML, Sette PGT, Dos Santos Costa GC, da Fonseca Benvindo AM, de Mello MJG, Costa GJ. Associations between obesity and severity of coronavirus disease 2019 in Brazilian inpatients: A 2021 secondary data analysis. Clin Obes 2024:e12698. [PMID: 39121457 DOI: 10.1111/cob.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 08/11/2024]
Abstract
In the backdrop of the global obesity pandemic, recognized as a notable risk factor for coronavirus disease 2019 (COVID-19) complications, the study aims to explore clinical and epidemiological attributes of hospitalized COVID-19 patients throughout 2021 in Brazil. Focused on four distinct age cohorts, the investigation scrutinizes parameters such as intensive care unit (ICU) admission frequency, invasive mechanical ventilation (IMV) usage, and in-hospital mortality among individuals with and without obesity. Using a comprehensive cross-sectional study methodology, encompassing adult COVID-19 cases, data sourced from the Influenza Epidemiological Surveillance Information System comprises 329 206 hospitalized patients. Of these individuals, 26.3% were affected by obesity. Analysis reveals elevated rates of ICU admissions, increased dependence on IMV, and heightened in-hospital mortality among the individuals with obesity across all age groups (p < .001). Logistic regression, adjusting for confounding variables, underscores a progressively rising odds ratio for mortality in younger age brackets: 1.2 (95%CI 1.1-1.3) for those under 50 years, 1.1 (95%CI 1.0-1.2) for the 50-59 age group, and 1.1 (95%CI 1.0-1.2) for the 60-69 age group. Conversely, no significant mortality difference is observed for patients over 70 years (OR: 0.972, 95%CI 0.9-1.1). In summary, hospitalized COVID-19 patients with obesity, particularly in younger age groups, exhibit elevated rates of ICU admission, IMV requirement, and in-hospital mortality compared with the control group. Notably, the 'obesity paradox' is not evident among hospitalized COVID-19 patients in 2021.
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Affiliation(s)
- Gabrielle Ribeiro Sena
- Department of Education and Research, Instituto de Medicina Integral Professor Fernando Figueira - IMIP, Recife, Brazil
- Department of Education and Research, Universidade de Pernambuco - UPE, Recife, Brazil
| | | | - Michelle Lima de Carvalho Silva
- Department of Education and Research, Faculdade Pernambucana de Saúde - FPS, Recife, Brazil
- Scientific Initiation Program, Instituto de Medicina Integral Professor Fernando Figueira - IMIP, Recife, Brazil
| | - Paloma Gomes Tavares Sette
- Department of Education and Research, Faculdade Pernambucana de Saúde - FPS, Recife, Brazil
- Scientific Initiation Program, Instituto de Medicina Integral Professor Fernando Figueira - IMIP, Recife, Brazil
| | | | | | | | - Guilherme Jorge Costa
- Department of Education and Research, Instituto de Medicina Integral Professor Fernando Figueira - IMIP, Recife, Brazil
- Department of Education and Research, Hospital Alfa, Recife, Brazil
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Hanganu AR, Dulămea AO, Niculae CM, Moisă E, Hristea A. Independent Risk Factors and Mortality Implications of De Novo Central Nervous System Involvement in Patients Hospitalized with Severe COVID-19: A Retrospective Cohort Study. J Clin Med 2024; 13:3948. [PMID: 38999510 PMCID: PMC11242379 DOI: 10.3390/jcm13133948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Central nervous system (CNS) involvement is a complication of COVID-19, adding to disease burden. The aim of this study is to identify the risk factors independently associated with CNS involvement in a cohort of patients hospitalized with severe forms of COVID-19 and the risk factors associated with all causes of in-hospital mortality and assess the impact of CNS involvement on in-hospital mortality of the severe COVID-19 patients. Methods: We performed a retrospective observational cohort study including adult patients with severe or critical forms of COVID-19 with and without new-onset CNS manifestations between March 2020 and December 2022. Results: We included 162 patients, 50 of which presented with CNS involvement. Independent risk factors for CNS involvement were female sex (p = 0.04, OR 3.67, 95%CI 1.05-12.85), diabetes mellitus (p = 0.008, OR 5.08, 95%CI 1.519-17.04)), lymphocyte count (0.04, OR 0.23, 95%CI 0.05-0.97), platelets count (p = 0.001, OR 0.98, 95%CI 0.98-0.99) CRP value (p = 0.04, OR 1.007, 95%CI 1.000-1.015), and CK value (p = 0.004, OR 1.003, 95%CI 1.001-1.005). Obesity was a protective factor (p < 0.001, OR 0.57, 95%CI 0.016-0.20). New-onset CNS manifestations (p = 0.002, OR 14.48, 95%CI 2.58-81.23) were independent risk factors for in-hospital mortality. In-hospital mortality was higher in the new-onset CNS involvement group compared to patients without neurological involvement, 44% versus 7.1% (p < 0.001). Conclusions: CNS involvement in severe COVID-19 patients contributes to all causes of in-hospital mortality. There are several risk factors associated with new-onset CNS manifestations and preventing and controlling them could have an important impact on patients' outcome.
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Affiliation(s)
- Andreea Raluca Hanganu
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 021105 Bucharest, Romania
- Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adriana Octaviana Dulămea
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cristian-Mihail Niculae
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 021105 Bucharest, Romania
| | - Emanuel Moisă
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Adriana Hristea
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 021105 Bucharest, Romania
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Neppala S, Chigurupati HD, Mopuru NN, Alle NR, James A, Bhalodia A, Shaik S, Bandaru RR, Nanjundappa A, Sunkara P, Gummadi J, Desai R. Impact Of body Mass Index on Cardiopulmonary Outcomes of COVID-19 Hospitalizations Complicated by Severe Sepsis. OBESITY PILLARS 2024; 10:100101. [PMID: 38435542 PMCID: PMC10905037 DOI: 10.1016/j.obpill.2024.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
Background Body Mass Index (BMI) has a significant impact on Coronavirus disease (COVID-19) patient outcomes; however, major adverse cardiac and cerebrovascular outcomes in patients with severe sepsis have been poorly understood. Our study aims to explore and provide insight into its association. Methods This is an observational study looking at the impact of BMI on COVID-19-severe sepsis hospitalizations. The primary outcomes are adjusted odds of all-cause in-hospital mortality, respiratory failure, and major adverse cardiac and cerebrovascular events (MACCE), which include acute myocardial infarction, cardiac arrest, and acute ischemic stroke. The secondary outcome was healthcare resource utilization. Coexisting comorbidities and patient features were adjusted with multivariable regression analyses. Results Of 51,740 patients with severe COVID-19-sepsis admissions, 11.4% were overweight, 24.8% had Class I obesity (BMI 30-34.9), 19.8% had Class II obesity (BMI 35-39.9), and 43.9% had the categorization of Class III obesity (BMI >40) cohorts with age>18 years. The odds of MACCE in patients with class II obesity and class III obesity (OR 1.09 and 1.54; 95CI 0.93-1.29 and 1.33-1.79) were significantly higher than in overweight (p < 0.001). Class I, Class II, and Class III patients with obesity revealed lower odds of respiratory failure compared to overweight (OR 0.89, 0.82, and 0.82; 95CI 0.75-1.05, 0.69-0.97, and 0.70-0.97), but failed to achieve statistical significance (p = 0.079). On multivariable regression analysis, all-cause in-hospital mortality revealed significantly higher odds in patients with Class III obesity, Class II, and Class I (OR 1.56, 1.17, and 1.06; 95CI 1.34-1.81, 0.99-1.38, and 0.91-1.24) vs. overweight patients (p < 0.001). Conclusions Patients with Class II and Class III obesity had significantly higher odds of MACCE and in-hospital mortality in COVID-19-severe sepsis admissions.
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Affiliation(s)
| | - Himaja Dutt Chigurupati
- Department of Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA
| | - Nikhilender Nag Mopuru
- Department of Medicine, Kamineni Academy of medical sciences and research Centre, Hyderabad, India
| | | | - Alpha James
- Department of Medicine, Bukovinian State Medical University, Chernivitsi, Ukraine
| | - Ami Bhalodia
- Department of Medicine, Pandit Deendayal Upadhyay Medical College, Gujrat, India
| | - Sajida Shaik
- Department of Medicine, Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Andhra Pradesh, India
| | | | | | - Praveena Sunkara
- Department of Medicine, Medstar Medical group, Charlotte Hall, MD, USA
| | - Jyotsna Gummadi
- Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA
| | - Rupak Desai
- Independent Outcomes Researcher, Atlanta, GA, USA
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Grapin K, De Bauchene R, Bonnet B, Mirand A, Cassagnes L, Calvet L, Thouy F, Bouzgarrou R, Henquell C, Evrard B, Adda M, Souweine B, Dupuis C. Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia in Critically Ill Patients: A Cluster Analysis According to Baseline Characteristics, Biological Features, and Chest CT Scan on Admission. Crit Care Med 2024; 52:e38-e46. [PMID: 37889095 DOI: 10.1097/ccm.0000000000006105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Inconsistent results from COVID-19 studies raise the issue of patient heterogeneity. OBJECTIVE The objective of this study was to identify homogeneous subgroups of patients (clusters) using baseline characteristics including inflammatory biomarkers and the extent of lung parenchymal lesions on CT, and to compare their outcomes. DESIGN Retrospective single-center study. SETTING Medical ICU of the University Hospital of Clermont-Ferrand, France. PATIENTS All consecutive adult patients aged greater than or equal to 18 years, admitted between March 20, 2020, and August 31, 2021, for COVID-19 pneumonia. INTERVENTIONS Characteristics at baseline, during ICU stay, and outcomes at day 60 were recorded. On the chest CT performed at admission the extent of lung parenchyma lesions was established by artificial intelligence software. MEASUREMENTS AND MAIN RESULTS Clusters were determined by hierarchical clustering on principal components using principal component analysis of admission characteristics including plasma interleukin-6, human histocompatibility leukocyte antigen-DR expression rate on blood monocytes (HLA-DR) monocytic-expression rate (mHLA-DR), and the extent of lung parenchymal lesions. Factors associated with day 60 mortality were investigated by univariate survival analysis. Two hundred seventy patients were included. Four clusters were identified and three were fully described. Cluster 1 (obese patients, with moderate hypoxemia, moderate extent of lung parenchymal lesions, no inflammation, and no down-regulation of mHLA-DR) had a better prognosis at day 60 (hazard ratio [HR] = 0.27 [0.15-0.46], p < 0.01), whereas cluster 2 (older patients with comorbidities, moderate extent of lung parenchyma lesions but significant hypoxemia, inflammation, and down-regulation of mHLA-DR) and cluster 3 (patients with severe parenchymal disease, hypoxemia, inflammatory reaction, and down-regulation of mHLA-DR) had an increased risk of mortality (HR = 2.07 [1.37-3.13], p < 0.01 and HR = 1.52 [1-2.32], p = 0.05, respectively). In multivariate analysis, only clusters 1 and 2 were independently associated with day 60 death. CONCLUSIONS Three clusters with distinct characteristics and outcomes were identified. Such clusters could facilitate the identification of targeted populations for the next trials.
