Comparing body mass index and obesity-related comorbidities as predictors in hospitalized COVID-19 patients

Mortality risk in patients with obesity and COVID-19 infection: a systematic review and meta-analysis

Obesity is a risk factor for severe respiratory diseases, including COVID-19 infection. Meta-analyses on mortality risk were inconsistent. We systematically searched 3 databases (Medline, Embase, CINAHL) and assessed the quality of studies using the Newcastle-Ottawa tool (CRD42020220140). We included 199 studies from US and Europe, with a mean age of participants 41.8-78.2 years, and a variable prevalence of metabolic co-morbidities of 20-80 %. Exceptionally, one third of the studies had a low prevalence of obesity of <20 %. Compared to patients with normal weight, those with obesity had a 34 % relative increase in the odds of mortality (p-value 0.002), with a dose-dependent relationship. Subgroup analyses showed an interaction with the country income. There was a high heterogeneity in the results, explained by clinical and methodologic variability across studies. We identified one trial only comparing mortality rate in vaccinated compared to unvaccinated patients with obesity; there was a trend for a lower mortality in the former group. Mortality risk in COVID-19 infection increases in parallel to an increase in BMI. BMI should be included in the predictive models and stratification scores used when considering mortality as an outcome in patients with COVID-19 infections. Furthermore, patients with obesity might need to be prioritized for COVID-19 vaccination.

Predicting COVID-19 outcomes with the Edmonton Obesity Staging System

BACKGROUND

Multiple studies have demonstrated a correlation between a high body mass index and discriminatory COVID-19 outcomes. Studies appear to indicate that there is a correlation between obesity-related comorbidities and less favorable outcomes.

OBJECTIVES

The primary aim of the current investigation is to conduct a thorough assessment of the correlation between BMI and comorbidities associated with obesity, and their potential impact on the severity and consequences of COVID-19 infection among patients receiving care in a tertiary healthcare setting.

DESIGN

Retrospective cohort.

SETTINGS

Tertiary rehabilitation center, Riyadh, Saudi Arabia.

PATIENTS AND METHODS

The study included all individuals who received medical treatment and tested positive for COVID-19 by means of RT-PCR during the period from March to September 2020. COVID-19 patients were classified using Edmonton Obesity Staging System (EOSS).

MAIN OUTCOME MEASURES

COVID-19-related complications, including pneumonia and cytokine release syndrome, as well as the time length to COVID-19 negativization.

SAMPLE SIZE

315 patients.

RESULTS

The median (25th-75th percentiles) age of the patients was 38 (31.5-49) years old. Males outnumbered females, and 66% of patients were non-Saudis. Forty-eight patients (15.2%) had obesity class I, whereas 13 patients (4.1%) had class II. Thirty-two patients (10.2%) were classified as EOSS stage 1, 105 patients (33.3%) were classified as EOSS stage 2, and 25 patients (7.9%) were assigned to EOSS stage 3. Males predominated in EOSS stages 1 and 2, whereas females predominated in stage 3. In EOSS stage 3, 52% of cases had moderate severity and 48% had severe illness.

CONCLUSIONS

EOSS distinguishes the COVID-19 risks of poor outcomes beyond BMI. Patients who were overweight or obese but remained in the stage 1 of the EOSS had a lower risk of a poor COVID-19 outome than normal-weight patients. The health status of obese patients is a more precise indicator of the progression of COVID-19 during hospitalization than BMI alone.

LIMITATIONS

Given the limited capacity of urgent care facilities to conduct a comprehensive evaluation of comorbidities and other relevant outcomes in all patients, it is plausible that certain patients may have been erroneously classified with an EOSS stage 2 diagnosis, when in fact they ought to have been assigned a stage 3 diagnosis.

Factors associated with inpatient complications among patients with obesity and COVID-19 at an urban safety-net hospital: A retrospective cohort study

Objective

Obesity increases morbidity and mortality from Coronavirus disease 2019 (COVID-19). This study characterized inpatient complications among patients with obesity and COVID-19-including myocardial infarction, renal failure requiring dialysis, stroke, secondary bacterial infection, and venous thromboembolism-and identified factors associated with developing at least one inpatient complication at a safety-net hospital with a diverse cohort.

Methods

A retrospective review was performed of all patients admitted for ≥3 days with COVID-19 between 16 March 2020, and 8 April 2020. Logistic regression identified factors associated with developing at least one COVID-19-related complication among patients with obesity (body mass index ≥30 kg/m2).

Results

374 patients were included; 53.7% were classified as having obesity, 43.9% identified as Black, and 38.5% identified as Latino or Hispanic. Obesity was not associated with having at least one inpatient complication on multivariable analysis, but increased age (aOR 1.02, [95% CI 1.01-1.04], p = 0.010) and obstructive sleep apnea (aOR 2.25, [1.08-4.85], p = 0.034) were associated with this outcome.

Conclusions

Obesity was not associated with specified inpatient complications among patients with COVID-19 admitted to a health system caring for diverse patients. Future studies should incorporate larger cohorts and reflect newer treatment protocols.