Background Although recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients. Methods We performed a retrospective study at a tertiary care health system of adult patients with COVID-19 who were admitted between March 1 and April 30, 2020. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m 2) and non-obese (BMI < 30 kg/m 2) cohorts. Primary outcomes were mortality, intensive care unit (ICU) admission, intubation, and 30-day readmission. Results A total of 1983 patients were included of whom 1031 (51.9%) had obesity and 952 (48.9%) did not have obesity. Patients with obesity were younger (P < 0.001), more likely to be female (P < 0.001) and African American (P < 0.001) compared to patients without obesity. Multivariable logistic models adjusting for differences in age, sex, race, medical comorbidities, and treatment modalities revealed no difference in 60-day mortality and 30-day readmission between obese and non-obese groups. In these models, patients with obesity had increased odds of ICU admission (adjusted OR, 1.37; 95% CI, 1.07-1.76; P = 0.012) and intubation (adjusted OR, 1.37; 95% CI, 1.04-1.80; P = 0.026). Conclusions Obesity in patients with COVID-19 is independently associated with increased risk for ICU admission and intubation. Recognizing that obesity impacts morbidity in this manner is crucial for appropriate management of COVID-19 patients.

Respiratory failure is the most common cause of death in patients with corona virus disease 2019 (COVID-19). There have been many investigations to determine predictors of bad outcomes in patients with this illness. Liver enzyme elevation has been described in hospitalized patients with severe COVID-19; however, little is known about the significance of liver injury regarding outcomes. We conducted a retrospective chart review of 348 patients admitted with COVID-19 in our quaternary care center. Liver injury on admission was defined based on the laboratory cutoff of aspartate aminotransferase >35 IU/L and/or alanine aminotransferase >52 IU/L. Patients were divided into two cohorts based on the presence or absence of liver injury. These cohorts were compared to assess differences in presentation, complications, and outcomes. The primary outcome was respiratory failure requiring intubation, and the secondary outcome was in-hospital mortality. The presence of new onset liver enzyme elevation on presentation was associated with increased severity of illness, need for mechanical ventilation, and mortality. Presence of liver injury increased the chance of acute hypoxic respiratory failure requiring mechanical ventilation by 1.79 times. The degree and timeline of liver enzyme elevation during hospitalization corresponded with elevations of other inflammatory markers. Conclusion: Liver injury appears to correlate with the inflammatory syndrome caused by COVID-19, with the degree of liver injury corresponding with severity of inflammation. We suggest early and continued monitoring of liver enzymes as they can be useful to identify patients who may need early escalation of care. (Hepatology Communications 2020;0:1-9). C oronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused global alarm. COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020. Originally from Wuhan, China, the virus has since spread to over 187 countries. (1) The rapid influx of information from many countries has aimed to help clinicians better understand trends in clinical characteristics, complications, and management strategies. COVID-19 is primarily a respiratory illness, with severe acute hypoxic respiratory failure being the most severe complication. (2) However, observational studies have also reported cardiac, renal, neurologic, and gastrointestinal involvement. (3,4) Elevated liver enzymes have been noted to be common in patients presenting with COVID-19, with some studies reporting an incidence up to 53%. (5) More significant transaminase elevations have been seen in patients with severe illness compared to mild disease. (6-10)

Research on the influence of different architectural styles and ventilation systems on mite allergen levels is crucial to decrease mite allergen exposures in houses. The purpose of this study was to examine the seasonal changes in mite allergen (Der 1) levels on the floors and mattresses of houses with different architectural styles and ventilation systems. METHODS: Thirty-one families, without considering the families' histories of allergies, participated in this study. Written consent was obtained from all the families. All 31 families lived in Hamamatsu-city, Japan. Dust samples were monthly collected from the floors of the living rooms and mattresses in the bedrooms from March 2019 to February 2020. Mite allergen Der 1 (Der f 1 and Der p 1) levels were measured using sandwich ELISA. The air temperature and relative humidity in each house were measured using hygrothermography. RESULTS: Ten families lived in detached houses with balanced ventilation (group A), 10 families lived in detached houses with exhaustonly ventilation (group B), and 11 families lived in concrete apartment buildings with exhaust-only ventilation (group C). All groups showed significant seasonal changes in mean monthly temperature and relative humidity. Group A showed significantly lower mean monthly relative humidity than other groups. Group A showed significantly lower levels of Der 1 in mattress dust than other groups. CONCLUSIONS: Different architectural styles and ventilation systems may have some influence on mite allergen levels and could possibly be modified to decrease mite allergen exposure in houses.

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