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Affiliation(s)
- Kévin Grapin
- CHU Clermont-Ferrand, Service de Médecine intensive et réanimation, Clermont-Ferrand, France
| | | | - Benjamin Bonnet
- CHU Clermont-Ferrand, Service d'Immunologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Laboratoire d'Immunologie, ECREIN, UMR1019, UNH, UFR Médecine de Clermont-Ferrand, Clermont-Ferrand, France
| | - Audrey Mirand
- CHU Clermont-Ferrand, 3IHP, Service de virologie, Clermont-Ferrand, France
- Université Clermont Auvergne, UMR CNRS 6023, LMGE, Clermont-Ferrand, France
| | - Lucie Cassagnes
- CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
- Université Clermont Auvergne, ASMS, UMR 1019, UNH, INRAe, CRNH Auvergne, Clermont-Ferrand, France
| | - Laure Calvet
- CHU Clermont-Ferrand, Service de Médecine intensive et réanimation, Clermont-Ferrand, France
| | - François Thouy
- CHU Clermont-Ferrand, Service de Médecine intensive et réanimation, Clermont-Ferrand, France
| | - Radhia Bouzgarrou
- CHU Clermont-Ferrand, Service de Médecine intensive et réanimation, Clermont-Ferrand, France
| | - Cécile Henquell
- CHU Clermont-Ferrand, 3IHP, Service de virologie, Clermont-Ferrand, France
- Université Clermont Auvergne, UMR CNRS 6023, LMGE, Clermont-Ferrand, France
| | - Bertrand Evrard
- CHU Clermont-Ferrand, Service d'Immunologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Laboratoire d'Immunologie, ECREIN, UMR1019, UNH, UFR Médecine de Clermont-Ferrand, Clermont-Ferrand, France
| | - Mireille Adda
- CHU Clermont-Ferrand, Service de Médecine intensive et réanimation, Clermont-Ferrand, France
| | - Bertrand Souweine
- CHU Clermont-Ferrand, Service de Médecine intensive et réanimation, Clermont-Ferrand, France
- Université Clermont Auvergne, UMR CNRS 6023, LMGE, Clermont-Ferrand, France
| | - Claire Dupuis
- CHU Clermont-Ferrand, Service de Médecine intensive et réanimation, Clermont-Ferrand, France
- Université Clermont Auvergne, ASMS, UMR 1019, UNH, INRAe, CRNH Auvergne, Clermont-Ferrand, France
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Elkhapery A, Abdelhay A, Boppana HK, Abdalla Z, Mohamed M, Al‐Ali O, Hashem A, Mahmoud A, Mahmoud E, Niu C, Dalbah R, Chow M. Higher body mass index is strongly linked to poor outcomes in adult COVID-19 hospitalizations: A National Inpatient Sample Study. Obes Sci Pract 2024; 10:e692. [PMID: 38264003 PMCID: PMC10804336 DOI: 10.1002/osp4.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 01/25/2024] Open
Abstract
Aims The coronavirus disease 2019 (COVID-19) pandemic has resulted in more than 6 million deaths worldwide. Studies on the impact of obesity on patients hospitalized with COVID-19 pneumonia have been conflicting, with some studies describing worse outcomes in patients with obesity, while other studies reporting no difference in outcomes. Previous studies on obesity and critical illness have described improved outcomes in patients with obesity, termed the "obesity paradox." The study assessed the impact of obesity on the outcomes of COVID-19 hospitalizations, using a nationally representative database. Materials and Methods ICD-10 code U071 was used to identify all hospitalizations with the principal diagnosis of COVID-19 infection in the National Inpatient Database 2020. ICD-10 codes were used to identify outcomes and comorbidities. Hospitalizations were grouped based on body mass index (BMI). Multivariable logistic regression was used to adjust for demographic characteristics and comorbidities. Results A total of 56,033 hospitalizations were identified. 48% were male, 49% were white and 22% were black. Patients hospitalized with COVID-19 pneumonia in the setting of obesity and clinically severe obesity were often younger. Adjusted for differences in comorbidities, there was a significant increase in mortality, incidence of mechanical ventilation, shock, and sepsis with increased BMI. The mortality was highest among hospitalizations with BMI ≥60, with an adjusted odds ratio of 2.66 (95% Confidence interval 2.18-3.24) compared to hospitalizations with normal BMI. There were increased odds of mechanical ventilation across all BMI groups above normal, with the odds of mechanical ventilation increasing with increasing BMI. Conclusion The results show that obesity is independently associated with worse patient outcomes in COVID-19 hospitalizations and is associated with higher in-patient mortality and higher rates of mechanical ventilation. The underlying mechanism of this is unclear, and further studies are needed to investigate the cause of this.
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Affiliation(s)
- Ahmed Elkhapery
- Rochester General Hospital Internal Medicine Residency ProgramRochesterNew YorkUSA
| | - Ali Abdelhay
- Rochester General Hospital Internal Medicine Residency ProgramRochesterNew YorkUSA
| | | | - Zeinab Abdalla
- Department of MedicineUniversity of SharjahSharjahUnited Arab Emirates
| | - Mohamed Mohamed
- Rochester General Hospital Internal Medicine Residency ProgramRochesterNew YorkUSA
| | - Omar Al‐Ali
- Rochester General Hospital Internal Medicine Residency ProgramRochesterNew YorkUSA
| | - Anas Hashem
- Rochester General Hospital Internal Medicine Residency ProgramRochesterNew YorkUSA
| | - Amir Mahmoud
- Rochester General Hospital Internal Medicine Residency ProgramRochesterNew YorkUSA
| | - Eisa Mahmoud
- Rochester General Hospital Internal Medicine Residency ProgramRochesterNew YorkUSA
| | - Chengu Niu
- Rochester General Hospital Internal Medicine Residency ProgramRochesterNew YorkUSA
| | - Rami Dalbah
- Department of Internal MedicineEast Tennessee State UniversityJohnson CityTennesseeUSA
| | - Ming‐Yan Chow
- Department of Pulmonary and Critical CareRochester General HospitalRochesterNew YorkUSA
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Carra FA, de Melo ME, Stumpf MAM, Cercato C, Fernandes AE, Mancini MC. The impact of obesity in hospitalized patients with COVID-19: a retrospective cohort study. Diabetol Metab Syndr 2024; 16:20. [PMID: 38238775 PMCID: PMC10797807 DOI: 10.1186/s13098-023-01246-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/22/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Obesity is believed to be a risk factor for COVID-19 and unfavorable outcomes, although data on this remains to be better elucidated. OBJECTIVE To evaluate the impact of obesity on the endpoints of patients hospitalized due to SARS-CoV-2. METHODS This retrospective cohort study evaluated patients hospitalized at a tertiary hospital (Hospital das Clínicas da Faculdade de Medicina da USP) from March to December 2020. Only patients positive for COVID-19 (real-time PCR or serology) were included. Data were collected from medical records and included clinical and demographic information, weight and height, SAPS-3 score, comorbidities, and patient-centered outcomes (mortality, and need for mechanical ventilation, renal replacement therapy, or vasoactive drugs). Patients were divided into categories according to their BMI (underweight, eutrophic, overweight and obesity) for comparison porpoise. RESULTS A total of 2547 patients were included. The mean age was 60.3 years, 56.2% were men, 65.2% were white and the mean BMI was 28.1 kg/m2. SAPS-3 score was a risk factor for all patient-centered outcomes (HR 1.032 for mortality, OR 1.03 for dialysis, OR 1.07 for vasoactive drug use, and OR 1.08 for intubation, p < 0.05). Male sex increased the risk of death (HR 1.175, p = 0.027) and dialysis (OR 1.64, p < 0.001), and underweight was protective for vasoactive drug use (OR 0.45, p = 0.027) and intubation (OR 0.31, p < 0.003). CONCLUSION Obesity itself was not an independent factor for worse patient-centered outcomes. Critical clinical state (indirectly evaluated by SAPS-3) appears to be the most important variable related to hard outcomes in patients infected with COVID-19.
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Affiliation(s)
- Fábio Alfano Carra
- Unidade de Obesidade, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brasil.
| | - Maria Edna de Melo
- Unidade de Obesidade, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brasil
- Laboratório de Carboidratos e Radioimuniensaio (LIM-18), Faculdade de Medicina da Universidade São Paulo, São Paulo, Brasil
| | - Matheo A M Stumpf
- Unidade de Obesidade, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brasil
| | - Cintia Cercato
- Unidade de Obesidade, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brasil
| | - Ariana E Fernandes
- Unidade de Obesidade, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brasil
| | - Marcio C Mancini
- Unidade de Obesidade, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo, R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brasil
- Laboratório de Carboidratos e Radioimuniensaio (LIM-18), Faculdade de Medicina da Universidade São Paulo, São Paulo, Brasil
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Urdapilleta I, El Khoury L, Catheline JM, Lahlou S, Demarchi S. Mediating factors explain anxiety experienced by women with obesity during the Covid-19 pandemic. PLoS One 2023; 18:e0295034. [PMID: 38117823 PMCID: PMC10732381 DOI: 10.1371/journal.pone.0295034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/14/2023] [Indexed: 12/22/2023] Open
Abstract
The Covid-19 pandemic could be a source of great anxiety, especially for those at higher risk, such as women experiencing obesity. The aim of this study was to measure how some personal characteristics such as BMI (from underweight to class 3 obesity), bariatric surgery (yes or no), comorbidities, or age (as antecedent variables), and mediating factors impacted state anxiety during the Covid-19 Pandemic. Mediating factors were related to subjective knowledge or attitudes (e.g. interest or beliefs and practices around Covid-19, subjective health perception, and confidence in the government). French women (N = 532) were invited to take part in a voluntary online health survey during lockdown in Paris and its suburbs. Results showed that women with higher BMI had higher anxiety scores, primarily because they feel less healthy than other people. Secondly, the larger the body size of the participants was (BMI), the less they reported that information about Covid-19 held their attention. This lack of interest resulted in feelings of anxiety not being generated. Thirdly, the larger their body size was, the less confidence they had in the effectiveness of the proposed measures by the government and therefore, the more anxious they were. Finally, older age predicted higher interest in the pandemic, higher subjective health, and higher confidence in the government. Identifying obesity as a potential risk factor for anxiety disorders is crucial, but measuring the relationship between state anxiety and personal characteristics (e.g. BMI) requires considering mediating variables (e.g. subjective health perception). To reduce anxiety in women with obesity, it appears necessary to focus on psychological programs that can help them improve their perception of their health, as well as the confidence they may have in institutions, especially for younger women.
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Affiliation(s)
- Isabel Urdapilleta
- Department of Psychology, Laboratoire Cognitions Humaine et Artificielle (CHArt—EA 4004), Université Paris 8, Vincennes-Saint-Denis, France
| | - Lionel El Khoury
- Digestive Surgery Department, Delafontaine Hospital, Saint-Denis, France
| | | | - Saadi Lahlou
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
- Paris Institute for Advanced Study, Paris, France
| | - Samuel Demarchi
- Department of Psychology, Laboratoire Cognitions Humaine et Artificielle (CHArt—EA 4004), Université Paris 8, Vincennes-Saint-Denis, France
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8
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Wiebe N, Lloyd A, Crumley ET, Tonelli M. Associations between body mass index and all-cause mortality: A systematic review and meta-analysis. Obes Rev 2023; 24:e13588. [PMID: 37309266 DOI: 10.1111/obr.13588] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Fasting insulin and c-reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the "average" associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non-first order polynomials or splines. All-cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2 . Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β -0.829 [95% CI -1.313, -0.345] and adjusted β -0.746 [95% CI -1.471, -0.021]), Covid-19 (unadjusted β -0.333 [95% CI -0.650, -0.015]), critically ill (adjusted β -0.550 [95% CI -1.091, -0.010]), and surgical (unadjusted β -0.415 [95% CI -0.824, -0.006]) populations. The associations for general, cancer, and non-communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re-examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.
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Affiliation(s)
- Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Anita Lloyd
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ellen T Crumley
- Rowe School of Business, Dalhousie University, Halifax, Nova Scotia, Canada
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Nadimpalli G, O’Hara LM, Magder LS, Johnson JK, Haririan A, Pineles L, Goodman KE, Baghdadi JD, Pineles BL, Harris AD. Comorbidities associated with 30-day readmission following index coronavirus disease 2019 (COVID-19) hospitalization: A retrospective cohort study of 331,136 patients in the United States. Infect Control Hosp Epidemiol 2023; 44:1325-1333. [PMID: 36189788 PMCID: PMC11018251 DOI: 10.1017/ice.2022.232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hospital readmission is unsettling to patients and caregivers, costly to the healthcare system, and may leave patients at additional risk for hospital-acquired infections and other complications. We evaluated the association between comorbidities present during index coronavirus disease 2019 (COVID-19) hospitalization and the risk of 30-day readmission. DESIGN, SETTING, AND PARTICIPANTS We used the Premier Healthcare database to perform a retrospective cohort study of COVID-19 hospitalized patients discharged between April 2020 and March 2021 who were followed for 30 days after discharge to capture readmission to the same hospital. RESULTS Among the 331,136 unique patients in the index cohort, 36,827 (11.1%) had at least 1 all-cause readmission within 30 days. Of the readmitted patients, 11,382 (3.4%) were readmitted with COVID-19 as the primary diagnosis. In the multivariable model adjusted for demographics, hospital characteristics, coexisting comorbidities, and COVID-19 severity, each additional comorbidity category was associated with an 18% increase in the odds of all-cause readmission (adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 1.17-1.19) and a 10% increase in the odds of readmission with COVID-19 as the primary readmission diagnosis (aOR, 1.10; 95% CI, 1.09-1.11). Lymphoma (aOR, 1.86; 95% CI, 1.58-2.19), renal failure (aOR, 1.32; 95% CI, 1.25-1.40), and chronic lung disease (aOR, 1.29; 95% CI, 1.24-1.34) were most associated with readmission for COVID-19. CONCLUSIONS Readmission within 30 days was common among COVID-19 survivors. A better understanding of comorbidities associated with readmission will aid hospital care teams in improving postdischarge care. Additionally, it will assist hospital epidemiologists and quality administrators in planning resources, allocating staff, and managing bed-flow issues to improve patient care and safety.
