Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA.
BMJ Open. 2021 Jan 31;11(1):e044526. doi: 10.1136/bmjopen-2020-044526.
To determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions.
Retrospective cohort study.
Urban tertiary care center in New York City.
302 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).
Primary 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.
Patients 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.
In 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.
确定肥胖和糖尿病是否是 COVID-19 严重后果的危险因素，并比较这两种情况下的患者结局。
回顾性队列研究。
纽约市一家城市三级保健中心。
随机选择 302 名在住院环境中入院的患者，年龄≥18 岁，通过鼻 PCR 拭子实验室确诊 COVID-19。根据体重指数和血红蛋白 A1c 将患者分为两组。150 名患者被纳入非肥胖、非糖尿病组，152 名患者被纳入相应的组（单纯肥胖、肥胖和糖尿病以及糖尿病）。
主要结局是急性肾损伤的发展、开始肾脏替代治疗、氨基转移酶升高、肌钙蛋白升高、乳酸酸中毒、脓毒性休克的发展、血管加压素的使用、急性呼吸窘迫综合征（ARDS）和插管的存在。次要结局是住院天数和死亡率。
肥胖和/或糖尿病患者更有可能发展为 ARDS（79 例与 57 例，p<0.0001）和需要插管（71 例与 45 例，p=0.0031）。肥胖和/或糖尿病患者更有可能需要血管加压素（60 例与 41 例，p=0.0284）和发生乳酸酸中毒（中位数 3.15mmol/L，IQR 1.8 至 5.2mmol/L，p=0.0432）。比较有糖尿病和无肥胖症的患者与单纯肥胖的患者，他们发展为 ARDS 的可能性更高（87.5%，p=0.0305）。尽管有这些发现，但死亡率没有差异。
在因 COVID-19 住院的患者中，肥胖和/或糖尿病患者更有可能出现严重并发症，但死亡率差异可忽略不计。这突出了密切监测这些患者和需要进一步研究以解释死亡率发现的重要性。
