Abstract
BackgroundPatients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes.Methods1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category.ResultsThe risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02–1.97 and 2.78, 95% CI 1.83–4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06–2.74, and 2.62, 95% CI 1.65–4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42–0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03–2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50–3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight.ConclusionsEOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.
Highlights
Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resulting coronavirus disease-2019 (COVID-19) is a global pandemic that has collided with the ongoing epidemic of chronic non transmissible diseases [1]
The objective of this study is to evaluate in patients with normal weight, overweight and obesity hospitalised for COVID-19, the performance of the Edmonton Obesity Staging System (EOSS) staging system compared to the traditional Body mass index (BMI) classification, on COVID-19 outcomes
Patients with EOSS stages 0–1 had the lowest values for fasting glucose, ferritin, D-dimer, higher oxygen saturation and the lowest prevalence of critical disease, mechanical ventilation and death
Summary
Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resulting coronavirus disease-2019 (COVID-19) is a global pandemic that has collided with the ongoing epidemic of chronic non transmissible diseases [1]. Vulnerable groups include the elderly, immunocompromised individuals and those with pre-existing chronic diseases, such as arterial hypertension, diabetes, cardiovascular diseases, and respiratory diseases [3] Many of these conditions coexist with obesity, and in younger individuals, obesity is a main promoter [4]. Obesity is increasing worldwide; with prevalence estimates of overweight and obesity in Mexico around 72% [5] This is a chronic condition characterised by endocrine, metabolic and inflammatory disorders [6] that may influence the immune responses on exposure to SARS-CoV-2 [7]. Patients with obesity have an increased risk for adverse COVID-19 outcomes. Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management
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