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Affiliation(s)
- Gita Nadimpalli
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Lyndsay M. O’Hara
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Laurence S. Magder
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - J. Kristie Johnson
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
- Department of Pathology, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Abdolreza Haririan
- Division of Nephrology, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Lisa Pineles
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine E. Goodman
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D. Baghdadi
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Beth L. Pineles
- Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Anthony D. Harris
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
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10
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Shimoyama K, Endo A, Shimazui T, Tagami T, Yamakawa K, Hayakawa M, Ogura T, Hirayama A, Yasunaga H, Oda J. Association between obesity and mortality in critically ill COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective observational study. Sci Rep 2023; 13:11961. [PMID: 37488189 PMCID: PMC10366113 DOI: 10.1038/s41598-023-39157-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023] Open
Abstract
This study aimed to determine whether obesity and disease outcomes are associated in patients with critically-ill coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation (IMV). This retrospective observational study using Japanese multicenter registry data included COVID-19 patients who required IMV and were discharged between January and September 2020. The patients were divided into the obese (body mass index [BMI] ≥ 25 kg/m2) and nonobese (BMI < 25 kg/m2) groups. Logistic regression models were used to analyze the association between obesity and disease outcomes. The primary outcome was in-hospital mortality; the secondary outcome was venovenous extracorporeal membrane oxygenation (VV-ECMO) implementation. Altogether, 477 patients were enrolled (obese, n = 235, median BMI, 28.2 kg/m2; nonobese, n = 242, median BMI, 22.4 kg/m2). Obesity was significantly associated with lower in-hospital mortality in the unadjusted logistic regression model (odds ratio 0.63; 95% confidence interval, 0.42-0.97; p = 0.033), but not with mortality in the adjusted logistic regression model using age, sex, and Charlson Comorbidity Index as covariates (p = 0.564). Obesity was not associated with VV-ECMO implementation in both unadjusted and adjusted models (unadjusted, p = 0.074; adjusted, p = 0.695). Obesity was not associated with outcomes in COVID-19 patients requiring IMV. Obesity may not be a risk factor for poor outcomes in these patients.
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Affiliation(s)
- Keiichiro Shimoyama
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, 6-7-1, Nisi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Takashi Shimazui
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba, 292-8535, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation SAISEIKAI, Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hong, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan
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11
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Sutkowska E, Stanek A, Madziarska K, Jakubiak GK, Sokołowski J, Madziarski M, Sutkowska-Stępień K, Biernat K, Mazurek J, Borowkow-Bulek A, Czyżewski J, Wilk G, Jagasyk A, Marciniak D. Physical Activity Modifies the Severity of COVID-19 in Hospitalized Patients-Observational Study. J Clin Med 2023; 12:4046. [PMID: 37373739 DOI: 10.3390/jcm12124046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIM Physical activity (PA) can modulate the immune response, but its impact on infectious disease severity is unknown. We assess if the PA level impacts the severity of COVID-19. METHODS Prospective, cohort study for adults hospitalized due to COVID-19, who filled out the International Physical Activity Questionnaire (IPAQ). Disease severity was expressed as death, transfer to intensive care unit (ICU), oxygen therapy (OxTh), hospitalization length, complications, C-reactive protein, and procalcitonin level. RESULTS Out of 326 individuals, 131 (57; 43.51% women) were analyzed: age: median-70; range: 20-95; BMI: mean-27.18 kg/m²; and SD: ±4.77. During hospitalization: 117 (83.31%) individuals recovered, nine (6.87%) were transferred to ICU, five (3.82%) died, and 83 (63.36%) needed OxTh. The median for the hospital stay was 11 (range: 3-49) for discharged patients, and mean hospitalization length was 14 (SD: ±5.8312) for deaths and 14.22 days (SD: ±6.92) for ICU-transferred patients. The median for MET-min/week was 660 (range: 0-19,200). Sufficient or high PA was found in recovered patients but insufficient PA was observed in dead or ICU-transferred patients (p = 0.03). The individuals with poor PA had a higher risk of death (HR = 2.63; ±95%CI 0.58-11.93; p = 0.037). OxTh was used more often in the less active individuals (p = 0.03). The principal component analysis confirmed a relationship between insufficient PA and an unfavorable course of the disease. CONCLUSION A higher level of PA is associated with a milder course of COVID-19.
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Affiliation(s)
- Edyta Sutkowska
- University Rehabilitation Centre, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-902 Bytom, Poland
| | - Katarzyna Madziarska
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Grzegorz K Jakubiak
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-902 Bytom, Poland
| | - Janusz Sokołowski
- Clinical Department of Emergency Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Marcin Madziarski
- Clinical Department of Rheumatology and Internal Medicine, University Hospital, 50-556 Wroclaw, Poland
| | - Karolina Sutkowska-Stępień
- Department of General, Minimally Invasive and Endocrine Surgery, University Hospital, 50-556 Wroclaw, Poland
| | - Karolina Biernat
- University Rehabilitation Centre, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Justyna Mazurek
- University Rehabilitation Centre, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Adrianna Borowkow-Bulek
- Department of Internal Medicine, Angiology and Physical Medicine, Specialist Hospital No.2, 41-902 Bytom, Poland
| | - Jakub Czyżewski
- Postgraduate-Internship, University Hospital, 50-556 Wrocław, Poland
| | - Gabriela Wilk
- Postgraduate-Internship, University Hospital, 50-556 Wrocław, Poland
| | - Arkadiusz Jagasyk
- Postgraduate-Internship, University Hospital, 50-556 Wrocław, Poland
| | - Dominik Marciniak
- Department of Drugs Form Technology, Wroclaw Medical University, 50-556 Wroclaw, Poland
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12
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Tadayon Najafabadi B, Rayner DG, Shokraee K, Shokraie K, Panahi P, Rastgou P, Seirafianpour F, Momeni Landi F, Alinia P, Parnianfard N, Hemmati N, Banivaheb B, Radmanesh R, Alvand S, Shahbazi P, Dehghanbanadaki H, Shaker E, Same K, Mohammadi E, Malik A, Srivastava A, Nejat P, Tamara A, Chi Y, Yuan Y, Hajizadeh N, Chan C, Zhen J, Tahapary D, Anderson L, Apatu E, Schoonees A, Naude CE, Thabane L, Foroutan F. Obesity as an independent risk factor for COVID-19 severity and mortality. Cochrane Database Syst Rev 2023; 5:CD015201. [PMID: 37222292 PMCID: PMC10207996 DOI: 10.1002/14651858.cd015201] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Since December 2019, the world has struggled with the COVID-19 pandemic. Even after the introduction of various vaccines, this disease still takes a considerable toll. In order to improve the optimal allocation of resources and communication of prognosis, healthcare providers and patients need an accurate understanding of factors (such as obesity) that are associated with a higher risk of adverse outcomes from the COVID-19 infection. OBJECTIVES To evaluate obesity as an independent prognostic factor for COVID-19 severity and mortality among adult patients in whom infection with the COVID-19 virus is confirmed. SEARCH METHODS MEDLINE, Embase, two COVID-19 reference collections, and four Chinese biomedical databases were searched up to April 2021. SELECTION CRITERIA We included case-control, case-series, prospective and retrospective cohort studies, and secondary analyses of randomised controlled trials if they evaluated associations between obesity and COVID-19 adverse outcomes including mortality, mechanical ventilation, intensive care unit (ICU) admission, hospitalisation, severe COVID, and COVID pneumonia. Given our interest in ascertaining the independent association between obesity and these outcomes, we selected studies that adjusted for at least one factor other than obesity. Studies were evaluated for inclusion by two independent reviewers working in duplicate. DATA COLLECTION AND ANALYSIS: Using standardised data extraction forms, we extracted relevant information from the included studies. When appropriate, we pooled the estimates of association across studies with the use of random-effects meta-analyses. The Quality in Prognostic Studies (QUIPS) tool provided the platform for assessing the risk of bias across each included study. In our main comparison, we conducted meta-analyses for each obesity class separately. We also meta-analysed unclassified obesity and obesity as a continuous variable (5 kg/m2 increase in BMI (body mass index)). We used the GRADE framework to rate our certainty in the importance of the association observed between obesity and each outcome. As obesity is closely associated with other comorbidities, we decided to prespecify the minimum adjustment set of variables including age, sex, diabetes, hypertension, and cardiovascular disease for subgroup analysis. MAIN RESULTS: We identified 171 studies, 149 of which were included in meta-analyses. As compared to 'normal' BMI (18.5 to 24.9 kg/m2) or patients without obesity, those with obesity classes I (BMI 30 to 35 kg/m2), and II (BMI 35 to 40 kg/m2) were not at increased odds for mortality (Class I: odds ratio [OR] 1.04, 95% confidence interval [CI] 0.94 to 1.16, high certainty (15 studies, 335,209 participants); Class II: OR 1.16, 95% CI 0.99 to 1.36, high certainty (11 studies, 317,925 participants)). However, those with class III obesity (BMI 40 kg/m2 and above) may be at increased odds for mortality (Class III: OR 1.67, 95% CI 1.39 to 2.00, low certainty, (19 studies, 354,967 participants)) compared to normal BMI or patients without obesity. For mechanical ventilation, we observed increasing odds with higher classes of obesity in comparison to normal BMI or patients without obesity (class I: OR 1.38, 95% CI 1.20 to 1.59, 10 studies, 187,895 participants, moderate certainty; class II: OR 1.67, 95% CI 1.42 to 1.96, 6 studies, 171,149 participants, high certainty; class III: OR 2.17, 95% CI 1.59 to 2.97, 12 studies, 174,520 participants, high certainty). However, we did not observe a dose-response relationship across increasing obesity classifications for ICU admission and hospitalisation. AUTHORS' CONCLUSIONS Our findings suggest that obesity is an important independent prognostic factor in the setting of COVID-19. Consideration of obesity may inform the optimal management and allocation of limited resources in the care of COVID-19 patients.
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Affiliation(s)
| | - Daniel G Rayner
- Faculty Health Sciences, McMaster University, Hamilton, Canada
| | - Kamyar Shokraee
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Shokraie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Panahi
- Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Paravaneh Rastgou
- School of Medicine, Tabriz University of Medical Sciences, Tehran, Iran
| | | | - Feryal Momeni Landi
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pariya Alinia
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Parnianfard
- Research Center for Evidence-Based Medicine, Iranian Evidence-Based Medicine (EBM) Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nima Hemmati
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Banivaheb
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Radmanesh
- Society of Clinical Research Associates, Toronto, Canada
- Graduate division, Master of Advanced Studies in Clinical Research, University of California, San Diego, California, USA
| | - Saba Alvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parmida Shahbazi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Elaheh Shaker
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Same
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdullah Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Peyman Nejat
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alice Tamara
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic, Cardiovascular and Aging Cluster, The Indonesian Medical Education and Research Institute, Jakarta, Indonesia
| | - Yuan Chi
- Yealth Network, Beijing Yealth Technology Co., Ltd, Beijing, China
- Cochrane Campbell Global Ageing Partnership, London, UK
| | - Yuhong Yuan
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada
| | - Nima Hajizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Cynthia Chan
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Jamie Zhen
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Dicky Tahapary
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Ontario, Canada
| | - Laura Anderson
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Celeste E Naude
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
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13
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Gholi Z, Vahdat Shariatpanahi Z, Yadegarynia D, Eini-Zinab H. Associations of body mass index with severe outcomes of COVID-19 among critically ill elderly patients: A prospective study. Front Nutr 2023; 10:993292. [PMID: 36908906 PMCID: PMC9994813 DOI: 10.3389/fnut.2023.993292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Background and Aim Few studies assessed the associations of overweight and obesity with severe outcomes of coronavirus disease 2019 (COVID-19) among elderly patients. This study was conducted to assess overweight and obesity in relation to risk of mortality, delirium, invasive mechanical ventilation (IMV) requirement during treatment, re-hospitalization, prolonged hospitalization, and ICU admission among elderly patients with COVID-19. Methods This was a single-center prospective study that was done on 310 elderly patients with COVID-19 hospitalized in the intensive care unit (ICU). We collected data on demographic characteristics, laboratory parameters, nutritional status, blood pressure, comorbidities, medications, and types of mechanical ventilation at baseline. Patients were followed up during ICU admission and until 45 days after the first visit, and data on delirium incidence, mortality, need for a form of mechanical ventilation, discharge day from ICU and hospital, and re-hospitalization were recorded for each patient. Results During the follow-up period, we recorded 190 deaths, 217 cases of delirium, and 35 patients who required IMV during treatment. After controlling for potential confounders, a significant association was found between obesity and delirium such that obese patients with COVID-19 had a 62% higher risk of delirium compared with normal-weight patients (HR: 1.62, 95% CI: 1.02-2.57). This association was not observed for overweight. In terms of other outcomes including ICU/45-day mortality, IMV therapy during treatment, re-hospitalization, prolonged hospitalization, and ICU admission, we found no significant association with overweight and obesity either before or after controlling for potential confounders. Conclusion We found that obesity may be a risk factor for delirium among critically ill elderly patients with COVID-19.
