Pulmonology, Allergy & Clinical Immunology Outpatient Clinic, Bergamo, Italy.
Departmental Unit of Pneumology & Allergology-COVID19 Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
Mayo Clin Proc. 2021 Apr;96(4):921-931. doi: 10.1016/j.mayocp.2021.01.021. Epub 2021 Feb 4.
We aimed to investigate whether the stratification of outpatients with coronavirus disease 2019 (COVID-19) pneumonia by body mass index (BMI) can help predict hospitalization and other severe outcomes.
We prospectively collected consecutive cases of community-managed COVID-19 pneumonia from March 1 to April 20, 2020, in the province of Bergamo and evaluated the association of overweight (25 kg/m ≤ BMI <30 kg/m) and obesity (≥30 kg/m) with time to hospitalization (primary end point), low-flow domiciliary oxygen need, noninvasive mechanical ventilation, intubation, and death due to COVID-19 (secondary end points) in this cohort. We analyzed the primary end point using multivariable Cox models.
Of 338 patients included, 133 (39.4%) were overweight and 77 (22.8%) were obese. Age at diagnosis was younger in obese patients compared with those overweight or with normal weight (P<.001), whereas diabetes, dyslipidemia, and heart diseases were differently distributed among BMI categories. Azithromycin, hydroxychloroquine, and prednisolone use were similar between BMI categories (P>.05). Overall, 105 (31.1%) patients were hospitalized, and time to hospitalization was significantly shorter for obese vs over- or normal-weight patients (P<.001). In the final multivariable analysis, obese patients were more likely to require hospitalization than nonobese patients (hazard ratio, 5.83; 95% CI, 3.91 to 8.71). Results were similar in multiple sensitivity analyses. Low-flow domiciliary oxygen need, hospitalization with noninvasive mechanical ventilation, intubation, and death were significantly associated with obesity (P<.001).
In patients with community-managed COVID-19 pneumonia, obesity is associated with a higher hospitalization risk and overall worse outcomes than for nonobese patients.
我们旨在研究 2019 年冠状病毒病（COVID-19）肺炎患者的体重指数（BMI）分层是否有助于预测住院和其他严重结局。
我们前瞻性地收集了 2020 年 3 月 1 日至 4 月 20 日在贝加莫省管理的社区管理 COVID-19 肺炎的连续病例，并评估了超重（25kg/m≤BMI<30kg/m）和肥胖（≥30kg/m）与住院时间（主要终点）、低流量家庭氧疗需求、无创机械通气、插管以及 COVID-19 死亡（次要终点）之间的关联。我们使用多变量 Cox 模型分析了主要终点。
在 338 例患者中，133 例（39.4%）超重，77 例（22.8%）肥胖。与超重或体重正常的患者相比，肥胖患者的诊断年龄更年轻（P<.001），而糖尿病、血脂异常和心脏病在 BMI 类别中分布不同。BMI 类别之间阿奇霉素、羟氯喹和泼尼松龙的使用相似（P>.05）。总体而言，105 例（31.1%）患者住院，肥胖患者的住院时间明显短于超重或体重正常的患者（P<.001）。在最终的多变量分析中，肥胖患者比非肥胖患者更有可能需要住院治疗（风险比，5.83；95%置信区间，3.91 至 8.71）。多次敏感性分析结果相似。低流量家庭氧疗需求、需住院行无创机械通气、插管和死亡与肥胖显著相关（P<.001）。
在社区管理的 COVID-19 肺炎患者中，肥胖与较高的住院风险和整体较差的结局相关，比非肥胖患者更严重。
