Clinical and Microbiological Outcomes in Overweight or Obese Patients Hospitalized for COVID-19
DOI:
https://doi.org/10.17533/udea.iatreia.256Keywords:
Body Mass index, COVID-19 , intensive care unit, obesity, SARS-CoV-2Abstract
Introduction: COVID-19 infection has been one of the most significant pandemics in history, and obesity is a factor that increases the risk of complications.
Objective: To characterize patients diagnosed with COVID-19, according to their body mass index (BMI) and clinical outcomes of the infection.
Methods: Descriptive study in adults hospitalized for COVID-19 disease and classified according to their BMI. Microbiological and clinical variables were recorded, in addition to outcomes attributed to the infection. The information was analyzed using descriptive methods.
Results: 167 patients were included with a median age of 64 years (IQR=22), 13.8% with normal BMI, 45.5% overweight and 40.7% obese. In the overweight group, higher levels of ferritin, C-reactive protein and liver enzymes were identified compared to the normal BMI and obese groups. The number of days on mechanical ventilation was higher in overweight and obese patients (Median:14[IQR=21] and Median:12[IQR=21], respectively), compared to the normal BMI group (Median:9[IQR=13]). Up to one co-infecting microorganism was found in 51.4%, two in 25.7%, and three in 22.8%. At least 85% of patients who presented renal, neurological and hepatic dysfunction had a BMI >25 kg/m2. The overall mortality was 48.5% and predominated in overweight (51.8%) and obese (26.5%) patients.
Conclusion: A higher frequency of morbidity and mortality outcomes clinically attributed to COVID-19 was evident in overweight patients. However, analytical designs are needed to demonstrate the possible additional risk in overweight patients with COVID-19.
Downloads
References
Nakeshbandi M, Maini R, Daniel P, Rosengarten S, Parmar P, Wilson C, et al. The impact of obesity on COVID-19 complications: a retrospective cohort study. Int J Obes [Internet]. 2020;44(9):1832-7. https://doi.org/10.1038/s41366-020-0648-x
Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med [Internet]. 2020;382(24):2372-4. https://doi.org/10.1056/NEJMc2010419
Gobierno presenta Encuesta Nacional de Situación Nutricional de Colombia (ENSIN) 2015 [Internet]. Bogotá: Ministerio de Salud y Protección Social. [citado 25 de diciembre de 2021]. Disponible en: https://www.minsalud.gov.co/Paginas/Gobierno-presenta-Encuesta-Nacional-de-Situaci%C3%B3n-Nutricional-de-Colombia-ENSIN-2015.aspx
Ibáñez AL. El Problema de la Obesidad en América. Rev Chil Cir [Internet]. 2007;59(6):399-400. https://doi.org/10.4067/S0718-40262007000600001
Hossain P, Kawar B, Nahas ME. Obesity and Diabetes in the Developing World - A Growing Challenge. N Engl J Med [Internet]. 2007;356(3):213-5. https://doi.org/10.1056/NEJMp068177
CDC. Obesity is a Common, Serious, and Costly Disease [Internet]. [citado 12 de octubre de 2022]. 2022. Disponible en: https://www.cdc.gov/obesity/data/adult.html
Khatiwada S, Subedi A. Lung microbiome and coronavirus disease 2019 (COVID-19): Possible link and implications. Hum Microbiome J [Internet]. 2020;17:100073. https://doi.org/10.1016/j.humic.2020.100073
Honce R, Schultz-Cherry S. Impact of Obesity on Influenza A Virus Pathogenesis, Immune Response, and Evolution. Front Immunol [Internet]. 2019;10:1071. https://doi.org/10.3389/fimmu.2019.01071
Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and Outcomes in COVID-19: When an Epidemic and Pandemic Collide. Mayo Clin Proc [Internet]. 2020;95(7):1445-53. https://doi.org/10.1016/j.mayocp.2020.05.006
Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst CH, et al. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev Off J Int Assoc Study Obes. noviembre de 2020;21(11):e13128. https://doi.org/10.1111/
Organización Mundial de la Salud. Manejo clínico de la COVID-19: orientaciones evolutivas [Internet]. 2021. https://apps.who.int/iris/handle/10665/340629
Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Requiring Invasive Mechanical Ventilation. Obes Silver Spring Md [Internet]. 2020;28(7):1195-9. https://doi.org/10.1002/oby.22831
Gao YD, Ding M, Dong X, Zhang JJ, Kursat-Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy [Internet]. 2021;76(2):428-55. https://doi.org/10.1111/all.14657
Leeuw AJM, Oude-Luttikhuis MAM, Wellen AC, Müller C, Calkhoven CF. Obesity and its impact on COVID-19. J Mol Med [Internet]. 2021;99(7):899-915. https://doi.org/10.1007/s00109-021-02072-4
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet [Internet]. 2020;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3
Caussy C, Wallet F, Laville M, Disse E. Obesity is Associated with Severe Forms of COVID‐19. Obes Silver Spring Md [Internet]. 2020;28(7):1175. https://doi.org/10.1002/oby.22842
Fanelli V, Ranieri VM. Mechanisms and Clinical Consequences of Acute Lung Injury. Ann Am Thorac Soc [Internet]. 2015;12(Supplement 1):S3-8. https://doi.org/10.1513/AnnalsATS.201407-340MG
Hamer M, Gale CR, Kivimäki M, Batty GD. Overweight, obesity, and risk of hospitalization for COVID-19: A community-based cohort study of adults in the United Kingdom. Proc Natl Acad Sci [Internet]. 2020;117(35):21011-3.