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Affiliation(s)
- Zahra Gholi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Vahdat Shariatpanahi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Yadegarynia
- Infectious Disease and Tropical Medicine Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Hassan Eini-Zinab
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, and National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Nzinnou Mbiaketcha IS, Buh Nkum C, Tchio-Nighie KH, Njoudap Mfopou I, Nguegoue Tchokouaha F, Ateudjieu J. Chronic diseases and mortality among hospitalised COVID-19 patients at Bafoussam Regional Hospital in the West region of Cameroon. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001572. [PMID: 36963083 PMCID: PMC10021159 DOI: 10.1371/journal.pgph.0001572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023]
Abstract
Reducing mortality among COVID-19 cases is a major challenge for most health systems worldwide. Estimating the risk of preexisting comorbidities on COVID-19 mortality may promote the importance of targeting at-risk populations to improve survival through primary and secondary prevention. This study was conducted to explore the contribution of exposure to some chronic diseases on the mortality of COVID-19. This was a case control study. The data were collected from the records of all patients hospitalised at Bafoussam Regional Hospital (BRH) from March 2020 to December 2021. A grid was used to extract data on patient history, case management and outcome of hospitalised patients. We estimated the frequency of each common chronic disease and assessed the association between suffering from all and each chronic disease (Diabetes or/and Hypertension, immunodeficiency condition, obesity, tuberculosis, chronic kidney disease) and fatal outcome of hospitalised patients by estimating crude and adjusted odd ratios and their corresponding 95% confidence intervals (CI) using time to symptom onset and hospital admission up to three days, age range 65 years and above, health professional worker and married status as confounder's factors. Of 645 included patients, 120(20.23%) deaths were recorded. Among these 645 patients, 262(40.62%) were males, 128(19.84%) aged 65 years and above. The mean length of stay was 11.07. On admission, 204 (31.62%) patients presented at least one chronic disease. The most common chronic disease were hypertension (HBP) 73(11.32%), followed by diabetes + HBP 62 (9.61%), by diabetes 55(8.53%) and Immunodeficiency condition 14(2.17%). Diabetes and Diabetes + HBP were associated with a higher risk of death respectively aOR = 2.71[95%CI = 1.19-6.18] and aOR = 2.07[95% CI = 1.01-4.23] but HBP did not significantly increased the risk of death. These results suggest that health authorities should prioritize these specific group to adopt primary and secondary preventive interventions against SARS-CoV-2 infection.
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Affiliation(s)
- Imelda Sonia Nzinnou Mbiaketcha
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang Cameroon, Dschang, Cameroun
- Department of Health Research, M.A. SANTE (Meilleur Acces aux Soins de Sante), Yaounde, Cameroon
| | - Collins Buh Nkum
- Department of Health Research, M.A. SANTE (Meilleur Acces aux Soins de Sante), Yaounde, Cameroon
| | - Ketina Hirma Tchio-Nighie
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang Cameroon, Dschang, Cameroun
- Department of Health Research, M.A. SANTE (Meilleur Acces aux Soins de Sante), Yaounde, Cameroon
| | | | - Francois Nguegoue Tchokouaha
- Department of COVID-19 Management Bafoussam Regional Hospital, Bafoussam, Cameroon
- Department of Internal Medicine, Bafoussam Regional Hospital Center, Bafoussam, Cameroun
| | - Jérôme Ateudjieu
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang Cameroon, Dschang, Cameroun
- Department of Health Research, M.A. SANTE (Meilleur Acces aux Soins de Sante), Yaounde, Cameroon
- Division of Health Operations Research, Cameroon Ministry of Public, Yaounde, Cameroon
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15
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Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R, Leonardi-Bee J, Fernandez E, Carnicer-Pont D, Vestbo J, Semenza JC, Deogan C, Suk JE, Kramarz P, Lamb F, Penttinen P. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. Eur Respir Rev 2022; 31:220098. [PMID: 36323422 PMCID: PMC9724816 DOI: 10.1183/16000617.0098-2022] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. METHODS We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients. FINDINGS We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease. INTERPRETATION The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Dolors Carnicer-Pont
- Catalan Institute of Oncology, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), Barcelona, Spain
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Piotr Kramarz
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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16
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Ohno M, Dzúrová D. Body Mass Index and Risk for COVID-19-Related Hospitalization in Adults Aged 50 and Older in Europe. Nutrients 2022; 14:nu14194001. [PMID: 36235653 PMCID: PMC9572204 DOI: 10.3390/nu14194001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Higher body mass index (BMI) has been associated with a higher risk for severe COVID-19 outcomes. The aim of this study was to investigate associations among BMI, underlying health conditions and hospital admission as well as the effects of COVID-19 vaccines in adults aged 50 years and older in Europe using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) which was collected from June to August 2021, shortly after the second wave of the COVID-19 pandemic occurred in Europe. Survey data totalling 1936 individuals were used for statistical analyses to calculate the likelihood of hospitalization due to COVID-19 infection in relation to BMI, sociodemographic factors, comorbidities and COVID vaccination status. Approximately 16% of individuals testing positive for COVID-19 were hospitalized for COVID-19, and over 75% of these hospitalized individuals were either overweight or obese. The likelihood of hospitalization for individuals with obesity was approximately 1.5 times (CI [1.05–2.05]) higher than those with a healthy weight (BMI = 18.5–24.9 kg/m2) after adjusting for BMI, sex and age. After adjusting for sociodemographic factors, vaccination and comorbidities, the likelihood of hospitalization for individuals with obesity was 1.34 times higher than those with a healthy weight (CI [0.94–1.90]). Vaccine uptake was lowest in individuals with obesity (BMI ≥ 30 kg/m2) in all age groups. Individuals who had not received a vaccine were 1.8 times more likely to be hospitalized (CI [1.34–2.30]). Across European regions, obesity is associated with higher odds of hospitalization, and vaccination may be effective to reduce these odds for older adults.
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17
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Yoo YJ, Wilkins KJ, Alakwaa F, Liu F, Torre-Healy LA, Krichevsky S, Hong SS, Sakhuja A, Potu CK, Saltz JH, Saran R, Zhu RL, Setoguchi S, Kane-Gill SL, Mallipattu SK, He Y, Ellison DH, Byrd JB, Parikh CR, Moffitt RA, Koraishy FM. COVID-19-associated AKI in hospitalized US patients: incidence, temporal trends, geographical distribution, risk factors and mortality. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.09.02.22279398. [PMID: 36093355 PMCID: PMC9460976 DOI: 10.1101/2022.09.02.22279398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Acute kidney injury (AKI) is associated with mortality in patients hospitalized with COVID-19, however, its incidence, geographic distribution, and temporal trends since the start of the pandemic are understudied. Methods Electronic health record data were obtained from 53 health systems in the United States (US) in the National COVID Cohort Collaborative (N3C). We selected hospitalized adults diagnosed with COVID-19 between March 6th, 2020, and January 6th, 2022. AKI was determined with serum creatinine (SCr) and diagnosis codes. Time were divided into 16-weeks (P1-6) periods and geographical regions into Northeast, Midwest, South, and West. Multivariable models were used to analyze the risk factors for AKI or mortality. Results Out of a total cohort of 306,061, 126,478 (41.0 %) patients had AKI. Among these, 17.9% lacked a diagnosis code but had AKI based on the change in SCr. Similar to patients coded for AKI, these patients had higher mortality compared to those without AKI. The incidence of AKI was highest in P1 (49.3%), reduced in P2 (40.6%), and relatively stable thereafter. Compared to the Midwest, the Northeast, South, and West had higher adjusted AKI incidence in P1, subsequently, the South and West regions continued to have the highest relative incidence. In multivariable models, AKI defined by either SCr or diagnostic code, and the severity of AKI was associated with mortality. Conclusions Uncoded cases of COVID-19-associated AKI are common and associated with mortality. The incidence and distribution of COVID-19-associated AKI have changed since the first wave of the pandemic in the US.
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Affiliation(s)
- Yun Jae Yoo
- Department of Biology, Stony Brook University, Stony Brook, NY
| | - Kenneth J. Wilkins
- Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services, University of the Health Sciences, Bethesda, MD
| | - Fadhl Alakwaa
- Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Luke A. Torre-Healy
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Spencer Krichevsky
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Stephanie S. Hong
- Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ankit Sakhuja
- Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Chetan K. Potu
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Joel H. Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Rajiv Saran
- Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Richard L. Zhu
- Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Soko Setoguchi
- Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
| | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
| | - Sandeep K. Mallipattu
- Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Yongqun He
- Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
| | - David H. Ellison
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
| | - James Brian Byrd
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Richard A. Moffitt
- Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
| | - Farrukh M. Koraishy
- Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
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18
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Šarčević Z, Tepavčević A. Body mass index and comorbidities are associated with the duration of COVID-19 symptoms in non-hospitalized patients. J Int Med Res 2022; 50:3000605221127520. [PMID: 36177839 PMCID: PMC9528022 DOI: 10.1177/03000605221127520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Evidence indicates that people with a high body mass index (BMI) tend to develop more severe forms of coronavirus disease 2019 (COVID-19). In this study, we aimed to determine the association between the duration of COVID-19 symptoms and variables such as BMI, age, presence of comorbidities, and smoking in non-hospitalized patients. Methods In this observational cross-sectional analytical study, we analyzed the data of patients with COVID-19 but without severe manifestations. We conducted descriptive statistics, non-parametric tests, and multivariate quasi-Poisson regression in the analysis. The quasi-Poisson regression model was configured with the duration of COVID-19 symptoms as the response variable, and BMI and the presence of comorbidities as the explanatory variables. Results Among 302 non-hospitalized patients, we found a significant difference in COVID-19 symptom duration between the overweight group and the group with normal weight. Multivariate quasi-Poisson regression analysis showed that BMI and the presence of comorbidities were associated with the duration of COVID-19 symptoms. On the contrary, sex, age, and smoking status were not related to COVID-19 symptom duration. Conclusions BMI and comorbidities were associated with the duration of COVID-19 symptoms in non-hospitalized patients.
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Affiliation(s)
- Zoran Šarčević
- Novi Sad Health Care Centre, Sports Medicine Centre, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Andreja Tepavčević
- Faculty of Sciences, University of Novi Sad, Novi Sad, Serbia.,Mathematical Institute SANU, Belgrade, Serbia
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19
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Jennings M, Burova M, Hamilton LG, Hunter E, Morden C, Pandya D, Beecham R, Moyses H, Saeed K, Afolabi PR, Calder PC, Dushianthan A. Body mass index and clinical outcome of severe COVID-19 patients with acute hypoxic respiratory failure: Unravelling the “obesity paradox” phenomenon. Clin Nutr ESPEN 2022; 51:377-384. [PMID: 36184231 PMCID: PMC9356629 DOI: 10.1016/j.clnesp.2022.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
Background and aims Although obesity have been generally shown to be an independent risk factor for poor outcomes in COVID-19 infection, some studies demonstrate a paradoxical protective effect (“obesity paradox”). This study examines the influence of obesity categories on clinical outcomes of severe COVID-19 patients admitted to an intensive care unit with acute hypoxic respiratory failure requiring either non-invasive or invasive mechanical ventilation. Methods This is a single centre, retrospective study of consecutive COVID-19 patients admitted to the intensive care unit between 03/2020 to 03/2021. Patients were grouped according to the NICE Body Mass Index (BMI) category. Admission variables including age, sex, comorbidities, and ICU severity indices (APACHE-II, SOFA and PaO2/FiO2) were collected. Data were compared between BMI groups for outcomes such as need for invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and 28-day and overall hospital mortality. Results 340 patients were identified and of those 333 patients had their BMI documented. Just over half of patients (53%) had obesity. Those with extreme obesity (obesity groups II and III) were younger with fewer comorbidities, but were more hypoxaemic at presentation, than the healthy BMI group. Although non-significant, obesity groups II and III paradoxically showed a lower in-hospital mortality than the healthy weight group. However, adjusted (age, sex, APACHE-II and CCI) competing risk regression analysis showed three-times higher mortality in obese category I (sub-distribution hazard ratio = 3.32 (95% CI 1.30–8.46), p = 0.01) and a trend to higher mortality across all obesity groups compared to the healthy weight group. Conclusions In this cohort, those with obesity were at higher risk of mortality after adjustment for confounders. We did not identify an “obesity paradox” in this cohort. The obesity paradox may be explained by confounding factors such as younger age, fewer comorbidities, and less severe organ failures. The impact of obesity on indicators of morbidity including likelihood of requirement for organ support measures was not conclusively demonstrated and requires further scrutiny.
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Affiliation(s)
- Michael Jennings
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Maria Burova
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Laura G Hamilton
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Elsie Hunter
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Clare Morden
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Darshni Pandya
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Ryan Beecham
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Helen Moyses
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Paul R Afolabi
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Philip C Calder
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK.
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20
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Albarrán‐Sánchez A, Ramírez‐Rentería C, Anda‐Garay JC, Noyola‐García ME, Alberti‐Minutti P, Flores‐Padilla G, Guizar‐García LA, Contreras‐García CE, Marrero‐Rodríguez D, Taniguchi‐Ponciano K, Mercado M, Ferreira‐Hermosillo A. Differences in mortality rate among patients hospitalized with severe COVID-19 according to their body mass index. Obes Sci Pract 2022; 8:423-432. [PMID: 35949279 PMCID: PMC9358728 DOI: 10.1002/osp4.584] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022] Open
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/m2 (IQR 25.4-32.4 kg/m2), 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.
