Naaraayan Ashutossh, Nimkar Abhishek, Pant Sushil, Hasan Amrah, Durdevic Momcilo, Elenius Henrik, Nava Suarez Corina, Jesmajian Stephen
Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA.
Cureus. 2021 May 25;13(5):e15235. doi: 10.7759/cureus.15235.
Obesity has been recognized as a risk factor for poor outcomes in coronavirus disease 2019 (COVID-19) illness. We analyzed the impact of patient characteristics including obesity on hospital mortality and specifically analyzed the effect of obesity by body mass index (BMI) class and by sex.
This retrospective case series included adult patients consecutively hospitalized with confirmed COVID-19 illness between March 12, 2020 and May 13, 2020, at a teaching hospital in the New York City (NYC) metropolitan area. Data were manually extracted from electronic health records by the authors and included demographics, comorbidities, laboratory parameters, and outcomes (hospital mortality or discharge). We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.
Some 348 patients were included in this study, of whom 207 were discharged and 141 died in the hospital. Multivariable regression showed increasing odds of in-hospital death with older age and excess weight. Interestingly obesity increased mortality in women [odds ratio (OR) 4.4, confidence interval (CI) (1.4-13.5) p=0.01] but not among men [OR 1.4, CI (0.5-3.6) p=0.5]. Among women, the effect of excess weight on mortality was seen in a "dose-effect" fashion, with increasingly higher odds of mortality from progressively worsening obesity (OR ranging between 2.7 and 6.9). Out of all the comorbidities, only obesity positively correlated with peak levels of C-reactive protein (CRP).
Advancing age is a risk factor for in-hospital death during COVID-19 illness. Obese women could be at a higher risk for mortality due to COVID-19 and should take extra precautions to prevent contamination by social distancing and other measures. Immunomodulators may be more effective in obese women affected by COVID-19. Further studies are needed to help elucidate this association.
肥胖已被公认为是2019冠状病毒病（COVID-19）病情预后不良的一个风险因素。我们分析了包括肥胖在内的患者特征对医院死亡率的影响，并特别按体重指数（BMI）类别和性别分析了肥胖的影响。
本回顾性病例系列纳入了2020年3月12日至2020年5月13日期间在纽约市（NYC）大都市地区一家教学医院连续住院的确诊COVID-19成年患者。作者从电子健康记录中手动提取数据，包括人口统计学、合并症、实验室参数和结局（医院死亡率或出院情况）。我们使用单变量和多变量逻辑回归方法来探究与院内死亡相关的风险因素。
本研究共纳入约348例患者，其中207例出院，141例在医院死亡。多变量回归显示，年龄增长和超重会增加院内死亡几率。有趣的是，肥胖会增加女性的死亡率[比值比（OR）4.4，置信区间（CI）（1.4 - 13.5），p = 0.01]，但对男性则无此影响[OR 1.4，CI（0.5 - 3.6），p = 0.5]。在女性中，超重对死亡率的影响呈“剂量效应”方式，随着肥胖程度逐渐加重，死亡率几率越来越高（OR在2.7至6.9之间）。在所有合并症中，只有肥胖与C反应蛋白（CRP）的峰值水平呈正相关。
年龄增长是COVID-19疾病期间院内死亡的一个风险因素。肥胖女性因COVID-19导致死亡的风险可能更高，应采取额外预防措施，通过保持社交距离和其他措施防止感染。免疫调节剂可能对受COVID-19影响的肥胖女性更有效。需要进一步研究以帮助阐明这种关联。
