Peres Karina Colombera, Riera Rachel, Martimbianco Ana Luiza Cabrera, Ward Laura Sterian, Cunha Lucas Leite
Laboratory of Cancer Molecular Genetics, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Front Endocrinol (Lausanne). 2020 Aug 14;11:562. doi: 10.3389/fendo.2020.00562. eCollection 2020.
A better understanding of the SARS-CoV-2 virus behavior and possible risk factors implicated in poor outcome has become an urgent need. We performed a systematic review in order to investigate a possible association between body weight and prognosis among patients diagnosed with COVID-19. We searched in Cochrane Library, EMBASE, MEDLINE, WHO-Global Literature on Coronavirus Disease, OpenGrey, and Medrxiv. We used the ROBINS-I tool or Cross-Sectional/Prevalence Study Quality tool from AHRQ, to evaluate the methodological quality of included studies. Nine studies (two prospective cohorts, four retrospective cohorts and three cross-sectional) were included and assessed the relationship between obesity and COVID-19 prognosis. Risk of bias of the included studies ranged from moderate to critical. Clinical and methodological heterogeneity among them precluded meta-analyses. Most of the included studies showed some degree of association to: (a) higher BMI and worse clinical presentation and (b) obesity and need of hospitalization. The results were inconsistent about the impact of obesity on mortality. Based on limited methodological quality studies, obesity seems to predict poor clinical evolution in patients with COVID-19. Further studies with appropriate prospective design are needed to reduce the uncertainty on this evidence.
更好地了解严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒的行为以及与不良预后相关的可能风险因素已成为当务之急。我们进行了一项系统综述，以调查确诊为冠状病毒病2019（COVID-19）的患者体重与预后之间可能存在的关联。我们在考克兰图书馆、EMBASE、医学期刊数据库、世界卫生组织全球冠状病毒病文献、OpenGrey和Medrxiv中进行了检索。我们使用美国医疗保健研究与质量局（AHRQ）的ROBINS-I工具或横断面/患病率研究质量工具来评估纳入研究的方法学质量。纳入了9项研究（2项前瞻性队列研究、4项回顾性队列研究和3项横断面研究），并评估了肥胖与COVID-19预后之间的关系。纳入研究的偏倚风险从中度到严重不等。它们之间的临床和方法学异质性排除了进行荟萃分析的可能性。大多数纳入研究显示出某种程度的关联：（a）较高的体重指数（BMI）与更差的临床表现，以及（b）肥胖与住院需求。关于肥胖对死亡率的影响，结果并不一致。基于方法学质量有限的研究，肥胖似乎预示着COVID-19患者临床病情的不良演变。需要进一步开展具有适当前瞻性设计的研究，以减少这一证据的不确定性。