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Affiliation(s)
- Alejandra Albarrán‐Sánchez
- Servicio de Medicina Interna del Hospital de EspecialidadesCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Claudia Ramírez‐Rentería
- Unidad de Investigación Médica en Enfermedades EndocrinasCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Juan C. Anda‐Garay
- Servicio de Medicina Interna del Hospital de EspecialidadesCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Maura E. Noyola‐García
- Servicio de Medicina Interna del Hospital de EspecialidadesCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Paolo Alberti‐Minutti
- Servicio de Medicina Interna del Hospital de EspecialidadesCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Guillermo Flores‐Padilla
- Servicio de Medicina Interna del Hospital de EspecialidadesCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Luis A. Guizar‐García
- Servicio de Medicina Interna del Hospital de EspecialidadesCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Carlos E. Contreras‐García
- Servicio de Medicina Interna del Hospital de EspecialidadesCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Daniel Marrero‐Rodríguez
- Unidad de Investigación Médica en Enfermedades EndocrinasCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Keiko Taniguchi‐Ponciano
- Unidad de Investigación Médica en Enfermedades EndocrinasCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Moises Mercado
- Unidad de Investigación Médica en Enfermedades EndocrinasCentro Médico Nacional Siglo XXIMexico CityMexico
| | - Aldo Ferreira‐Hermosillo
- Unidad de Investigación Médica en Enfermedades EndocrinasCentro Médico Nacional Siglo XXIMexico CityMexico
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21
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Vulturar DM, Crivii CB, Orăsan OH, Palade E, Buzoianu AD, Zehan IG, Todea DA. Obesity Impact on SARS-CoV-2 Infection: Pros and Cons "Obesity Paradox"-A Systematic Review. J Clin Med 2022; 11:3844. [PMID: 35807129 PMCID: PMC9267674 DOI: 10.3390/jcm11133844] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/12/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND During the last years, the COVID-19 pandemic meets the pandemic generated by obesity, raising many questions regarding the outcomes of those with severe forms of infection. METHODS The present systematic review summarises and analyses the data providing evidence for or against the "obesity-paradox" in COVID-19 patients. After applying the inclusion and exclusion criteria, 23 studies were included. We also analysed the presumably underlying basic mechanisms. RESULTS The patients with a body mass index (BMI) of 30-40 kg/m2 presented severe symptoms that led to intensive care unit (ICU) admission but not increased death rate. Those with a higher degree of obesity, with a BMI higher than 40 kg/m2, led to a rise in the death rate, particularly in young patients. Obesity was associated with a higher rate of ICU admission but was not determined as an independent predictor of increased mortality. In contrast, some studies suggest a strong association between obesity or morbid obesity and the risk of death. CONCLUSIONS The existence of "obesity-paradox" cannot be stated; our study presents obesity as a critical risk factor in the evolution of COVID-19.
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Affiliation(s)
- Damiana-Maria Vulturar
- Department of Pneumology, Iuliu Hațieganu University of Medicine and Pharmacy, 400332 Cluj-Napoca, Romania; (D.-M.V.); (D.A.T.)
| | - Carmen-Bianca Crivii
- Morphological Sciences Department, Iuliu Hațieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Olga Hilda Orăsan
- 5th Department Internal Medicine, 4th Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania;
| | - Emanuel Palade
- Department of Cardiovascular and Thoracic Surgery, Iuliu Hațieganu University of Medicine and Pharmacy, 400332 Cluj-Napoca, Romania;
| | - Anca-Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - Iulia Georgiana Zehan
- Department of Cardiology, Heart Institute, Iuliu Hațieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania;
| | - Doina Adina Todea
- Department of Pneumology, Iuliu Hațieganu University of Medicine and Pharmacy, 400332 Cluj-Napoca, Romania; (D.-M.V.); (D.A.T.)
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22
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Graziano E, Peghin M, De Martino M, De Carlo C, Da Porto A, Bulfone L, Casarsa V, Sozio E, Fabris M, Cifù A, Grassi B, Curcio F, Isola M, Sechi LA, Tascini C, Croatto L, Ditaranto P, Ditaranto LM. The impact of body composition on mortality of COVID-19 hospitalized patients: A prospective study on abdominal fat, obesity paradox and sarcopenia. Clin Nutr ESPEN 2022; 51:437-444. [PMID: 36184240 PMCID: PMC9295328 DOI: 10.1016/j.clnesp.2022.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
Background & aims Obesity has been described as a predisposing risk factor to severe forms of COVID-19, but conflicting results are emerging on its real impact on the mortality of COVID-19. We aimed to compare clinical outcomes and mortality among COVID-19 patients according to obesity, metabolic syndrome and adiposity distribution. Methods We conducted a prospective observational study of all consecutive adult patients with a confirmed diagnosis of SARS-CoV-2 infection admitted to the Infectious Diseases Clinic at Udine Hospital, Italy, from January 2021 to February 2021. At admission, the study population was submitted to specific anthropometric, laboratory and bioimpedance analysis (BIA) measurements and divided into five groups according to: 1) BMI < or >30 kg/m2; 2) waist circumference (WC) < or >98 cm for women, < or >102 cm for men; 3) presence or absence of metabolic syndrome (MS); 4) visceral adipose tissue (VAT) distribution; and 5) presence or absence of sarcopenia (SP) both based on BIA. We then compared clinical outcomes (ventilatory support, intensive care unit (ICU) admission, ICU length of stay, total hospital length of stay and mortality), immune and inflammatory makers and infectious and non-infectious acute complications within the five groups. Results A total of 195 patients were enrolled in the study. The mean age of patients was 71 years (IQR 61–80) and 64.6% (126) were male. The most common comorbidities were hypertension (55.9%) and MS (55.4%). Overall mortality was 19.5%. Abdominal adiposity, measured both with WC and with BIA, and SP were significantly associated with need for increased ventilator support (p = 0.013 for WC; p = 0.037, 0.027 and 0.009 for VAT; p = 0.004 and 0.036 for FMI; and p = 0.051 for SP), but not with ICU admission (WC p = 0.627, VAT p = 0.153, FMI p = 0.519 and SP p = 0.938), length of stay (WC p = 0.345, VAT p = 0.650, FMI p = 0.159 and SP p = 0.992) and mortality (WC p = 0.277, VAT p = 0.533, FMI p = 0.957 and SP p = 0.211). Obesity and MS did not discriminate for the intensity of ventilatory outcome (p = 0.142 and p = 0.198, respectively), ICU admission (p = 0.802 and p = 0.947, respectively), length of stay (p = 0.471 and p = 0.768, respectively) and mortality (p = 0.495 and p = 0.268, respectively). We did not find significant differences in inflammatory markers and secondary complications within the five groups. Conclusions In patients admitted with COVID-19, increased WC, visceral abdominal fat and SP are associated with higher need for ventilatory support. However, obesity, MS, SP and abdominal adiposity are not sensitive predictive factors for mortality.
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23
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Serio CD, Malgaroli A, Ferrari P, Kenett RS. The reproducibility of COVID-19 data analysis: paradoxes, pitfalls, and future challenges. PNAS NEXUS 2022; 1:pgac125. [PMID: 36741433 PMCID: PMC9896906 DOI: 10.1093/pnasnexus/pgac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023]
Abstract
In the midst of the COVID-19 experience, we learned an important scientific lesson: knowledge acquisition and information quality in medicine depends more on "data quality" rather than "data quantity." The large number of COVID-19 reports, published in a very short time, demonstrated that the most advanced statistical and computational tools cannot properly overcome the poor quality of acquired data. The main evidence for this observation comes from the poor reproducibility of results. Indeed, understanding the data generation process is fundamental when investigating scientific questions such as prevalence, immunity, transmissibility, and susceptibility. Most of COVID-19 studies are case reports based on "non probability" sampling and do not adhere to the general principles of controlled experimental designs. Such collected data suffers from many limitations when used to derive clinical conclusions. These include confounding factors, measurement errors and bias selection effects. Each of these elements represents a source of uncertainty, which is often ignored or assumed to provide an unbiased random contribution. Inference retrieved from large data in medicine is also affected by data protection policies that, while protecting patients' privacy, are likely to reduce consistently usefulness of big data in achieving fundamental goals such as effective and efficient data-integration. This limits the degree of generalizability of scientific studies and leads to paradoxical and conflicting conclusions. We provide such examples from assessing the role of risks factors. In conclusion, new paradigms and new designs schemes are needed in order to reach inferential conclusions that are meaningful and informative when dealing with data collected during emergencies like COVID-19.
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Affiliation(s)
- Clelia Di Serio
- Vita-Salute San Raffaele University, UniSR, Milan, Italy
- University Centre of Statistics in the Biomedical Sciences CUSSB, UniSR, Milan, Italy
- Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland
| | | | - Paolo Ferrari
- Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland
- Ente Ospedaliero Cantonale, Lugano, Switzerland
- Clinical School, University of New South Wales, Sydney, Australia
| | - Ron S Kenett
- KPA,Samuel Neaman Institute, Technion, Haifa, Israel
- University of Turin, Turin, Italy
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Patel HM, Khandwala S, Somani P, Li Q, Tovar S, Montano A. Determining whether ethnic minorities with severe obesity face a disproportionate risk of serious disease and death from COVID-19: outcomes from a Southern California-based retrospective cohort study. BMJ Open 2022; 12:e059132. [PMID: 35768090 PMCID: PMC9243495 DOI: 10.1136/bmjopen-2021-059132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/10/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Obesity has been recognised as a risk factor for poor outcomes associated with COVID-19. Ethnic minorities with COVID-19 have been independently found to fare poorly. We aim to determine if ethnic minorities with severe obesity-defined as a body mass index (BMI) above 40 kg/m²-experience higher rates of hospitalisation, invasive ventilation and death. DESIGN AND SETTING Retrospective cohort study from 1 March 2020 to 28 February 2021 within an integrated healthcare organisation in Southern California. PARTICIPANTS We identified 373 831 patients by COVID-19 diagnosis code or positive laboratory test. METHODS Multivariable Poisson regression with robust error variance estimated adjusted risks of hospitalisation, invasive ventilator use and death within 30 days. Risks were stratified by ethnicity and BMI. RESULTS We identified multiple differences in risk of poor outcomes across BMI categories within individual ethnic groups. Hospitalisation risk with a BMI over 45 kg/m² was greater in Asian (RR 2.31, 95% CI 1.53 to 3.49; p<0.001), Hispanic (RR 3.22, 95% CI 2.99 to 3.48; p<0.001) and Pacific Islander (RR 3.79, 95% CI 2.49 to 5.75; p<0.001) patients compared with White (RR 2.04, 95% CI 1.79 to 2.33; p<0.001) and Black (RR 2.00, 95% CI 1.70 to 2.34; p<0.001) patients. A similar trend was observed with invasive ventilation risk. The risk of death was greater in Asian (RR 3.96, 95% CI 1.88 to 8.33; p<0.001), Hispanic (RR 3.03, 95% CI 2.53 to 3.61; p<0.001) and Pacific Islander (RR 4.60, 95% CI 1.42 to 14.92; p=0.011) patients compared with White (RR 1.47, 95% CI 1.13 to 1.91; p=0.005) and Black (RR 2.83, 95% CI 1.99 to 4.02; p<0.001) patients with a BMI over 45 kg/m². CONCLUSIONS Ethnic minorities with severe obesity, particularly Asian, Hispanic and Pacific Islander patients, had a statistically significant higher risk of hospitalisation, invasive ventilator use and death due to COVID-19. Potential explanations include differences in adipose tissue deposition, overall inflammation and ACE-2 receptor expression.
