Comparing the effect of obesity on major adverse cardiovascular events in patients hospitalized with coronavirus disease-2019 (COVID-19): insights from the national inpatient sample (NIS) database

Abstract

Abstract Introduction Recent studies have shown an ‘obesity paradox,’ which refers to improved hospital outcomes and prognosis in obese individuals when compared to their non-obese counterparts. This paradox is evident when myocardial infarction (MI), venous thromboembolism (VTE), and cardiovascular mortality are considered. There is limited information extrapolated from large inpatient databases describing inpatient hospital outcomes of patients with obesity and concomitant COVID-19. Purpose To determine the association of obesity with inpatient mortality of acute (MI), cerebrovascular accidents (CVA) and cardiovascular death in patients with COVID-19 using the NIS database. Methods The NIS database for calendar year 2020 was queried to identify adult hospitalizations with a primary diagnosis of COVID-19 and a secondary diagnosis of obesity. Cases were identified using International Classification of Diseases – 10 Clinical Modification (ICD-10-CM) codes. The primary outcome was inpatient mortality; secondary outcomes were length of stay (LOS), total hospital charge (THC), and inpatient complications. Linear, univariate, and multivariate logistic regression were used to analyze the outcomes and adjust for confounders. Results A total of 1,050,045 hospitalizations for COVID-19 were identified, 292,800 (27.9%) of which had the co-diagnosis of obesity. Out of the identified hospitalizations with COVID-19 and obesity, 29,290 (10%) died. After multivariate adjustment for confounding variables, obesity was associated with increased inpatient mortality (adjusted odds [aOR] 1.37; 95% confidence interval [CI] 1.32-1.42, p < 0.001), while CVA and acute MI were negatively associated with obesity (aOR 0.81; CI 0.68-0.97, p = 0.023 and aOR 0.92; CI 0.86-0.99, p = 0.026, respectively). Additionally, obesity was associated with multiple inpatient complications, including but not limited to: sepsis (aOR 1.44; CI 1.38-1.51, p < 0.001); acute respiratory failure (aOR 1.46; CI 1.43-1.50, p < 0.001), need for intubation (aOR 1.66; CI 1.60-1.73, p < 0.001), need for mechanical ventilation (aOR 1.69; CI 1.62-1.75, p < 0.001); cardiac arrest (aOR 1.32; CI 1.23-1.42, p < 0.001); and need for cardiopulmonary resuscitation (aOR 1.37; CI 1.26-1.50, p < 0.001). Conclusion The findings of this study are inconsistent with the obesity paradox. Obese patients hospitalized with COVID-19 had an increased association of mortality and inpatient complications; however, there was a negative association between obesity and CVA and acute MI.