Abstract
Conflicting results have been obtained through meta-analyses for the role of obesity as a risk factor for adverse outcomes in patients with coronavirus disease-2019 (COVID-19), possibly due to the inclusion of predominantly multimorbid patients with severe COVID-19. Here, we aimed to study obesity alone or in combination with other comorbidities as a risk factor for short-term all-cause mortality and other adverse outcomes in Mexican patients evaluated for suspected COVID-19 in ambulatory units and hospitals in Mexico. We performed a retrospective observational analysis in a national cohort of 71 103 patients from all 32 states of Mexico from the National COVID-19 Epidemiological Surveillance Study. Two statistical models were applied through Cox regression to create survival models and logistic regression models to determine risk of death, hospitalisation, invasive mechanical ventilation, pneumonia and admission to an intensive care unit, conferred by obesity and other comorbidities (diabetes mellitus (DM), chronic obstructive pulmonary disease, asthma, immunosuppression, hypertension, cardiovascular disease and chronic kidney disease). Models were adjusted for other risk factors. From 24 February to 26 April 2020, 71 103 patients were evaluated for suspected COVID-19; 15 529 (21.8%) had a positive test for SARS-CoV-2; 46 960 (66.1%), negative and 8614 (12.1%), pending results. Obesity alone increased adjusted mortality risk in positive patients (hazard ratio (HR) = 2.7, 95% confidence interval (CI) 2.04-2.98), but not in negative and pending-result patients. Obesity combined with other comorbidities further increased risk of death (DM: HR = 2.79, 95% CI 2.04-3.80; immunosuppression: HR = 5.06, 95% CI 2.26-11.41; hypertension: HR = 2.30, 95% CI 1.77-3.01) and other adverse outcomes. In conclusion, obesity is a strong risk factor for short-term mortality and critical illness in Mexican patients with COVID-19; risk increases when obesity is present with other comorbidities.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes an acute respiratory and systemic disease known as coronavirus disease (COVID-19)
A total of 71 103 patients evaluated for suspected COVID-19 were included for analysis, of which 15 529 (21.8%) tested positive for SARS-CoV-2, 46 960 (66.1%) were negative and 8614 (12.1%) had pending results
The proportions of hospitalised patients, clinical diagnosis of pneumonia, invasive mechanical ventilation (IMV) and intensive care unit (ICU) admission were greater in the positive-test group (Table 1)
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes an acute respiratory and systemic disease known as coronavirus disease (COVID-19). Systemic adiposity at all levels (subcutaneous, visceral and ectopic) may complicate the management of acute lung and systemic diseases such as COVID-19 through mechanical and inflammatory complications that commonly occur in the ‘chronic diseases associated with adiposity’ [2]. Mechanical consequences derive from the accumulation of adipose tissue in soft tissues of the pharynx, which may compromise ventilation, and the visceral compartment at the mesenteric and omental levels, causing renal compression that favours systemic arterial hypertension and other dysregulations [3]. Inflammatory mechanisms are promoted when adipocytes saturate their storage capacity and undergo apoptosis, leading to a local inflammatory response that favours remodelling of adipose tissue with a phenotypic switch of regulatory
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