The relationship between obesity, hemoglobin A1c and the severity of COVID-19 at an urban tertiary care center in New York City: a retrospective cohort study

Abstract

ObjectivesTo determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions.DesignRetrospective cohort study.SettingUrban tertiary care center in New York City.Participants302 patients admitted in an inpatient setting, ≥18 years old, with a laboratory-confirmed diagnosis of COVID-19 via nasal PCR swab were randomly selected. Patients were separated into two cohorts based on their body mass index and hemoglobin A1c. 150 patients were placed in the non-obese, non-diabetic cohort and 152 patients were placed in the corresponding cohort (obesity alone, obesity and diabetes, and diabetes alone).MeasurementsPrimary outcomes were development of acute kidney injury, commencement of renal replacement therapy, aminotransferase elevation, troponin elevation, lactic acidosis, development of septic shock, use of vasopressors, presence of acute respiratory distress syndrome (ARDS) and intubation. The secondary outcomes were length of stay in days and mortality.ResultsPatients with obesity and/or diabetes were more likely to develop ARDS (79 patients vs 57 patients, p<0.0001) and to be intubated (71 patients vs 45 patients, p=0.0031). Patients with obesity and/or diabetes were more likely to require vasopressors (60 patients vs 41 patients, p=0.0284) and to develop lactic acidosis (median 3.15 mmol/L, IQR 1.8 to 5.2 mmol/L, p=0.0432). When comparing patients with diabetes with and without obesity against patients with obesity alone, they were more likely to develop ARDS (87.5%, p=0.0305). Despite these findings, there was no difference in mortality.ConclusionsIn patients hospitalised with COVID-19, those with obesity and/or diabetes were more likely to suffer severe complications, but had negligible differences in mortality. This highlights the importance of close monitoring of patients with these conditions and additional areas of research needed to explain the mortality findings.

Comparing body mass index and obesity‐related comorbidities as predictors in hospitalized COVID‐19 patients

“… 19 , 39 It may also reflect our real‐world cohort consisting of those presenting with an elevated BMI from suburban New York, which likely differs from previous study cohorts. 40 Furthermore, similar to other recently published cohorts of hospitalized COVID‐19 patients, 32 , 41 , 42 , 43 , 44 , 45 , 46 , 47 the present study did not demonstrate an association between BMI and poor COVID‐19 outcomes. This difference between earlier studies and more recent work may reflect better defined cohorts that enable a more nuanced analysis of the association between BMI and COVID‐19‐related outcomes such that the appropriate adjustments can be made for the effects of obesity‐related comorbidities.…”

Obesity as a Risk Factor for Severe COVID-19 and Complications: A Review

“…Our search was limited by published full-text article in English language. Most studies investigating this association used BMI categories as the predictor variable [24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Four cross-sectional studies did not specify the used classification of obesity [38][39][40][41] presumably using the WHO guidelines defining obesity as BMI of 30 or higher.…”

“…Four cross-sectional studies did not specify the used classification of obesity [38][39][40][41] presumably using the WHO guidelines defining obesity as BMI of 30 or higher. Outcome variables included: hospitalization [36,38,42], ICU admission [31,35,37,38,[43][44][45], intubation [24,25,29,37,38], invasive mechanical ventilation [26,31,34], disease severity [27,28,30,33] and death [24][25][26][27][28][29]32,[38][39][40][41]. Of the eleven studies investigating the association between BMI and mortality in hospitalized COVID-19 patients, ten studies observed an increased mortality rate in patients that were overweight (BMI ≥ 25 to <30) [24,32], or suffering from obesity (BMI ≥ 30) [25,29,[38][39][40][41], or severe obesity (BMI ≥ 35) [26,…”

How Do Inflammatory Mediators, Immune Response and Air Pollution Contribute to COVID-19 Disease Severity? A Lesson to Learn

“…From the beginning of the spread of SARS-CoV-2 infection, it was clear that people responded to the infection in different ways, from asymptomatic condition to severe multiple organ symptoms. From the very beginning, the presence of comorbidities was recognised as giving an increased risk of developing severe COVID-19, particularly for cardiovascular diseases, diabetes, and obesity [111][112][113][114]. Many reviews have been published on COVID-19 and comorbidities.…”

“…Clinical and biochemical features involved in disease symptom severity in SARS-CoV-2 infected subjects. Above, the role of primary factors of risk (clinical features: age, diabetes, cardiovascular diseases, and obesity [111][112][113][114]125,150]) for severe disease are shown. Below, other factors (biochemical features: levels of vitamin D, statins, interferon activity, and G6PD [132][133][134]138,140,145]) that are suggested to be involved in COVID-19 severity are summarised.…”