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Affiliation(s)
- Hemesh Mahesh Patel
- Family Medicine and Virtual Medicine, Southern California Permanente Medical Group, Huntington Beach, California, USA
| | - Shefali Khandwala
- Family Medicine, Southern California Permanente Medical Group, Anaheim, California, USA
| | - Poonam Somani
- Internal Medicine, Southern California Permanente Medical Group, Simi Valley, California, USA
| | - Qiaowu Li
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Stephanie Tovar
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Alejandra Montano
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Singh R, Rathore SS, Khan H, Karale S, Chawla Y, Iqbal K, Bhurwal A, Tekin A, Jain N, Mehra I, Anand S, Reddy S, Sharma N, Sidhu GS, Panagopoulos A, Pattan V, Kashyap R, Bansal V. Association of Obesity With COVID-19 Severity and Mortality: An Updated Systemic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne) 2022; 13:780872. [PMID: 35721716 PMCID: PMC9205425 DOI: 10.3389/fendo.2022.780872] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Background Obesity affects the course of critical illnesses. We aimed to estimate the association of obesity with the severity and mortality in coronavirus disease 2019 (COVID-19) patients. Data Sources A systematic search was conducted from the inception of the COVID-19 pandemic through to 13 October 2021, on databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Study Selection and Data Extraction Full-length articles focusing on the association of obesity and outcome in COVID-19 patients were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for study selection and data extraction. Our Population of interest were COVID-19 positive patients, obesity is our Intervention/Exposure point, Comparators are Non-obese vs obese patients The chief outcome of the study was the severity of the confirmed COVID-19 positive hospitalized patients in terms of admission to the intensive care unit (ICU) or the requirement of invasive mechanical ventilation/intubation with obesity. All-cause mortality in COVID-19 positive hospitalized patients with obesity was the secondary outcome of the study. Results In total, 3,140,413 patients from 167 studies were included in the study. Obesity was associated with an increased risk of severe disease (RR=1.52, 95% CI 1.41-1.63, p<0.001, I2 = 97%). Similarly, high mortality was observed in obese patients (RR=1.09, 95% CI 1.02-1.16, p=0.006, I2 = 97%). In multivariate meta-regression on severity, the covariate of the female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2 = 40% of the between-study heterogeneity for severity. The aforementioned covariates were found to be significant for mortality as well, and these covariates collectively explained R2 = 50% of the between-study variability for mortality. Conclusions Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and improvement of guidelines for patient care management is recommended.
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Affiliation(s)
- Romil Singh
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Hira Khan
- Department of Neurology, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Smruti Karale
- Department of Internal Medicine, Government Medical College-Kolhapur, Kolhapur, India
| | - Yogesh Chawla
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Nirpeksh Jain
- Department of Emergency Medicine, Marshfield Clinic, Marshfield, WI, United States
| | - Ishita Mehra
- Department of Internal Medicine, North Alabama Medical Center, Florence, AL, United States
| | - Sohini Anand
- Department of Internal Medicine, Patliputra Medical College and Hospital, Dhanbad, India
| | - Sanjana Reddy
- Department of Internal Medicine, Gandhi Medical College, Secunderabad, India
| | - Nikhil Sharma
- Department of Nephrology, Mayo Clinic, Rochester, MI, United States
| | - Guneet Singh Sidhu
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MI, United States
| | | | - Vishwanath Pattan
- Department of Medicine, Division of Endocrinology and Metabolism, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Vikas Bansal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MI, United States
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26
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Tsoulis MW, Garcia VL, Hou W, Arcan C, Miller JD. Comparing body mass index and obesity-related comorbidities as predictors in hospitalized COVID-19 patients. Clin Obes 2022; 12:e12514. [PMID: 35194933 PMCID: PMC9111682 DOI: 10.1111/cob.12514] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/12/2022]
Abstract
The association between body mass index (BMI) and poor COVID-19 outcomes in patients has been demonstrated across numerous studies. However, obesity-related comorbidities have also been shown to be associated with poor outcomes. The purpose of this study was to determine whether BMI or obesity-associated comorbidities contribute to elevated COVID-19 severity in non-elderly, hospitalized patients with elevated BMI (≥25 kg/m2 ). This was a single-center, retrospective cohort study of 526 hospitalized, non-elderly adult (aged 18-64) COVID-19 patients with BMI ≥25 kg/m2 in suburban New York from March 6 to May 11, 2020. The Edmonton Obesity Staging System (EOSS) was used to quantify the severity of obesity-related comorbidities. EOSS was compared with BMI in multivariable regression analyses to predict COVID-19 outcomes. We found that higher EOSS scores were associated with poor outcomes after demographic adjustment, unlike BMI. Specifically, patients with increased EOSS scores had increased odds of acute kidney injury (adjusted odds ratio [aOR] = 6.40; 95% CI 3.71-11.05), intensive care unit admission (aOR = 10.71; 95% CI 3.23-35.51), mechanical ventilation (aOR = 3.10; 95% CI 2.01-4.78) and mortality (aOR = 5.05; 95% CI 1.83-13.90). Obesity-related comorbidity burden as determined by EOSS was a better predictor of poor COVID-19 outcomes relative to BMI, suggesting that comorbidity burden may be driving risk in those hospitalized with elevated BMI.
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Affiliation(s)
- Michael W. Tsoulis
- Renaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Victor L. Garcia
- Department of PathologyDivision of Bioinformatics at Renaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Wei Hou
- Department of FamilyPopulation and Preventive Medicine at Renaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Chrisa Arcan
- Department of Family Medicine and Population HealthVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Joshua D. Miller
- Department of MedicineDivision of Endocrinology and Metabolism at Renaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
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Baltodano-Calle MJ, Polo-Vasquez JS, Romani-Pozo A, Gutarra-Saldaña D, Guija-Poma E. Leptin as a potential prognostic marker of the severity of COVID-19 infection in obese patients. Nutr Metab Cardiovasc Dis 2022; 32:743-744. [PMID: 35109999 PMCID: PMC8660140 DOI: 10.1016/j.numecd.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Maria J Baltodano-Calle
- Universidad Peruana Cayetano Heredia Facultad de Medicina, Lima, Peru; Sociedad Científica de Estudiantes De Medicina Cayetano Heredia (SOCEMCH), Lima, Peru.
| | - Jhoanna S Polo-Vasquez
- Universidad Peruana Cayetano Heredia Facultad de Medicina, Lima, Peru; Sociedad Científica de Estudiantes De Medicina Cayetano Heredia (SOCEMCH), Lima, Peru
| | - Alina Romani-Pozo
- Universidad Peruana Cayetano Heredia Facultad de Medicina, Lima, Peru
| | | | - Emilio Guija-Poma
- Universidad de San Martin de Porres Facultad de Medicina Humana, Centro de Investigación de Bioquímica y Nutrición, Lima, Peru
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28
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King JT, Yoon JS, Bredl ZM, Habboushe JP, Walker GA, Rentsch CT, Tate JP, Kashyap NM, Hintz RC, Chopra AP, Justice AC. Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1307 US academic medical centre inpatients and 427 224 US Medicare patients. J Epidemiol Community Health 2022; 76:254-260. [PMID: 34583962 PMCID: PMC8483922 DOI: 10.1136/jech-2021-216697] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Veterans Health Administration COVID-19 (VACO) Index predicts 30-day all-cause mortality in patients with COVID-19 using age, sex and pre-existing comorbidity diagnoses. The VACO Index was initially developed and validated in a nationwide cohort of US veterans-we now assess its accuracy in an academic medical centre and a nationwide US Medicare cohort. METHODS With measures and weights previously derived and validated in US national Veterans Health Administration (VA) inpatients and outpatients (n=13 323), we evaluated the accuracy of the VACO Index for estimating 30-day all-cause mortality using area under the receiver operating characteristic curve (AUC) and calibration plots of predicted versus observed mortality in inpatients at a single US academic medical centre (n=1307) and in Medicare inpatients and outpatients aged 65+ (n=427 224). RESULTS 30-day mortality varied by data source: VA 8.5%, academic medical centre 17.5%, Medicare 16.0%. The VACO Index demonstrated similar discrimination in VA (AUC=0.82) and academic medical centre inpatient population (AUC=0.80), and when restricted to patients aged 65+ in VA (AUC=0.69) and Medicare inpatient and outpatient data (AUC=0.67). The Index modestly overestimated risk in VA and Medicare data and underestimated risk in Yale New Haven Hospital data. CONCLUSIONS The VACO Index estimates risk of short-term mortality across a wide variety of patients with COVID-19 using data available prior to or at the time of diagnosis. The VACO Index could help inform primary and booster vaccination prioritisation, and indicate who among outpatients testing positive for SARS-CoV-2 should receive greater clinical attention or scarce treatments.
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Affiliation(s)
- Joseph T King
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - James S Yoon
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Joseph P Habboushe
- Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
- MDCalc.com, New York, New York, USA
| | - Graham A Walker
- MDCalc.com, New York, New York, USA
- Emergency Medicine, Kaiser Permanente, Oakland, California, USA
| | - Christopher T Rentsch
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Janet P Tate
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nitu M Kashyap
- Yale New Haven Health System, New Haven, Connecticut, USA
| | - Richard C Hintz
- Joint Data Analytics Team, Yale Center for Clinical Investigation, New Haven, Connecticut, USA
| | | | - Amy C Justice
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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29
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Espiritu AI, Reyes NGD, Leochico CFD, Sy MCC, Villanueva Iii EQ, Anlacan VMM, Jamora RDG. Body mass index and its association with COVID-19 clinical outcomes: Findings from the Philippine CORONA study. Clin Nutr ESPEN 2022; 49:402-410. [PMID: 35623845 PMCID: PMC8968152 DOI: 10.1016/j.clnesp.2022.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/04/2022] [Accepted: 03/11/2022] [Indexed: 12/17/2022]
Abstract
Background and aims To explore the association between body mass index (BMI) and adverse outcomes in a large cohort of patients with coronavirus disease 2019 (COVID-19). Methods This is a secondary analysis of a 37-site, nationwide, multicenter, retrospective cohort study that investigated the clinical and neurological outcomes of adult patients with confirmed COVID-19 admitted from February to December 15, 2020. Results We analyzed 4,463 patients with BMI and outcome data. A total of 790 (17.7%) and 710 (15.9%) had the primary outcome of in-hospital mortality and need for invasive mechanical ventilation (IMV), respectively. There was no significant association between WHO BMI groups and these outcomes. Using Asia-Pacific cutoffs showed a significant association between obesity and in-hospital mortality risk (P = 0.012). Being underweight was an independent predictor of prolonged IMV requirement regardless of BMI criteria used (P < 0.01). Obesity correlated with the need for intensive care unit admission using Asia-Pacific cutoffs (P = 0.029). There was a significant association between any BMI abnormality and odds of severe/critical COVID-19 (P < 0.05). Obese patients with concomitant acute neurological presentation/diagnosis during their COVID-19 admission were shown to have lower odds of neurologic recovery (P < 0.05). Conclusions We found BMI abnormalities to be associated with several adverse clinical and neurologic outcomes, although such associations may be more evident with the use of race-specific BMI criteria.
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Affiliation(s)
- Adrian I Espiritu
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, ON M5B 1W8, Canada.
| | - Nikolai Gil D Reyes
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Carl Froilan D Leochico
- Department of Rehabilitation Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City and Global City, Philippines.
| | - Marie Charmaine C Sy
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Emilio Q Villanueva Iii
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
| | - Veeda Michelle M Anlacan
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Roland Dominic G Jamora
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Institute for Neurosciences, St. Luke's Medical Center, Quezon City & Global City, Philippines.
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30
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Rosário Ferreira ME, Santos de Andrade AV, Ferreira Queiroz AA, Martins-Filho PR, de Aquino Neves EL, Oliveira de Carvalho F, de Souza Araujo AA, Ramos Silva É, Santos Nunes P. COVID-19 and obesity: a systematic review and meta-analysis on the pre-existing clinical conditions, COVID-19 symptoms, laboratory findings and clinical outcomes. EXCLI JOURNAL 2022; 20:1610-1614. [PMID: 35024019 PMCID: PMC8743833 DOI: 10.17179/excli2021-4226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/22/2021] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | | | | | - Fernanda Oliveira de Carvalho
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil.,Federal University of Sergipe, University Hospital (HU-UFS/EBSERH), Aracaju, Sergipe, Brazil
| | | | - Érika Ramos Silva
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Paula Santos Nunes
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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31
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Gryczyńska W, Litvinov N, Bitew B, Bartosz Z, Kośmider W, Bogdański P, Skrypnik D. Excess Body Mass-A Factor Leading to the Deterioration of COVID-19 and Its Complications-A Narrative Review. Viruses 2021; 13:v13122427. [PMID: 34960696 PMCID: PMC8708912 DOI: 10.3390/v13122427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023] Open
Abstract
Currently, the world is facing two serious pandemics: obesity and COVID-19. It is well-established that the prevalence of obesity has risen dramatically, causing a deterioration in the health quality of the population and increasing susceptibility for the unfavourable course of acute infections. It has been observed that excess body mass significantly influences the COVID-19 outcome. The aim of this review is to present the latest scientific reports on the impact of excess body mass on the course and complications of COVID-19. The Web of Science, PubMed, and Google Scholar databases were searched. Only studies reporting patients stated to be COVID-19 positive based on the results of a nasopharyngeal swab and the ribonucleic acid test were included. It is shown that thromboembolic and ischemic complications, namely stroke, disseminated intravascular coagulation, severe hyperglycaemia, and leukoencephalopathy are more likely to appear in COVID-19 positive patients with obesity compared to non-obese subjects. COVID-19 complications such as cardiomyopathy, dysrhythmias, endothelial dysfunction, acute kidney injury, dyslipidaemia, lung lesions and acute respiratory distress syndrome have a worse outcome among obese patients.
