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Haber R, Ghezzawi M, Puzantian H, Haber M, Saad S, Ghandour Y, El Bachour J, Yazbeck A, Hassanieh G, Mehdi C, Ismail D, Abi-Kharma E, El-Zein O, Khamis A, Chakhtoura M, Mantzoros C. Mortality risk in patients with obesity and COVID-19 infection: a systematic review and meta-analysis. Metabolism 2024; 155:155812. [PMID: 38360130 DOI: 10.1016/j.metabol.2024.155812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
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.
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Affiliation(s)
- Rachelle Haber
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Ghezzawi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Houry Puzantian
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
| | - Marc Haber
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sacha Saad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yara Ghandour
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Anthony Yazbeck
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Celine Mehdi
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Dima Ismail
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Elias Abi-Kharma
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ola El-Zein
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Assem Khamis
- Hull York Medical School, University of Hull, York, United Kingdom
| | - Marlene Chakhtoura
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Christos Mantzoros
- Beth Israel Deaconess Medical Center and Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
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Rinaldi I, Yulianti M, Yunihastuti E, Rajabto W, Irawan C, Sukrisman L, Rachman A, Mulansari NA, Lubis AM, Prasetyawaty F, Cahyanur R, Priantono D, Ahani AR, Muthalib A, Sudoyo A, Atmakusuma TD, Reksodiputro AH, Djoerban Z, Tambunan K, Winston K, Shufiyani YM, Wiyono L, Pratama S, Edina BC. Factors Associated with All-Cause 30-Day Mortality in Indonesian Inpatient COVID-19 Patients at Cipto Mangunkusumo National General Hospital. J Clin Med 2024; 13:2998. [PMID: 38792539 PMCID: PMC11122025 DOI: 10.3390/jcm13102998] [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: 02/27/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction: Indonesia, as a developing country, has limited data on the factors associated with 30-day mortality in COVID-19 patients in Indonesia. As a matter of fact, study analyzing factors associated with 30-day mortality of COVID-19 infection in Indonesia has never been conducted. This study aims to fill this gap in the literature by conducting a large-scale analysis of factors associated with 30-day mortality in COVID-19 patients in Indonesia. Method: This study employed a single-center retrospective cohort observational design, and was conducted at Cipto Mangunkusumo National General Hospital between the years 2022 and 2023. Sampling was conducted using the consecutive sampling method. The study included patients aged 18 years and above who had been confirmed to have COVID-19 infection. Survival analysis was conducted using Kaplan-Meier and multivariate Cox regression analysis. Result: Our study included a total of 644 patients, with 120 patients (18.6%) expiring within 30 days. In the multivariate analysis using the backward Wald method, severe COVID-19 (HR: 7.024; 95% CI: 3.971-12.744; p value: <0.0001), moderate COVID-19 infection (HR: 1.660; 95% CI: 1.048-2.629; p value: 0.031), liver cirrhosis (HR: 3.422; 95% CI: 1.208-9.691; p value: 0.021), female sex (HR: 1.738; 95% CI: 1.187-2.545; p value: 0.004), old age (HR: 2.139; 95% CI: 1.279-3.577; p value: 0.004), high leukocyte (HR: 11.502; 95% CI: 1.523-86.874; p value: 0.018), high NLR (HR: 1.720; 95% CI: 1.049-2.819; p value: 0.032), high CRP (HR: 1.906; 95% CI: 1.092-3.329; p value: 0.023), high procalcitonin (HR: 3.281; 95% CI: 1.780-6.049; p value: 0.001), and high creatinine (HR: 1.863; 95% CI: 1.240-2.800; p value: 0.003) were associated with 30-day mortality from COVID-19 infection. Subgroup analysis excluding cancer patients showed that age, D-Dimer, CRP, and PCT were associated with 30-day mortality in COVID-19 patients, while steroid therapy is protective. Conclusions: This study finds that COVID-19 severity, liver cirrhosis, sex, age, leukocyte, NLR, CRP, creatinine, and procalcitonin were associated with COVID-19 mortality within 30 days. These findings underscore the multifactorial nature of COVID-19 infection mortality. It is important, therefore, that patients which exhibit these factors should be treated more aggressively to prevent mortality.
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Affiliation(s)
- Ikhwan Rinaldi
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Mira Yulianti
- Respirology and Critical Care, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia;
| | - Evy Yunihastuti
- Allergy and Immunology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia;
| | - Wulyo Rajabto
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Cosphiadi Irawan
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Lugyanti Sukrisman
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Andhika Rachman
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Nadia Ayu Mulansari
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Anna Mira Lubis
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Findy Prasetyawaty
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Rahmat Cahyanur
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Dimas Priantono
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Ardhi Rahman Ahani
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Abdul Muthalib
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Aru Sudoyo
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Tubagus Djumhana Atmakusuma
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Arry Harryanto Reksodiputro
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Zubairi Djoerban
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Karmel Tambunan
- Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (W.R.); (C.I.); (L.S.); (A.R.); (A.M.L.); (F.P.); (R.C.); (D.P.); (A.R.A.); (A.M.); (A.S.); (T.D.A.); (A.H.R.); (Z.D.); (K.T.)
| | - Kevin Winston
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (K.W.); (Y.M.S.); (L.W.); (S.P.); (B.C.E.)
| | - Yuli Maulidiya Shufiyani
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (K.W.); (Y.M.S.); (L.W.); (S.P.); (B.C.E.)
| | - Lowilius Wiyono
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (K.W.); (Y.M.S.); (L.W.); (S.P.); (B.C.E.)
| | - Samuel Pratama
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (K.W.); (Y.M.S.); (L.W.); (S.P.); (B.C.E.)
| | - Brenda Cristie Edina
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (K.W.); (Y.M.S.); (L.W.); (S.P.); (B.C.E.)
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