Abstract
ObjectivesThe coronavirus disease 2019 (COVID-19) has become a worst pandemic. The clinical characteristics vary from asymptomatic to fatal. This study aims to examine the association between body mass index (BMI) levels and the severity of COVID-19.Methods and study designA cohort study included 147 adult patients with confirmed COVID-19 were categorized into 4 groups by BMI levels on admission: <18.5 (underweight), 18.5–22.9 (normal weight), 23.0–24.9 (overweight), and ≥25.0 kg/m2 (obese). Rates of pneumonia, severe pneumonia, acute kidney injury (AKI), and ICU stay during hospitalization across BMI group was determined. Logistic regression analysis was used to determine the association between BMI and severe pneumonia.ResultsOf the totals, patients having a BMI <18.5, 18.5–22.9, 23.0–24.9, and ≥25.0 kg/m2 were 12.9%, 38.1%, 17.7%, and 31.3%, respectively. The rates of pneumonia and severe pneumonia tended to be higher in patients with higher BMI, whereas the rates of AKI and ICU stay were higher in patients with BMI <18.5 kg/m2 and ≥ 25 kg/m2, when compared to patients with normal BMI. After controlling for age, sex, diabetes, hypertension and dyslipidemia in the logistic regression analysis, having a BMI ≥25.0 kg/m2 was associated with higher risk of severe pneumonia (OR 4.73; 95% CI, 1.50–14.94; p = 0.003) compared to having a BMI 18.5–22.9 kg/m2. During admission, elevated hemoglobin and alanine aminotransferase levels on day 7 and 14 of illness were associated with higher BMI levels. In contrast, rising of serum creatinine levels was observed in underweight patients on days 12 and 14 of illness.ConclusionsObesity in patients with COVID-19 was associated with severe pneumonia and adverse outcomes such as AKI, transaminitis and ICU stay. Underweight patients should be closely monitored for AKI. Further studies in body composition are warranted to explore the links between adiposity and COVID-19 pathogenesis.
Highlights
The Coronavirus Disease 2019 (COVID-19), an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become one of the worst pandemics in this century
The rates of pneumonia and severe pneumonia tended to be higher in patients with higher body mass index (BMI), whereas the rates of acute kidney injury (AKI) and intensive care unit (ICU) stay were higher in patients with BMI
After controlling for age, sex, diabetes, hypertension and dyslipidemia in the logistic regression analysis, having a BMI 25.0 kg/m2 was associated with higher risk of severe pneumonia compared to having a BMI 18.5–22.9 kg/m2
Summary
The Coronavirus Disease 2019 (COVID-19), an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become one of the worst pandemics in this century. The World Health Organization (WHO) announced the confirmation of COVID-19 as a pandemic on March 11th, 2020 [1]. As of May 26th, 2020, COVID-19 has affected over 5.5 million people worldwide, causing more than 347,000 fatalities [2]. In addition to several degrees of pneumonia, COVID-19 may cause injury of many organs including liver, kidneys and heart [4]. Adiposity affects adverse health outcomes such as coronary artery disease, cerebrovascular disease, insulin resistance, hypertension and fatty liver disease [6]. Obesity could be correlated to adverse outcomes and severity of COVID-19
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