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Affiliation(s)
- Weronika Gryczyńska
- Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (W.G.); (N.L.); (B.B.); (Z.B.); (W.K.)
| | - Nikita Litvinov
- Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (W.G.); (N.L.); (B.B.); (Z.B.); (W.K.)
| | - Bezawit Bitew
- Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (W.G.); (N.L.); (B.B.); (Z.B.); (W.K.)
- Ethiopian Medical Students’ Association, Zambia Street, Addis Ababa P.O. Box 9302, Ethiopia
| | - Zuzanna Bartosz
- Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (W.G.); (N.L.); (B.B.); (Z.B.); (W.K.)
| | - Weronika Kośmider
- Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (W.G.); (N.L.); (B.B.); (Z.B.); (W.K.)
| | - Paweł Bogdański
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland;
| | - Damian Skrypnik
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland;
- Correspondence:
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32
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Denson JL, Gillet AS, Zu Y, Brown M, Pham T, Yoshida Y, Mauvais-Jarvis F, Douglas IS, Moore M, Tea K, Wetherbie A, Stevens R, Lefante J, Shaffer JG, Armaignac DL, Belden KA, Kaufman M, Heavner SF, Danesh VC, Cheruku SR, St Hill CA, Boman K, Deo N, Bansal V, Kumar VK, Walkey AJ, Kashyap R. Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19. JAMA Netw Open 2021; 4:e2140568. [PMID: 34935924 PMCID: PMC8696573 DOI: 10.1001/jamanetworkopen.2021.40568] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome. OBJECTIVE To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used data from the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study collected from 181 hospitals across 26 countries from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with metabolic syndrome (defined as ≥3 of the following criteria: obesity, prediabetes or diabetes, hypertension, and dyslipidemia) and a control population without metabolic syndrome. Participants included adult patients hospitalized for COVID-19 during the study period who had a completed discharge status. Data were analyzed from February 22 to October 5, 2021. EXPOSURES Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia. MAIN OUTCOMES AND MEASURES The primary outcome was in-hospital mortality. Secondary outcomes included ARDS, intensive care unit (ICU) admission, need for invasive mechanical ventilation, and length of stay (LOS). RESULTS Among 46 441 patients hospitalized with COVID-19, 29 040 patients (mean [SD] age, 61.2 [17.8] years; 13 059 [45.0%] women and 15713 [54.1%] men; 6797 Black patients [23.4%], 5325 Hispanic patients [18.3%], and 16 507 White patients [57.8%]) met inclusion criteria. A total of 5069 patients (17.5%) with metabolic syndrome were compared with 23 971 control patients (82.5%) without metabolic syndrome. In adjusted analyses, metabolic syndrome was associated with increased risk of ICU admission (adjusted odds ratio [aOR], 1.32 [95% CI, 1.14-1.53]), invasive mechanical ventilation (aOR, 1.45 [95% CI, 1.28-1.65]), ARDS (aOR, 1.36 [95% CI, 1.12-1.66]), and mortality (aOR, 1.19 [95% CI, 1.08-1.31]) and prolonged hospital LOS (median [IQR], 8.0 [4.2-15.8] days vs 6.8 [3.4-13.0] days; P < .001) and ICU LOS (median [IQR], 7.0 [2.8-15.0] days vs 6.4 [2.7-13.0] days; P < .001). Each additional metabolic syndrome criterion was associated with increased risk of ARDS in an additive fashion (1 criterion: 1147 patients with ARDS [10.4%]; P = .83; 2 criteria: 1191 patients with ARDS [15.3%]; P < .001; 3 criteria: 817 patients with ARDS [19.3%]; P < .001; 4 criteria: 203 patients with ARDS [24.3%]; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that metabolic syndrome was associated with increased risks of ARDS and death in patients hospitalized with COVID-19. The association with ARDS was cumulative for each metabolic syndrome criteria present.
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Affiliation(s)
- Joshua L Denson
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Yuanhao Zu
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Margo Brown
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Thaidan Pham
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Yilin Yoshida
- Section of Endocrinology and Metabolism, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
- Southeast Louisiana Veterans Affairs Healthcare System, New Orleans
| | - Franck Mauvais-Jarvis
- Section of Endocrinology and Metabolism, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
- Southeast Louisiana Veterans Affairs Healthcare System, New Orleans
| | - Ivor S Douglas
- Division of Pulmonary Sciences & Critical Care Medicine, Denver Health Medical Center, Denver, Colorado
- University of Colorado, Anschutz School of Medicine, Aurora
| | - Mathew Moore
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Kevin Tea
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Andrew Wetherbie
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Rachael Stevens
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - John Lefante
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jeffrey G Shaffer
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Katherine A Belden
- Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Smith F Heavner
- Prisma Health Department of Medicine, Prisma Health Upstate, Greenville, South Carolina
| | - Valerie C Danesh
- Baylor Scott & White Health, Department of Nursing, Dallas, Texas
| | - Sreekanth R Cheruku
- Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas
| | | | - Karen Boman
- Society of Critical Care Medicine, Mount Prospect, Illinois
| | - Neha Deo
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vikas Bansal
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Allan J Walkey
- The Pulmonary Center, Division of Pulmonary, Allergy, Sleep and Critical Care; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Rahul Kashyap
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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De Cassai A, Longhini F, Romagnoli S, Cavaliere F, Caroleo A, Foti L, Furlani E, Gianoli S, Monteleone F, Saraco G, Villa G, Conti G, Navalesi P. Research on SARS-COV-2 pandemic: a narrative review focused on the Italian contribution. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8596088 DOI: 10.1186/s44158-021-00017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Since late 2019, a severe acute respiratory syndrome, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread with overwhelming speed causing over 214 million confirmed infections and more than 4.5 million deaths worldwide. In this framework, Italy had the second highest number of SARS-CoV-2 infections worldwide, and the largest number of deaths. A global effort of both the scientific community and governments has been undertaken to stem the pandemic. The aim of this paper is to perform a narrative review of the Italian contribution to the scientific literature regarding intensive care management of patients suffering from COVID-19, being one of the first western countries to face an outbreak of SARS-CoV-2 infection.
Main body
We performed a narrative review of the literature, dedicating particular attention and a dedicated paragraph to ventilatory support management, chest imaging findings, biomarkers, possible pharmacological interventions, bacterial superinfections, prognosis and non-clinical key aspects such as communication and interaction with relatives.
Conclusions
Many colleagues, nurses and patients died leaving their families alone. To all of them, we send our thoughts and dedicate these pages.
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Mahamat-Saleh Y, Fiolet T, Rebeaud ME, Mulot M, Guihur A, El Fatouhi D, Laouali N, Peiffer-Smadja N, Aune D, Severi G. Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies. BMJ Open 2021; 11:e052777. [PMID: 34697120 PMCID: PMC8557249 DOI: 10.1136/bmjopen-2021-052777] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/07/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions. METHODS Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework. RESULTS A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I2=90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I2=91%, n=54, high certainty) for patients with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2 and 1.12 (95% CI 1.07 to 1.17, I2=68%, n=25) per 5 kg/m2 increase in BMI. There was evidence of a J-shaped non-linear dose-response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22-24, and a 1.5-2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40-45). The SRR was 1.28 (95% CI 1.17 to 1.40, I2=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I2=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I2=75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively. CONCLUSION Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths. TRIAL REGISTRATION NUMBER CRD42020218115.
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Affiliation(s)
- Yahya Mahamat-Saleh
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Thibault Fiolet
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Mathieu Edouard Rebeaud
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Matthieu Mulot
- Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchatel, Neuchâtel, Switzerland
| | - Anthony Guihur
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Douae El Fatouhi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nasser Laouali
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nathan Peiffer-Smadja
- Universite de Paris, IAME, INSERM, Paris, France
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gianluca Severi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
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Czapla M, Juárez-Vela R, Gea-Caballero V, Zieliński S, Zielińska M. The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU. Nutrients 2021; 13:3302. [PMID: 34684305 PMCID: PMC8538443 DOI: 10.3390/nu13103302] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has become one of the leading causes of death worldwide. The impact of poor nutritional status on increased mortality and prolonged ICU (intensive care unit) stay in critically ill patients is well-documented. This study aims to assess how nutritional status and BMI (body mass index) affected in-hospital mortality in critically ill COVID-19 patients Methods: We conducted a retrospective study and analysed medical records of 286 COVID-19 patients admitted to the intensive care unit of the University Clinical Hospital in Wroclaw (Poland). RESULTS A total of 286 patients were analysed. In the sample group, 8% of patients who died had a BMI within the normal range, 46% were overweight, and 46% were obese. There was a statistically significantly higher death rate in men (73%) and those with BMIs between 25.0-29.9 (p = 0.011). Nonsurvivors had a statistically significantly higher HF (Heart Failure) rate (p = 0.037) and HT (hypertension) rate (p < 0.001). Furthermore, nonsurvivors were statistically significantly older (p < 0.001). The risk of death was higher in overweight patients (HR = 2.13; p = 0.038). Mortality was influenced by higher scores in parameters such as age (HR = 1.03; p = 0.001), NRS2002 (nutritional risk score, HR = 1.18; p = 0.019), PCT (procalcitonin, HR = 1.10; p < 0.001) and potassium level (HR = 1.40; p = 0.023). CONCLUSIONS Being overweight in critically ill COVID-19 patients requiring invasive mechanical ventilation increases their risk of death significantly. Additional factors indicating a higher risk of death include the patient's age, high PCT, potassium levels, and NRS ≥ 3 measured at the time of admission to the ICU.
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Affiliation(s)
- Michał Czapla
- Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland;
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Raúl Juárez-Vela
- Biomedical Research Centre of La Rioja (CIBIR), Research Group GRUPAC, Research Unit on Health System Sustainability (GISSOS), University of La Rioja, 26004 Logroño, Spain
| | - Vicente Gea-Caballero
- Faculty of Health Sciences, International University of Valencia, 46002 Valencia, Spain;
| | - Stanisław Zieliński
- Department and Clinic of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, 50-556 Wrocław, Poland; (S.Z.); (M.Z.)
- Department of Anaesthesiology and Intensive Care, University Hospital, 50-556 Wrocław, Poland
| | - Marzena Zielińska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, 50-556 Wrocław, Poland; (S.Z.); (M.Z.)
- Department of Paediatric Anaesthesiology and Intensive Care, University Hospital, 50-556 Wrocław, Poland
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Natural Dietary and Medicinal Plants with Anti-Obesity Therapeutics Activities for Treatment and Prevention of Obesity during Lock Down and in Post-COVID-19 Era. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11177889] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Overweight and obesity have become global epidemics, especially during the lockdown due to the COVID-19 pandemic. The potential of medicinal plants as a better and safe option in treating obesity and overweight has gained attention in recent years. Obesity and overweight has become a major public health concern, and its incidence rising at an alarming rate. Obesity is one of the major types of metabolic syndrome, resulting in various types of problems such as hypertension, diabetes, dyslipidemia, and excess fat accumulation. The current searching was done by the keywords in main indexing systems including Scopus, PubMed/MEDLINE, the search engine of Google Scholar, and Institute for Scientific Web of Science. The keywords were traditional medicine, health benefits, pharmaceutical science, pomegranate, punicalin, punicalagin, and ellagitannins. Google Scholar was searched manually for possible missing manuscripts, and there was no language restriction in the search. This review was carried out to highlight the importance of medicinal plants which are common in traditional medicinal sciences of different countries, especially Asia to prevent and treatment of obesity and overweight during the global pandemic and the post-COVID-19 era.
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Gómez-Zorita S, Milton-Laskibar I, García-Arellano L, González M, Portillo MP. An Overview of Adipose Tissue ACE2 Modulation by Diet and Obesity. Potential Implications in COVID-19 Infection and Severity. Int J Mol Sci 2021; 22:7975. [PMID: 34360741 PMCID: PMC8347022 DOI: 10.3390/ijms22157975] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 12/11/2022] Open
Abstract
The present review is aimed at analysing the current evidence concerning the potential modulation of obesity and/or diet in adipose tissue ACE2. Additionally, the potential implications of these effects on COVID-19 are also addressed. The results published show that diet and obesity are two factors that effectively influence the expression of Ace2 gene in adipose tissue. However, the shifts in this gene do not always occur in the same direction, nor with the same intensity. Additionally, there is no consensus regarding the implications of increased adipose tissue ACE2 expression in health. Thus, while in some studies a protective role is attributed to ACE2 overexpression, other studies suggest otherwise. Similarly, there is much debate regarding the role played by ACE2 in COVID-19 in terms of degree of infection and disease outcomes. The greater risk of infection that may hypothetically derive from enhanced ACE2 expression is not clear since the functionality of the enzyme seems to be as important as the abundance. Thus, the greater abundance of ACE2 in adipose tissue of obese subjects may be counterbalanced by its lower activation. In addition, a protective role of ACE2 overexpression has also been suggested, associated with the increase in anti-inflammatory factors that it may produce.
