Edwards Jordan N, Ganz Tomas, Nemeth Elizabeta, Martin Emily J, Jackson Nicholas J, Kim Airie
David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
J Crit Care Med (Targu Mures). 2025 Apr 30;11(2):140-148. doi: 10.2478/jccm-2025-0012. eCollection 2025 Apr.
The coronavirus disease 2019 (COVID-19) has infected millions of people worldwide resulting in high morbidity and mortality. Obesity is known to cause metabolic derangements and precipitate worse outcomes from viral pneumonia, potentially secondary to increased inflammation and/or altered respiratory mechanics.
Our study's aim was to examine the relationships among BMI, systemic inflammation, and respiratory mechanics in determining clinical outcomes.
This retrospective, observational cohort study included 199 adult patients with confirmed COVID-19 who were hospitalized at a quaternary-referral academic health system. Data were manually extracted from electronic medical records, including baseline demographics and clinical profiles, inflammatory markers, measures of respiratory mechanics, and clinical outcomes. We used the rank-sum test to compare the distributions of BMI and inflammatory markers between those with and without specific clinical outcomes, and the Pearson correlation to measure the correlations between BMI and inflammatory markers or respiratory mechanics.
Higher BMI was associated with worse clinical outcomes, including the need for Intensive Care Unit (ICU) admission, invasive mechanical ventilation (IMV), neuromuscular blockade, and prone positioning, particularly in male patients. Inflammation, as measured by C-reactive protein, lactate dehydrogenase (LDH), ferritin, and D-Dimer, was also increased in both male and female patients who required ICU admission, IMV, neuromuscular blockade, and prone positioning. However, only male patients had a positive correlation of LDH and D-Dimer levels with BMI. There was no correlation between BMI and respiratory mechanics, as measured by static compliance and the response to prone positioning.
Our findings suggest that the metabolic dysfunction and systemic inflammation seen in obesity, and not dysfunctional respiratory physiology, drive the negative clinical outcomes seen in this cohort of hospitalized COVID-19 patients.
2019年冠状病毒病（COVID-19）已在全球感染了数百万人，导致高发病率和死亡率。众所周知，肥胖会引起代谢紊乱，并使病毒性肺炎的预后更差，这可能继发于炎症增加和/或呼吸力学改变。
我们研究的目的是探讨体重指数（BMI）、全身炎症和呼吸力学在决定临床结局中的关系。
这项回顾性观察性队列研究纳入了199例确诊为COVID-19的成年患者，这些患者在一家四级转诊学术医疗系统住院。数据从电子病历中手动提取，包括基线人口统计学和临床特征、炎症标志物、呼吸力学指标和临床结局。我们使用秩和检验比较有和没有特定临床结局患者的BMI和炎症标志物分布，并使用Pearson相关性分析来测量BMI与炎症标志物或呼吸力学之间的相关性。
较高的BMI与较差的临床结局相关，包括入住重症监护病房（ICU）、有创机械通气（IMV）、神经肌肉阻滞和俯卧位通气的需求，尤其是在男性患者中。通过C反应蛋白、乳酸脱氢酶（LDH）、铁蛋白和D-二聚体测量的炎症在需要ICU入住、IMV、神经肌肉阻滞和俯卧位通气的男性和女性患者中也有所增加。然而，只有男性患者的LDH和D-二聚体水平与BMI呈正相关。通过静态顺应性和对俯卧位通气的反应测量，BMI与呼吸力学之间没有相关性。
我们的研究结果表明，肥胖中出现的代谢功能障碍和全身炎症，而非呼吸生理功能障碍，导致了这组住院COVID-19患者出现不良临床结局。
