J Obes Metab Syndr.  2022 Sep;31(3):245-253. 10.7570/jomes22011.

Increased Body Mass Index and Metabolic Syndrome Are Associated with Poor Outcomes in SARS-CoV-2-Positive Emergency Department Patients

• Thoppil JJ
• Stewart LK
• Pung L
• Nordenholz KE
• Camargo Jr. CA
• Courtney DM
• Kline JA
• on behalf of the RECOVER Network

• KMID: 2534001
• DOI: http://doi.org/10.7570/jomes22011

Abstract

Background
Increased body mass index (BMI) and metabolic syndrome (MetS) have been associated with adverse outcomes in viral syndromes. We sought to examine associations of increased BMI and MetS on several clinical outcomes in patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Methods
The registry of suspected COVID-19 in emergency care (RECOVER) is an observational study of SARSCoV-2-tested patients (n= 27,051) across 155 United States emergency departments (EDs). We used multivariable logistic regression to test for associations of several predictor variables with various clinical outcomes.
Results
We found that a BMI ≥30 kg/m² increased odds of SARS-CoV-2 test positivity (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.23–1.38), while MetS reduced odds of testing positive for SARS-CoV-2 (OR, 0.76; 95% CI, 0.71–0.82). Adjusted multivariable analysis found that MetS was significantly associated with the need for admission (OR, 2.11; 95% CI, 1.89–2.37), intensive care unit (ICU) care (OR, 1.58; 95% CI, 1.40–1.78), intubation (OR, 1.46; 95% CI, 1.28–1.66), mortality (OR, 1.29; 95% CI, 1.13–1.48), and venous thromboembolism (OR, 1.51; 95% CI, 1.07–2.13) in SARS-CoV-2-positive patients. Similarly, BMI ≥40 kg/m² was significantly associated with ICU care (OR, 1.97; 95% CI, 1.65–2.35), intubation (OR, 2.69; 95% CI, 2.22–3.26), and mortality (OR, 1.50; 95% CI, 1.22–1.84).
Conclusion
In this large nationwide sample of ED patients, we report a significant association of both high BMI and composite MetS with poor outcomes in SARS-CoV-2-positive patients. Findings suggest that composite MetS profile may be a more universal predictor of adverse disease outcomes, while the impact of BMI is more heavily modulated by SARS-CoV-2 status.

Keyword

Obesity; Body mass index; Metabolic syndrome; COVID-19; SARS-CoV-2