The Effect of Body Mass Index on Outcomes among COVID-19 Patients with Left Ventricular Assist Devices: A Multi-Institutional Study

Abstract

PurposeInfection with the Coronavirus (SARS-CoV-2) is particularly dangerous for patients with left ventricular assist devices (LVAD). Obesity is associated with worse outcomes among both LVAD and SARS-CoV-2 patients. This study evaluated the risk of obesity among LVAD patients who contracted SARS-CoV-2.MethodsA prospectively maintained Trans-CoV-VAD Registry of LVAD patients from 11 institutions who presented with SARS-CoV-2 was analyzed. Two cohorts, 1) non-obese and 2) obese, were formed utilizing a body mass index (BMI) cutoff of 30 k/m2. Presenting characteristics, hospitalization rates, ventilator & intensive care unit usage, and mortality were compared. Chi-squared, Fisher's exact test, Mann-Whitney U-tests and multivariable logistic regression models were utilized.ResultsAcross all centers, 46 LVAD patients contracted SARS-CoV-2 during the study period of whom 19 (41%) were obese. Time from LVAD implantation to infection was 2.4±2.5 years. Age and gender profiles were similar. Non-obese and obese patients had similar presenting symptoms, most commonly cough (52% vs 47%), fever (48% vs 37%), dyspnea (41% vs 47%) and fatigue (41% vs 37%). No difference in rates of hospital (70% vs 63%, p 0.8) and ICU admissions (26% vs 37%, p 0.3) was observed. Hospital (20.0±23.2 vs 17.1±14.2) and ICU length of stay were similar (16.2±26.1 vs. 13.9±13.1 days). Obese patients were more likely to require mechanical ventilation than non-obese patients (7% vs 26%, p<0.05). Overall risk of mortality was significantly elevated but similar (19% vs 16%, p 0.9). On multivariable modeling, BMI was not associated with increased risk of hospitalization, ICU admission or mechanical ventilation (p>0.10).ConclusionAmong LVAD patients who contract SARS-CoV-2, obese patients appear to have higher risk of intubation, but did not experience increased ICU requirements or mortality.