The role of obesity in inflammatory markers in COVID-19 patients

McNeill, Jenna; Lau, Elizabeth T.; Paniagua, Samantha M.; Liu, Elizabeth; Wang, Jessica K.; Bassett, Ingrid V.; Selvaggi, Caitlin; Lubitz, Steven A.; Foulkes, Andrea S.; Ho, Jennifer E.

doi:10.1016/j.orcp.2020.12.004

Cited by 38 publications

(30 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Besides, higher levels of serum inflammatory biomarkers such as C-reactive protein (CRP), interleukin (IL)-6, ferritin, fibrinogen, D-dimer, erythrocyte sedimentation rate (ESR), and lactate dehydrogenase are predictive of subsequent critical illness and worse outcome in patients with COVID-19 [2•]. The majority of these inflammatory biomarkers are slightly elevated in individuals with obesity due to the chronic subclinical lowgrade inflammation that characterizes obesity [54][55][56]. Recent data have shown that patients with obesity and COVID-19 exhibited higher initial and peak levels of CRP and ESR as well as higher peak D-dimer in comparison to individuals with normal weight and COVID-19 after adjusting for age, gender, smoking, and comorbidities, suggesting greater disease severity characterized by more exuberant inflammation in individuals with obesity [55].…”

Section: Current Evidence Of Epidemiologic Associations Between Obesity and Covid-19mentioning

confidence: 99%

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

et al. 2021

View full text Add to dashboard Cite

Purpose of Review A growing body of evidence suggests that obesity and increased visceral adiposity are strongly and independently linked to adverse outcomes and death due to COVID-19. This review summarizes current epidemiologic data, highlights pathogenetic mechanisms on the association between excess body weight and COVID-19, compares data from previous pandemics, discusses why COVID-19 challenges the “obesity paradox,” and presents implications in prevention and treatment as well as future perspectives. Recent Findings Data from meta-analyses based on recent observational studies have indicated that obesity increases the risks of infection from SARS-CoV-2, severe infection and hospitalization, admission to the ICU and need of invasive mechanical ventilation (IMV), and the risk of mortality, particularly in severe obesity. The risks of IMV and mortality associated with obesity are accentuated in younger individuals (age ≤ 50 years old). The meta-inflammation in obesity intersects with and exacerbates underlying pathogenetic mechanisms in COVID-19 through the following mechanisms and factors: (i) impaired innate and adaptive immune responses; (ii) chronic inflammation and oxidative stress; (iii) endothelial dysfunction, hypercoagulability, and aberrant activation of the complement; (iv) overactivation of the renin–angiotensin–aldosterone system; (v) overexpression of the angiotensin-converting enzyme 2 receptor in the adipose tissue; (vi) associated cardiometabolic comorbidities; (vii) vitamin D deficiency; (viii) gut dysbiosis; and (ix) mechanical and psychological issues. Summary Mechanistic and large epidemiologic studies using big data sources with omics data exploring genetic determinants of risk and disease severity as well as large randomized controlled trials (RCTs) are necessary to shed light on the pathways connecting chronic subclinical inflammation/meta-inflammation with adverse COVID-19 outcomes and establish the ideal preventive and therapeutic approaches for patients with obesity.

show abstract

Section: Current Evidence Of Epidemiologic Associations Between Obesity and Covid-19mentioning

confidence: 99%

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Greater disease severity in obese is characterized by more exuberant inflammation. 7 In our cohort of obese patients, the inflammatory markers, IL-6, ferritin, and CRP were raised, as multiples of lower limits of normal, by 25.9, 97.2, and 49.6 times, respectively.…”

Section: Discussionmentioning

confidence: 60%

Clinical Course and Outcome of Critically Ill Obese Patients with COVID-19 Admitted in Intensive Care Unit of a Single Center: Our Experience and Review

