Obesity, Inflammation, and Mortality in COVID-19: An Observational Study from the Public Health Care System of New York City.

Leonidas Palaiodimos,Colin Cha-Fong,Nichola Davis,Michail Kladas,Jeremy Sperling,Shankar Srinivasan,Sahana Parthasarathy,Damianos G Kokkinidis,Natalia Chamorro-Pareja,Robert T Faillace,Ryad Ali,Hugo O Teo,Kenneth Hupart,Michael Chang,Preeti Kishore,Sharanjit Kaur,Dimitrios Karamanis

doi:10.3390/jcm11030622

Abstract

Severe obesity increases the risk for negative outcomes in patients with coronavirus disease 2019 (COVID-19). Our objectives were to investigate the effect of BMI on in-hospital outcomes in our New York City Health and Hospitals’ ethnically diverse population, further explore this effect by age, sex, race/ethnicity, and timing of admission, and, given the relationship between COVID-19 and hyperinflammation, assess the concentrations of markers of systemic inflammation in different BMI groups. A retrospective study was conducted in hospitalized patients with COVID-19 in the public health care system of New York City from 1 March 2020 to 31 October 2020. A total of 8833 patients were included in this analysis (women: 3593, median age: 62 years). The median body mass index (BMI) was 27.9 kg/m2. Both overweight and obesity were independently associated with in-hospital death. The association of overweight and obesity with death appeared to be stronger in men, younger patients, and individuals of Hispanic ethnicity. We did not observe higher concentrations of inflammatory markers in patients with obesity as compared to those without obesity. In conclusion, overweight and obesity were independently associated with in-hospital death. Obesity was not associated with higher concentrations of inflammatory markers.

Highlights

Our study investigated the association of body mass index (BMI) with in-hospital outcomes in a cohort of 8833 patients admitted with COVID-19 in the largest public health care system of the United
We found that overweight and obesity were independently associated with in-hospital death, admission to intensive care unit (ICU), and invasive mechanical ventilation with more significant associations observed in the higher BMI groups
The association of overweight and obesity with death appeared to be stronger in men, younger patients, and individuals of Hispanic ethnicity compared to women, older patients, and individuals of other racial/ethnic backgrounds

Summary

Introduction

There is strong and consistent evidence that obesity increases the risk for worse outcomes in patients with coronavirus disease 2019 (COVID-19) [1,2,3,4]. Severe obesity (body mass index (BMI) ≥ 35 kg/m2 ), in particular, has been associated with five-fold risk for admission in an intensive care unit (ICU) [5], a seven-fold risk for intubation and mechanical ventilation [6], and four-fold risk for in-hospital death [7]. Some of the factors that are responsible for the worse outcomes in these groups are a high housing density, limited health care access, and a higher prevalence of comorbidities known to be associated with severe COVID-19, such as hypertension, diabetes, and obesity [9,15]. College graduates have a lower prevalence of obesity compared to those with less education [16]

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