Abstract
In this study, we aimed to investigate the relationship between body mass index (BMI) and multiple severe outcomes of the coronavirus disease 2019 (COVID-19) pneumonia. A total of 1091 patients hospitalized with COVID-19 pneumonia were included from Wuhan, China. Overall, 2.8% (n = 31) received invasive mechanical ventilation (IMV), 10.8% (n = 118) were admitted to the intensive care unit (ICU), 6.4% (n = 70) developed acute respiratory distress syndrome (ARDS), and 4.4% (n = 48) died. Multivariable-adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) of IMV therapy, ICU admission and ARDS associated with obesity were 2.86 (1.16-7.05), 2.62 (1.52-4.49) and 3.15 (1.69-5.88), respectively; underweight was significantly associated with death (HR 3.85, 95%CI 1.26-11.76). Restricted cubic spline analyses suggested U-shaped associations of BMI with ICU admission and death, but linear relationships of BMI with IMV therapy and ARDS. In conclusion, obesity had an increased risk of IMV therapy, ICU admission and ARDS, while underweight was associated with higher mortality in COVID-19 pneumonia. U-shaped associations of BMI with ICU admission and death, and linear relationships of BMI with IMV therapy and ARDS, were found. These findings indicate that extra caution should be taken when treating COVID-19 patients with underweight and obesity.
Highlights
The emerging coronavirus disease 2019 (COVID-19) first reported in Wuhan, China, is caused by a novel beta-coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]
Risk factors associated with disease severity and outcome have been investigated in several studies [7, 8], indicating that elderly age was associated with higher risks of acute respiratory distress syndrome (ARDS) and death, and patients with co-morbidities, such as preexisting concurrent cardiovascular or cerebrovascular diseases, or ARDS were at an increased risk of death from COVID-19 pneumonia [11, 12]
The levels of neutrophil counts, lymphocyte counts, alanine transaminase (ALT), serum creatinine and high-sensitivity C-reactive protein (hs-CRP) increased with body mass index (BMI)
Summary
The emerging coronavirus disease 2019 (COVID-19) first reported in Wuhan, China, is caused by a novel beta-coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]. It has rapidly spread across international borders causing a pandemic [3, 4]. Risk factors associated with disease severity and outcome have been investigated in several studies [7, 8], indicating that elderly age was associated with higher risks of acute respiratory distress syndrome (ARDS) and death, and patients with co-morbidities, such as preexisting concurrent cardiovascular or cerebrovascular diseases, or ARDS were at an increased risk of death from COVID-19 pneumonia [11, 12].
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