Kaur¹,

Aggarwal²,

Ganesh³

et al. 2021

Indian Journal of Critical Care Medicine

View full text Add to dashboard Cite

A bstract Introduction Obesity has been considered as one of the independent risk factors for a severe form of coronavirus disease-2019 (COVID-19) and relationship between obesity, critical illness, and infection is still poorly understood. We herein discuss clinical course and outcome of critically ill obese patients with COVID-19 admitted to critical care unit. Materials and methods We retrospectively analyzed data of critically ill obese patients hospitalized with COVID-19 over a span of 6 months. Management was guided according to the institutional protocol. Collected data included demographic parameters (age, sex, comorbidities, and body mass index (BMI)), complications, inflammatory markers (interleukin (IL)-6, Ferritin), length of mechanical ventilation, length of intensive care unit (ICU) stay, and inhospital death. Results There was no appreciable difference in terms of demographics, inflammatory markers, predictors of mortality scores, and comorbidity indices between the survivors and nonsurvivors. Among outcome analysis, there was a statistically significant difference between ventilator days between survivors and nonsurvivors ( p = 0.003 ** ). Conclusion Obesity itself is a significant risk factor for severe COVID-19 infection; however, if efficiently managed and in a protocol-determined manner, it can have a favorable outcome. How to cite this article Kaur M, Aggarwal R, Ganesh V, Kumar R, Patel N, Ayub A, et al . Clinical Course and Outcome of Critically Ill Obese Patients with COVID-19 Admitted in Intensive Care Unit of a Single Center: Our Experience and Review. Indian J Crit Care Med 2021;25(12):1382–1386.

show abstract

“…In our cohort, all obese patients had SARS-CoV-2 RNA detected in stools. Obesity is one of the main risk factors for severe COVID-19 and poor clinical outcomes[ 20 , 21 ], and is associated with a strong inflammatory response both in the general population and in COVID-19 patients[ 22 ]. This could justify a more prolonged viral shedding in this subgroup of patients.…”

Section: Discussionmentioning

confidence: 99%

High fecal calprotectin levels are associated with SARS-CoV-2 intestinal shedding in COVID-19 patients: A proof-of-concept study

Zerbato

Bella

Giuffrè

et al. 2021

WJG

View full text Add to dashboard Cite

BACKGROUND One third of coronavirus disease 2019 (COVID-19) patients have gastrointestinal symptoms. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA has been detected in stool samples of approximately 50% of COVID-19 individuals. Fecal calprotectin is a marker of gastrointestinal inflammation in the general population. AIM To investigate if fecal calprotectin correlates with SARS-CoV-2 intestinal shedding in COVID-19 patients with pneumonia. METHODS Patients with SARS-CoV-2 pneumonia admitted to the Infectious Disease Unit (University Hospital of Trieste, Italy) from September to November 2020 were consecutively enrolled in the study. Fecal samples were collected and analyzed for quantification of fecal calprotectin (normal value < 50 mg/kg) and SARS-CoV-2 RNA presence by polymerase chain reaction (PCR). Inter-group differences were determined between patients with and without diarrhea and patients with and without detection of fecal SARS-CoV-2. RESULTS We enrolled 51 adults (40 males) with SARS-CoV-2 pneumonia. Ten patients (20%) presented with diarrhea. Real-time-PCR of SARS-CoV-2 in stools was positive in 39 patients (76%), in all patients with diarrhea (100%) and in more than two thirds (29/41, 71%) of patients without diarrhea. Obesity was one of the most common comorbidities (13 patients, 25%); all obese patients (100%) ( P = 0.021) tested positive for fecal SARS-CoV-2. Median fecal calprotectin levels were 60 mg/kg [interquartile range (IQR) 21; 108]; higher fecal calprotectin levels were found in the group with SARS-CoV-2 in stools (74 mg/kg, IQR 29; 132.5) compared to the group without SARS-CoV-2 (39 mg/kg, IQR 14; 71) ( P < 0.001). CONCLUSION High fecal calprotectin levels among COVID-19 patients correlate with SARS-CoV-2 detection in stools supporting the hypothesis that this virus can lead to bowel inflammation and potentially to the ‘leaky gut’ syndrome.

show abstract

The role of obesity in inflammatory markers in COVID-19 patients

Cited by 38 publications

References 10 publications

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives

Clinical Course and Outcome of Critically Ill Obese Patients with COVID-19 Admitted in Intensive Care Unit of a Single Center: Our Experience and Review

High fecal calprotectin levels are associated with SARS-CoV-2 intestinal shedding in COVID-19 patients: A proof-of-concept study

Contact Info

Product

Resources

About