https://doi.org/10.1073/pnas.2011086117
WHO Coronavirus Disease (COVID-19) Dashboard [Internet]. [citado 23 de enero de 2021]. Disponible en: https://covid19.who.int
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet [Internet]. 2020;395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
Riquelme DJ, Oyarzún MD, Gallardo AD, Bedoya JJ, Bahamonde OC, Rincón CM, et al. Features of patients admitted with COVID-19 to a Chilean regional hospital during the first stages of the pandemic. Rev Med Chil [Internet]. 2022;150(4):465-72. https://doi.org/10.4067/S0034-98872022000400465
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA [Internet]. 2020;323(20):2052-9. https://doi.org/10.1001/jama.2020.6775
Yoshida Y, Gillet SA, Brown MI, Zu Y, Wilson SM, Ahmed SJ, et al. Clinical characteristics and outcomes in women and men hospitalized for coronavirus disease 2019 in New Orleans. Biol Sex Differ [Internet]. 2021;12(1):20. https://doi.org/10.1186/s13293-021-00359-2
Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med [Internet]. 2020;180(10):1345-55. https://doi.org/10.1001/jamainternmed.2020.3539
Gupta S, Hayek SS, Wang W, Chan L, Mathews KS, Melamed ML, et al. Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US. JAMA Intern Med [Internet]. 2020;180(11):1436-47. https://doi.org/10.1001/jamainternmed.2020.3596
Zhou Y, Chi J, Lv W, Wang Y. Obesity and diabetes as high‐risk factors for severe coronavirus disease 2019 (COVID‐19). Diabetes Metab Res Rev [Internet]. 2020;37(2):e3377. https://doi.org/10.1002/dmrr.3377
Frydrych LM, Bian G, O'Lone DE, Ward PA, Delano MJ. Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality. J Leukoc Biol [Internet]. 2018;104(3):525-34. https://doi.org/10.1002/JLB.5VMR0118-021RR
Sattar N, McInnes IB, McMurray JJV. Obesity Is a Risk Factor for Severe COVID-19 Infection. Circulation [Internet]. 2020;142(1):4-6. https://doi.org/10.1161/CIRCULATIONAHA.120.047659
Stevanovic D, Zdravkovic V, Poskurica M, Petrovic M, Cekerevac I, Zdravkovic N, et al. The Role of Bioelectrical Impedance Analysis in Predicting COVID-19 Outcome. Front Nutr [Internet]. 2022;9:906659. https://doi.org/10.3389/fnut.2022.906659
Cai Q, Chen F, Wang T, Luo F, Liu X, Wu Q, et al. Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China. Diabetes Care [Internet]. julio de 2020;43(7):1392-8. https://doi.org/10.2337/dc20-0576
Zhang ZL, Hou YL, Li DT, Li FZ. Laboratory findings of COVID-19: a systematic review and meta-analysis. Scand J Clin Lab Invest [Internet]. 2020;80(6):441-7. https://doi.org/10.1080/00365513.2020.1768587
Huang Y, Tu M, Wang S, Chen S, Zhou W, Chen D, et al. Clinical characteristics of laboratory confirmed positive cases of SARS-CoV-2 infection in Wuhan, China: A retrospective single center analysis. Travel Med Infect Dis [Internet]. 2020;36:101606. https://doi.org/10.1016/j.tmaid.2020.101606
Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci [Internet]. 2020;57(6):389-99. https://doi.org/10.1080/10408363.2020.1770685
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med [Internet]. 2020;8(5):475-81. https://doi.org/10.1016/S2213-2600(20)30079-5
Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int [Internet]. 2020;97(5):829-38. https://doi.org/10.1016/j.kint.2020.03.005
Kubin CJ, McConville TH, Dietz D, Zucker J, May M, Nelson B, et al. Characterization of Bacterial and Fungal Infections in Hospitalized Patients With Coronavirus Disease 2019 and Factors Associated With Health Care-Associated Infections. Open Forum Infect Dis [Internet]. 2021;8(6):ofab201. https://doi.org/10.1093/ofid/ofab201
Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing. Clin Infect Dis [Internet]. 2020;71(9):2459-68. https://doi.org/10.1093/cid/ciaa530
Cetin D, Lessig BA, Nasr E. Comprehensive Evaluation for Obesity: Beyond Body Mass Index. J Am Osteopath Assoc [Internet]. 2016;116(6):376-82. https://doi.org/10.7556/jaoa.2016.078
Kok P, Seidell JC, Meinders AE. [The value and limitations of the body mass index (BMI) in the assessment of the health risks of overweight and obesity]. Ned Tijdschr Geneeskd [Internet]. 2004;148(48):2379-82. Available From: https://pubmed.ncbi.nlm.nih.gov/15615272/
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Iatreia
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Papers published in the journal are available for use under the Creative Commons license, specifically Attribution-NonCommercial-ShareAlike 4.0 International.
The papers must be unpublished and sent exclusively to the Journal Iatreia; the author uploading the contribution is required to submit two fully completed formats: article submission and authorship responsibility.