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Affiliation(s)
- Saioa Gómez-Zorita
- Nutrition and Obesity Group, Lucio Lascaray Research Center, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain; (L.G.-A.); (M.P.P.)
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- BIOARABA Health Research Institute, 01006 Vitoria-Gasteiz, Spain
| | - Iñaki Milton-Laskibar
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, Spanish National Research Council, 28049 Madrid, Spain
| | - Laura García-Arellano
- Nutrition and Obesity Group, Lucio Lascaray Research Center, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain; (L.G.-A.); (M.P.P.)
| | - Marcela González
- Nutrition and Food Science Department, Faculty of Biochemistry and Biological Sciences, National University of Litoral and National Scientific and Technical Research Council (CONICET), Santa Fe 3000, Argentina;
| | - María P. Portillo
- Nutrition and Obesity Group, Lucio Lascaray Research Center, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain; (L.G.-A.); (M.P.P.)
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- BIOARABA Health Research Institute, 01006 Vitoria-Gasteiz, Spain
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Body Mass Index and Mortality in Coronavirus Disease 2019 and Other Diseases: A Cohort Study in 35,506 ICU Patients. Crit Care Med 2021; 50:e1-e10. [PMID: 34374504 PMCID: PMC8670082 DOI: 10.1097/ccm.0000000000005216] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: Obesity is a risk factor for severe coronavirus disease 2019 and might play a role in its pathophysiology. It is unknown whether body mass index is related to clinical outcome following ICU admission, as observed in various other categories of critically ill patients. We investigated the relationship between body mass index and inhospital mortality in critically ill coronavirus disease 2019 patients and in cohorts of ICU patients with non-severe acute respiratory syndrome coronavirus 2 viral pneumonia, bacterial pneumonia, and multiple trauma. DESIGN: Multicenter observational cohort study. SETTING: Eighty-two Dutch ICUs participating in the Dutch National Intensive Care Evaluation quality registry. PATIENTS: Thirty-five–thousand five-hundred six critically ill patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patient characteristics and clinical outcomes were compared between four cohorts (coronavirus disease 2019, nonsevere acute respiratory syndrome coronavirus 2 viral pneumonia, bacterial pneumonia, and multiple trauma patients) and between body mass index categories within cohorts. Adjusted analyses of the relationship between body mass index and inhospital mortality within each cohort were performed using multivariable logistic regression. Coronavirus disease 2019 patients were more likely male, had a higher body mass index, lower Pao2/Fio2 ratio, and were more likely mechanically ventilated during the first 24 hours in the ICU compared with the other cohorts. Coronavirus disease 2019 patients had longer ICU and hospital length of stay, and higher inhospital mortality. Odds ratios for inhospital mortality for patients with body mass index greater than or equal to 35 kg/m2 compared with normal weight in the coronavirus disease 2019, nonsevere acute respiratory syndrome coronavirus 2 viral pneumonia, bacterial pneumonia, and trauma cohorts were 1.15 (0.79–1.67), 0.64 (0.43–0.95), 0.73 (0.61–0.87), and 0.81 (0.57–1.15), respectively. CONCLUSIONS: The obesity paradox, which is the inverse association between body mass index and mortality in critically ill patients, is not present in ICU patients with coronavirus disease 2019–related respiratory failure, in contrast to nonsevere acute respiratory syndrome coronavirus 2 viral and bacterial respiratory infections.
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Reiner Benaim A, Sobel JA, Almog R, Lugassy S, Ben Shabbat T, Johnson A, Eytan D, Behar JA. Comparing COVID-19 and Influenza Presentation and Trajectory. Front Med (Lausanne) 2021; 8:656405. [PMID: 34055833 PMCID: PMC8160103 DOI: 10.3389/fmed.2021.656405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background: COVID-19 is a newly recognized illness with a predominantly respiratory presentation. It is important to characterize the differences in disease presentation and trajectory between COVID-19 patients and other patients with common respiratory illnesses. These differences can enhance knowledge of pathogenesis and help in guiding treatment. Methods: Data from electronic medical records were obtained from individuals admitted with respiratory illnesses to Rambam Health Care Campus, Haifa, Israel, between October 1st, 2014 and October 1st, 2020. Four groups of patients were defined: COVID-19 (693), influenza (1,612), severe acute respiratory infection (SARI) (2,292), and Others (4,054). The variable analyzed include demographics (7), vital signs (8), lab tests (38), and comorbidities (15) from a total of 8,651 hospitalized adult patients. Statistical analysis was performed on biomarkers measured at admission and for their disease trajectory in the first 48 h of hospitalization, and on comorobidity prevalence. Results: COVID-19 patients were overall younger in age and had higher body mass index, compared to influenza and SARI. Comorbidity burden was lower in the COVID-19 group compared to influenza and SARI. Severely- and moderately-ill COVID-19 patients older than 65 years of age suffered higher rate of in-hospital mortality compared to hospitalized influenza patients. At admission, white blood cells and neutrophils were lower among COVID-19 patients compared to influenza and SARI patients, while pulse rate and lymphoctye percentage were higher. Trajectories of variables during the first 2 days of hospitalization revealed that white blood count, neutrophils percentage and glucose in blood increased among COVID-19 patients, while decreasing among other patients. Conclusions: The intrinsic virulence of COVID-19 appeared higher than influenza. In addition, several critical functions, such as immune response, coagulation, heart and respiratory function, and metabolism were uniquely affected by COVID-19.
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Affiliation(s)
| | - Jonathan A. Sobel
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Snir Lugassy
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Tsviel Ben Shabbat
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Alistair Johnson
- MIT Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Danny Eytan
- Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Joachim A. Behar
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
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Predictors of Worse Prognosis in Young and Middle-Aged Adults Hospitalized with COVID-19 Pneumonia: A Multi-Center Italian Study (COVID-UNDER50). J Clin Med 2021; 10:jcm10061218. [PMID: 33804084 PMCID: PMC7999047 DOI: 10.3390/jcm10061218] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
Obesity as well as metabolic and cardiovascular comorbidities are established, significant predictors of worse prognosis in the overall COVID-19 population, but limited information is available on their roles in young and middle-aged adults (aged ≤ 50 years). The main objectives of the present Italian multi-center study were to describe clinical characteristics and role of selected prognostic predictors in a large cohort of young and middle-aged hospitalized patients. Nine pulmonology units, across north and center of Italy, were involved in this retrospective study. Comorbidities were classified according to their known or potential association with COVID-19. A total of 263 subjects were included. The prevalence of obesity was 25.9%, mechanical ventilation (MV) was needed in 27.7%, and 28 in-hospital deaths occurred (10.6%). Obesity and older age were the only independent, significant predictors for MV. Comorbidities, such as hypertension, diabetes, asthma, and increased D-dimer levels were significantly associated with higher mortality risk, regardless of age, body mass index, and MV. Obesity in young and middle-aged adults is a strong predictor of a more complicated COVID-19, without, however, evidence of a significant effect on in-hospital mortality. Selected comorbidities, including hypertension, diabetes and asthma, significantly impact survival even in a younger population, suggesting the need for prompt recognition of these conditions.
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Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry. Obes Res Clin Pract 2021; 15:275-280. [PMID: 33741308 PMCID: PMC7927637 DOI: 10.1016/j.orcp.2021.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023]
Abstract
Background Obesity has been described as a protective factor in cardiovascular and other diseases being expressed as ‘obesity paradox’. However, the impact of obesity on clinical outcomes including mortality in COVID-19 has been poorly systematically investigated until now. We aimed to compare clinical outcomes among COVID-19 patients divided into three groups according to the body mass index (BMI). Methods We retrospectively collected data up to May 31st, 2020. 3635 patients were divided into three groups of BMI (<25 kg/m2; n = 1110, 25−30 kg/m2; n = 1464, and >30 kg/m2; n = 1061). Demographic, in-hospital complications, and predictors for mortality, respiratory insufficiency, and sepsis were analyzed. Results The rate of respiratory insufficiency was more recorded in BMI 25−30 kg/m2 as compared to BMI < 25 kg/m2 (22.8% vs. 41.8%; p < 0.001), and in BMI > 30 kg/m2 than BMI < 25 kg/m2, respectively (22.8% vs. 35.4%; p < 0.001). Sepsis was more observed in BMI 25−30 kg/m2 and BMI > 30 kg/m2 as compared to BMI < 25 kg/m2, respectively (25.1% vs. 42.5%; p = 0.02) and (25.1% vs. 32.5%; p = 0.006). The mortality rate was higher in BMI 25−30 kg/m2 and BMI > 30 kg/m2 as compared to BMI < 25 kg/m2, respectively (27.2% vs. 39.2%; p = 0.31) (27.2% vs. 33.5%; p = 0.004). In the Cox multivariate analysis for mortality, BMI < 25 kg/m2 and BMI > 30 kg/m2 did not impact the mortality rate (HR 1.15, 95% CI: 0.889−1.508; p = 0.27) (HR 1.15, 95% CI: 0.893−1.479; p = 0.27). In multivariate logistic regression analyses for respiratory insufficiency and sepsis, BMI < 25 kg/m2 is determined as an independent predictor for reduction of respiratory insufficiency (OR 0.73, 95% CI: 0.538−1.004; p = 0.05). Conclusions HOPE COVID-19-Registry revealed no evidence of obesity paradox in patients with COVID-19. However, Obesity was associated with a higher rate of respiratory insufficiency and sepsis but was not determined as an independent predictor for a high mortality.
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Yu W, Rohli KE, Yang S, Jia P. Impact of obesity on COVID-19 patients. J Diabetes Complications 2021; 35:107817. [PMID: 33358523 PMCID: PMC7690270 DOI: 10.1016/j.jdiacomp.2020.107817] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/29/2020] [Accepted: 11/11/2020] [Indexed: 02/08/2023]
Abstract
With the increasing prevalence of obesity, there is a growing awareness of its impact on infectious diseases. In past epidemics of influenza A and Middle East respiratory syndrome (MERS) coronavirus, obesity has been identified as a risk factor influencing the severity of illness in infected persons. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for a large number of deaths and health damages worldwide. Increasing numbers of reports have linked obesity to more severe COVID-19 disease and death. This review focuses on the impact of obesity on patients with COVID-19. We comprehensively analyzed the various mechanisms of obesity affecting the severity of the disease. In addition, on the basis of the vulnerability of people with obesity during the COVID-19 epidemic, we summarized both individual-level and hospital-level prevention and management measures for COVID-19 patients with obesity and discussed the impact of isolation on people with obesity.
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Affiliation(s)
- Wanqi Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Kristen E Rohli
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.
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Mohammad S, Aziz R, Al Mahri S, Malik SS, Haji E, Khan AH, Khatlani TS, Bouchama A. Obesity and COVID-19: what makes obese host so vulnerable? IMMUNITY & AGEING 2021; 18:1. [PMID: 33390183 PMCID: PMC7779330 DOI: 10.1186/s12979-020-00212-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022]
Abstract
The disease (COVID-19) novel coronavirus pandemic has so far infected millions resulting in the death of over a million people as of Oct 2020. More than 90% of those infected with COVID-19 show mild or no symptoms but the rest of the infected cases show severe symptoms resulting in significant mortality. Age has emerged as a major factor to predict the severity of the disease and mortality rates are significantly higher in elderly patients. Besides, patients with underlying conditions like Type 2 diabetes, cardiovascular diseases, hypertension, and cancer have an increased risk of severe disease and death due to COVID-19 infection. Obesity has emerged as a novel risk factor for hospitalization and death due to COVID-19. Several independent studies have observed that people with obesity are at a greater risk of severe disease and death due to COVID-19. Here we review the published data related to obesity and overweight to assess the possible risk and outcome in Covid-19 patients based on their body weight. Besides, we explore how the obese host provides a unique microenvironment for disease pathogenesis, resulting in increased severity of the disease and poor outcome.
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Affiliation(s)
- Sameer Mohammad
- Experimental Medicine Department, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences-MNGHA, Riyadh, 11426, Saudi Arabia.
| | - Rafia Aziz
- Government Medical College Baramulla, Baramulla, Kashmir, India
| | - Saeed Al Mahri
- Experimental Medicine Department, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences-MNGHA, Riyadh, 11426, Saudi Arabia
| | - Shuja Shafi Malik
- Experimental Medicine Department, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences-MNGHA, Riyadh, 11426, Saudi Arabia
| | - Esraa Haji
- Experimental Medicine Department, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences-MNGHA, Riyadh, 11426, Saudi Arabia
| | - Altaf Husain Khan
- Biostatistics and Bioinformatics Department, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences-MNGHA, Riyadh, 11426, Saudi Arabia
| | - Tanvir Saleem Khatlani
- Department of Cellular Therapy, Stem Cells Unit, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences--MNGHA, Riyadh, 11426, Saudi Arabia
| | - Abderrezak Bouchama
- Experimental Medicine Department, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences-MNGHA, Riyadh, 11426, Saudi Arabia
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