Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.A.d.L., C.A., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., M.H.D., J.L.G.).
Parkland Health and Hospital System, Dallas, TX (N.S.H., J.A.d.L., S.R.D., A. Rao, S.C., A. Rosenblatt, A.A.H., J.L.G.).
Circulation. 2021 Jan 12;143(2):135-144. doi: 10.1161/CIRCULATIONAHA.120.051936. Epub 2020 Nov 17.
Obesity may contribute to adverse outcomes in coronavirus disease 2019 (COVID-19). However, studies of large, broadly generalizable patient populations are lacking, and the effect of body mass index (BMI) on COVID-19 outcomes- particularly in younger adults-remains uncertain.
We analyzed data from patients hospitalized with COVID-19 at 88 US hospitals enrolled in the American Heart Association's COVID-19 Cardiovascular Disease Registry with data collection through July 22, 2020. BMI was stratified by World Health Organization obesity class, with normal weight prespecified as the reference group.
Obesity, and, in particular, class III obesity, was overrepresented in the registry in comparison with the US population, with the largest differences among adults ≤50 years. Among 7606 patients, in-hospital death or mechanical ventilation occurred in 2109 (27.7%), in-hospital death in 1302 (17.1%), and mechanical ventilation in 1602 (21.1%). After multivariable adjustment, classes I to III obesity were associated with higher risks of in-hospital death or mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09-1.51], 1.57 [1.29-1.91], 1.80 [1.47-2.20], respectively), and class III obesity was associated with a higher risk of in-hospital death (hazard ratio, 1.26 [95% CI, 1.00-1.58]). Overweight and class I to III obese individuals were at higher risk for mechanical ventilation (odds ratio, 1.28 [95% CI, 1.09-1.51], 1.54 [1.29-1.84], 1.88 [1.52-2.32], and 2.08 [1.68-2.58], respectively). Significant BMI by age interactions were seen for all primary end points (-interaction<0.05 for each), such that the association of BMI with death or mechanical ventilation was strongest in adults ≤50 years, intermediate in adults 51 to 70 years, and weakest in adults >70 years. Severe obesity (BMI ≥40 kg/m) was associated with an increased risk of in-hospital death only in those ≤50 years (hazard ratio, 1.36 [1.01-1.84]). In adjusted analyses, higher BMI was associated with dialysis initiation and with venous thromboembolism but not with major adverse cardiac events.
Obese patients are more likely to be hospitalized with COVID-19, and are at higher risk of in-hospital death or mechanical ventilation, in particular, if young (age ≤50 years). Obese patients are also at higher risk for venous thromboembolism and dialysis. These observations support clear public health messaging and rigorous adherence to COVID-19 prevention strategies in all obese individuals regardless of age.
肥胖可能导致 2019 年冠状病毒病（COVID-19）的不良后果。然而，缺乏对大量广泛可推广的患者人群的研究，并且身体质量指数（BMI）对 COVID-19 结局的影响，特别是在年轻成年人中，仍然不确定。
我们分析了在美国心脏协会的 COVID-19 心血管疾病登记处登记的 88 家美国医院中因 COVID-19 住院的患者的数据，数据收集截至 2020 年 7 月 22 日。BMI 根据世界卫生组织肥胖类别分层，正常体重作为参考组。
与美国人口相比，登记处中肥胖症，特别是 III 类肥胖症的比例过高，其中≤50 岁的成年人之间的差异最大。在 7606 例患者中，有 2109 例（27.7％）发生院内死亡或机械通气，1302 例（17.1％）发生院内死亡，1602 例（21.1％）发生机械通气。经过多变量调整后，I 类至 III 类肥胖症与院内死亡或机械通气的风险增加相关（优势比，1.28 [95％CI，1.09-1.51]，1.57 [1.29-1.91]，1.80 [1.47-2.20]），III 类肥胖症与院内死亡风险增加相关（风险比，1.26 [95％CI，1.00-1.58]）。超重和 I 类至 III 类肥胖症患者发生机械通气的风险更高（优势比，1.28 [95％CI，1.09-1.51]，1.54 [1.29-1.84]，1.88 [1.52-2.32]和 2.08 [1.68-2.58]）。所有主要终点均观察到 BMI 与年龄的交互作用（-交互作用<0.05），这表明 BMI 与死亡或机械通气的关联在≤50 岁的成年人中最强，在 51 至 70 岁的成年人中中等，在>70 岁的成年人中最弱。严重肥胖症（BMI≥40kg/m）仅与≤50 岁人群的院内死亡风险增加相关（风险比，1.36 [1.01-1.84]）。在调整后的分析中，较高的 BMI 与开始透析和静脉血栓栓塞相关，但与主要不良心脏事件无关。
肥胖患者更有可能因 COVID-19 住院，并且如果年龄较小（≤50 岁），则更有可能发生院内死亡或机械通气。肥胖患者也有更高的静脉血栓栓塞和透析风险。这些观察结果支持明确的公共卫生信息传递，并在所有肥胖人群中严格遵守 COVID-19 预防策略，无论年龄大小。
