EVALUATING OBESITY PARADOX IN COVID 19: INSIGHTS FROM A SAFETY-NET HOSPITAL IN NEW YORK

Abstract

SESSION TITLE: New Developments in the Diagnosis and Management of Mycobacterial and Bacterial Chest Infections SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: The United States has become the new epicenter for COVID-19 infection The role of obesity in COVID-19 infection and ARDS is unclear Previous studies indicate obese hospitalized patients may have better outcomes including mortality, a phenomenon referred to as “obesity paradox ” This study aims to evaluate the effect of obesity on patients admitted with COVID-19 infection in a suburban safety-net hospital in New York METHODS: A retrospective unmatched single-center study of the first 142 patients (age≥18 y) admitted to our facility from March 9, 2020 to March 30, 2020 with the diagnosis of COVID-19 infection Body mass index (kg/m2) was used to stratify patients into nonobese (BMI 30) Further subdivisions based on WHO classification include underweight (<18 5), normal weight (≥18 5 to 24 9), overweight (≥25 0 to 29 9) subdivided into Class I (30 0 to 34 9), Class II (35 0 to 39 9), Class III morbid obesity (≥40) Statistical analyses were performed using SPSS The primary outcome was all-cause mortality, secondary outcomes include ICU admission, intubation, ARDS and more RESULTS: Out of the total 142 patients, 54 (37 46%) were obese Obese patients had statistically significant higher rates of requiring ICU admission (50% vs 27% p=0 014), developing ARDS (48 1% vs 29 2%), had longer hospital length of stay (11 2 vs 8 2, p=0 031) and were more likely to be admitted directly to the ICU from ED (29 6% vs 11 2%, p=0 019) Obese patients had higher mortality (42 6% vs 36 0%, p= 0 429) than nonobese Obese Covid-19 patients had more severe hypoxia on initial presentation (55 6% vs 42 7% p=0 136), intubation (40 7% vs 28 1%, p=0 118), worse PaO2/FIO2 ratios (173 9 vs 276 6, p=0 635) and septic shock (31 5% vs 20 2%, p=0 129) No statistical significance was seen between groups in terms of ethnicities, comorbidities including hypertension, diabetes and Charlson Comorbidity Index No statistical significance was observed in obesity subdivisions, however the morbidly obese group had the highest frequency of mortality at 54% CONCLUSIONS: Our study does not support the evidence of “Obesity Paradox” in COVID-19 infection, as obesity does not confer a statistical reduction in mortality In contrast, our study suggests increased morbidity based on increased ICU admissions, development of ARDS and longer hospital stay in obese patients Further studies are required to evaluate the role of obesity as an independent risk factor in COVID-19 CLINICAL IMPLICATIONS: Contrary to the Obesity Paradox, Obese patients with COVID-19 infection may have worse clinical outcomes than non-obese DISCLOSURES: No relevant relationships by Shiva Arjun, source=Web Response No relevant relationships by Andres Castillo, source=Web Response No relevant relationships by Jiten Desai, source=Web Response No relevant relationships by Kristen Farraj, source=Web Response No relevant relationships by Sandra Gomez Paz, source=Web Response No relevant relationships by Jaehyuck Im, source=Web Response No relevant relationships by Javed Iqbal, source=Web Response No relevant relationships by Paul Mustacchia, source=Web Response No relevant relationships by Upenkumar Patel, source=Web Response No relevant relationships by Rajmohan Rammohan, source=Web Response No relevant relationships by Kevin Yeroushalmi, source=Web Response