Abstract
BackgroundCoronavirus disease 2019(COVID-19) has spread worldwide. The present study aimed to characterize the clinical features and outcomes of imported COVID-19 patients with high body mass index (BMI) and the independent association of BMI with disease severity.MethodsIn this retrospective cohort study, 455 imported COVID-19 patients were admitted and discharged in Zhejiang province by February 28, 2020. Epidemiological, demographic, clinical, laboratory, radiological, treatment, and outcome data were collected, analyzed and compared between patients with BMI ≥ 24and < 24.ResultsA total of 268 patients had BMI < 24, and 187 patients had BMI ≥ 24. Those with high BMI were mostly men, had a smoking history, fever, cough, and sputum than those with BMI < 24. A large number of patients with BMI ≥ 24 were diagnosed as severe/critical types. Some biochemical indicators were significantly elevated in patients with BMI ≥ 24. Also, acute liver injury was the most common complication in these patients. The median days from illness onset to severe acute respiratory syndrome coronavirus 2 detection, duration of hospitalization, and days from illness onset to discharge were significantly longer in patients with BMI ≥ 24 than those with BMI < 24. High BMI, exposure to Wuhan, any coexisting medical condition, high temperature, C-reactive protein (CRP), and increased lactate dehydrogenase (LDH) were independent risk factors for severe/critical COVID-19. After adjusting for age, sex and above factors, BMI was still independently associated with progression to severe/critical illness (P = 0.0040). Hemoglobin, alanine aminotransferase (ALT), CRP, and serum creatinine (Scr) were independent risk factors associated with high BMI.ConclusionsContrasted with the imported COVID-19 patients with BMI < 24, high proportion of COVID-19 patients with BMI ≥ 24 in our study, especially those with elevated CRP and LDH, developed to severe type, with longer hospitalization duration and anti-virus course. Thus, high BMI is a risk factor for the progression and prognosis of imported COVID-19.
Highlights
IntroductionBy January 17, 2021, over 93 million cases were confirmed, and 2.0 million patients died worldwide due to the disease
The median days from illness onset to severe acute respiratory syndrome coronavirus 2 detection, duration of hospitalization, and days from illness onset to discharge were significantly longer in patients with body mass index (BMI) ≥ 24 than those with BMI < 24
After adjusting for age, sex and above factors, BMI was still independently associated with progression to severe/critical illness (P = 0.0040)
Summary
By January 17, 2021, over 93 million cases were confirmed, and 2.0 million patients died worldwide due to the disease. ACE2 is widely expressed in various organs and tissues, including lungs, cardiovascular system, kidneys, gut, bladder and brain [9,10,11,12], which might explain the multiple organ failure in some COVID-19 patients. A recent study suggested that ACE2 expression in adipose tissue was higher than that in lung tissue [13]. Since obese individuals have abundant adipose tissue to express a larger amount of ACE2 proteins may expose them to higher risk status for COVID-19 [13]. COVID-19 might infect adipose tissue and spread to other organs
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