Obesity is independently associated with septic shock, renal complications, and mortality in a multiracial patient cohort hospitalized with COVID-19

Abstract

Background Obesity has emerged as a risk factor for severe coronavirus disease 2019 (COVID-19) infection. To inform treatment considerations the relationship between obesity and COVID-19 complications and the influence of race, ethnicity, and socioeconomic factors deserves continued attention. Objective To determine if obesity is an independent risk factor for severe COVID-19 complications and mortality and examine the relationship between BMI, race, ethnicity, distressed community index and COVID-19 complications and mortality. Methods A retrospective cohort study of 1,019 SARS-CoV-2 positive adult admitted to an academic medical center (n = 928) and its affiliated community hospital (n-91) in New York City from March 1 to April 18, 2020. Results Median age was 64 years (IQR 52–75), 58.7% were men, 23.0% were Black, and 52.8% were Hispanic. The prevalence of overweight and obesity was 75.2%; median BMI was 28.5 kg/m2 (25.1–33.0). Over the study period 23.7% patients died, 27.3% required invasive mechanical ventilation, 22.7% developed septic shock, and 9.1% required renal replacement therapy (RRT). In the multivariable logistic regression model, BMI was associated with complications including intubation (Odds Ratio [OR]1.03, 95% Confidence Interval [CI]1.01–1.05), septic shock (OR 1.04, CI 1.01–1.06), and RRT (OR1.07, CI 1.04–1.10), and mortality (OR 1.04, CI 1.01–1.06). The odds of death were highest among those with BMI ≥ 40 kg/m2 (OR 2.05, CI 1.04–4.04). Mortality did not differ by race, ethnicity, or socioeconomic distress score, though Black and Asian patients were more likely to require RRT. Conclusions and relevance Severe complications of COVID-19 and death are more likely in patients with obesity, independent of age and comorbidities. While race, ethnicity, and socioeconomic status did not impact COVID-19 related mortality, Black and Asian patients were more likely to require RRT. The presence of obesity, and in some instances race, should inform resource allocation and risk stratification in patients hospitalized with COVID-19.

Dietary fish intake increased the concentration of soluble ACE2 in rats: can fish consumption reduce the risk of COVID-19 infection through interception of SARS-CoV-2 by soluble ACE2?

“…The major route of entry for SARS-CoV-2 is through the respiratory tract, and coexpression of ACE2 and TMPRSS2 has been found in cells in the nasal and buccal mucosa and in the epithelia of bronchus and larynx (3) . The risk for a severe course including death from coronavirus disease 2019 (COVID-19) after infection with SARS-CoV-2 is increased in persons with obesity (4,5) , and in line with the observation of elevated expressions of ACE2 and TMPRSS2 in the trachea of obese mice (6) .…”

“…ACE2 catalyses the removal of the carboxyterminal amino acid from angiotensin II to produce the vasodilator angiotensin-(1-7), and, with less affinity, removes the carboxyterminal leucyl residue from angiotensin I to produce angiotensin (1-9) (7) . ACE, on the other hand, removes the C-terminal dipeptide (histidyl-leucine) from angiotensin I to produce the vasoconstrictor angiotensin II and also removes the terminal dipeptide (phenylalanyl-histidine) from angiotensin (1)(2)(3)(4)(5)(6)(7)(8)(9) to produce angiotensin (1-7) and hydrolyses the vasodilator bradykinin (7) . Thus, ACE2 partly counteracts the effects of ACE by contributing to both the production of the vasodilator angiotensin 1-7 and decreases the availability of angiotensin I as a precursor for the vasoconstrictor angiotensin II through ACE activity, and consequently, upregulation of ACE2 activity may counteract some of the unfavourable effects of ACE.…”

The Impact of Comorbidities among Ethnic Minorities on COVID-19 Severity and Mortality in Canada and the USA: A Scoping Review

“…Of these 59 studies, 18 (30.5%) were conducted across the USA [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. Eight studies were conducted in Michigan [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ], six in New York [ 45 , 46 , 47 , 48 , 49 , 50 ], four in Atlanta [ 51 , 52 , 53 , 54 ], and four in California [ 55 , 56 , 57 , 58 ]. The remaining studies were divided as follows: one in three states (California, Oregon, and Washington) [ 59 ], one in Massachusetts [ 60 ], one in Tennessee [ 61 ], two in Wisconsin [ 62 , 63 ], one in Mississippi [ 64 ], one in Cleveland [ 65 ], one in Pennsylvania [ 66 ], two in Louisiana [ 67 , 68 ], one in the Midwest [ 69 ], one near the Mexico border [ 70 ], one in New Orleans [ ...…”

The Role of Bioelectrical Impedance Analysis in Predicting COVID-19 Outcome

“…However, the results regarding mortality are still inconsistent. Although some studies advocate obesity, defined by BMI, as a significant predictor of mortality, with OR ranging from 1.04 to 4.4, or even higher (1,3,4,26,(30)(31)(32), others failed to show statistical significance or even showed negative predictive values (3,5,6,16,33,34).…”