Association between obesity and clinical prognosis in patients infected with SARS-CoV-2

Abstract

Background: It is well established that obesity is a disease of sustained low-grade inflammation. However, it is currently unknown if obesity plays a role in the clinical manifestations and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. In this study, we aimed to investigate whether obesity played a role in clinical manifestations and prognosis in patients infected with SARS-CoV-2. Methods: This is a retrospective multicenter clinical study. A total of 96 patients hospitalized with SARS-CoV-2 infection were enrolled from Dongguan People's Hospital, Nanfang hospital and the First Affiliated Hospital of Xiamen University between 23 January and 14 February 2020. Demographic and clinical data were extracted from medical records. Acute respiratory distress syndrome (ARDS) was defined as oxygenation index (PaO 2 /FiO 2 ) ≤ 300 mmHg. We grouped patients through the body mass index (BMI). Associations were examined using the t test, χ 2 test and multivariate logistic forward regression test. Results: Patients with BMI < 24 were significantly younger (P = 0.025) with lower creatine kinase (P = 0.013), lower diastolic pressure blood (P = 0.035), lower serum creatinine (P = 0.012), lower lactate dehydrogenase (P = 0.001) and higher platelet count (P = 0.002). The BMI level was 20.78 ± 3.15 in patients without pneumonia compared with the patients with pneumonia (23.81 ± 3.49, P = 0.001). For patients without ARDS, an average BMI level of 22.65 ± 3.53 was observed, significantly lower than patients with ARDS (24.57 ± 3.59, P = 0.022). The mean BMI was 22.35 ± 3.56 in patients experienced with relieving the clinical symptoms or stable condition by radiographic tests, lower than patients with disease exacerbation with 24.89 ± 3.17 (P = 0.001). In addition, lymphocyte count (r = − 0.23, P = 0.027) and platelet count (r = − 0.44, P < 0.001) were negatively correlated with BMI. While hemoglobin (r = 0.267, P = 0.008), creatine kinase (r = 0.331, P = 0.001), serum creatinine (r = 0.424, P < 0.001) and lactate dehydrogenase (r = 0.343, P = 0.001) were significantly positive correlated with BMI. Multivariate analysis showed that older age (OR = 1.046, P = 0.009) and BMI ≥ 24 (OR = 1.258, P = 0.005) were independent risk factors associated ICU admission while BMI ≥ 24 (OR = 4.219, P = 0.007) was independent risk factor associated with radiographic disease exacerbation.

Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis

“…Based on retrospective data from 245 individuals with COVID-19, Liu et al [23] found that the unadjusted association between baseline hemoglobin levels and all-cause mortality during hospitalization was non-significant, and the odds ratio of death with increasing serum hemoglobin level was 0.98 (95% CI 0.96, 1.00, p = 0.05). Cai et al [24] studied factors associated with ICU admission and found no link between hemoglobin levels and odds of being admitted at ICU. In a study by Cen et al [25] hemoglobin levels below 110 g/L were linked with disease progression in patients with COVID-19; univariable hazard ratio was 3.91 (95% CI 2.99-5.10).…”

Obesity and COVID‐19: A jigsaw puzzle with still missing pieces

“…Selected data on obesity and outcome are shown in Table 1. [17][18][19][20][21][22][23] In western countries, although data from Italy have confirmed earlier Chinese reports, 24 a French study showed that patients with BMI > 35 kg/m 2 were at significantly higher risk for the requirement of intensive mechanical ventilation compared to normal-weight individuals (with BMI lower than 25 kg/m 2 ), even after adjusting for age, diabetes and hypertension. 25 These results were later replicated in a different hospital in France 26 and have generated more interest in the association between adipose tissue excess and disease pathophysiology.…”

“…Opposing roles have been attributed to adiponectin and IL-6 vis-a-vis the modulation of insulin sensitivity.Inhibition of adiponectin production by IL-6 and TNF-a, lowers adiponectin levels and perpetuates the low-grade chronic inflammation of metabolic disorders 71,72. It would be reasonable to study levels of these or other adipokines in patients with COVID-19 and assess their clinical utility as biomarkers of disease severity and progression. OBESITY AND CORONOVIRUSES: SPECIFIC MOLECULAR TARGETS AND SHARED PATHOPHYSIOLOGY Gattinoni et al suggested that COVID-19 pneumonia presents with two time-related main phenotypes identified based on CT findings: Type L, characterized by low elastance (ie, high compliance), low ventilation-to-perfusion ratio, low lung weight and low recruitability and Type H, characterized by high elastance, high right-to-left shunt, high lung weight and High recruitability.…”

Impacto da COVID-19 na gravidade e prognóstico de indivíduos com obesidade: uma revisão sistemática

“…Os estudos incluídos foram conduzidos no México, China, Estados Unidos e França 10-18 . O tempo de seguimento dos estudos variou de 1 a 2 meses, sendo cinco artigos [11][12][13]16,18 Referente aos parâmetros laboratoriais, como contagem de linfócitos 11,12,18 e de plaquetas foi visto que estes estavam negativamente correlacionados ao IMC, enquanto a contagem de hemoglobina, CK, creatinina sérica e LDH apresentaram correlação significativamente positiva 12 . Além disso, indivíduos obesos apresentam níveis mais altos de PCR, aspartato aminotransferase, glicemia em jejum e LDL 12,18 .…”