Infect Chemother.  2021 Jun;53(2):319-331. 10.3947/ic.2021.0026.

Is Obesity a Potential Risk factor for Poor Prognosis of COVID-19?

• Agca M
• Tuncay E
• Yıldırım E
• Yıldız R
• Sevim T
• Ernam D
• Yılmaz NO
• Teke NH
• Yavuz S
• Karakurt Z
• COVID-19 Team
• Ozmen I

• KMID: 2517462
• DOI: http://doi.org/10.3947/ic.2021.0026

Abstract

Background
Coronavirus disease 2019 (COVID-19) continues to cause major mortality and morbidity worldwide even after a year of its emergence. In its early days, hypertension, diabetes, and cardiovascular diseases were noted as poor prognostic factors, while obesity gained attention at a later stage. In the present study, unfavorable clinical outcomes (transfer to the intensive care unit, invasive mechanical ventilation, and mortality) were investigated in obese patients with COVID-19.
Materials and Methods
In this retrospective study we analyzed patients with positive polymerase chain reaction test in tertiary care hospital between March-May 2020. They were divided into 3 groups according to body mass index (BMI) as normal, overweight, and obese (BMI: 18.5 - 24.99 kg/m² , 25 - 29.99 kg/m² , and ≥ 30 kg/m² , respectively). We compared clinical features and laboratory findings of these groups and recorded adverse clinical outcomes. Multivariate logistic analysis was performed for unfavorable outcomes.
Results
There were 99 patients (35%), 116 (41%), and 69 patients (24%) in the normal-weight, overweight, and obese group, respectively. Among all patients, 52 (18%) patients were transferred to the intensive care unit (ICU), 30 (11%) patients received invasive mechanical ventilation (IMV), and 22 patients (8%) died. Obese patients had minimum 1 more comorbidity than normal BMI patients (73% vs. 50%, P = 0.002), and a longer median (interquartile range [IQR]) duration of hospitalization (8 [5 - 12] vs. 6 [5 - 9]) days, P = 0.006). Obese participants had higher concentrations of serum C-reactive protein, procalcitonin, ferritin than nonobese patients (P <0.05 in all). In a multivariate analysis, obesity was associated with ICU admission (adjusted odds ratio [aOR]: 2.99, 95% confidence interval [CI]: 1.26 - 7.04, P = 0.012). Moreover, IMV requirement was associated with obesity (aOR: 8.73, 95% CI: 2.44 - 31.20, P = 0.001). Mortality occurred in 16%, 9%, and 1% of the obese group, overweight group, and normal-weight group, respectively (Chi-square trend analysis, P = 0.002).
Conclusion
Obesity is a risk factor for adverse outcomes and caused increased mortality, hence requiring close follow-up.

Keyword

Body mass index; COVID-19; Intensive care unit; Obesity; SARS-CoV-2