tetano
Editor, Senior Moderator
Ann Intern Med
. 2020 Jul 29.
doi: 10.7326/M20-3214. Online ahead of print.
Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection: A Retrospective Cohort Study
Michaela R Anderson[SUP] 1 [/SUP], Joshua Geleris[SUP] 1 [/SUP], David R Anderson[SUP] 2 [/SUP], Jason Zucker[SUP] 1 [/SUP], Yael R Nobel[SUP] 1 [/SUP], Daniel Freedberg[SUP] 1 [/SUP], Jennifer Small-Saunders[SUP] 1 [/SUP], Kartik N Rajagopalan[SUP] 1 [/SUP], Richard Greendyk[SUP] 3 [/SUP], Sae-Rom Chae[SUP] 1 [/SUP], Karthik Natarajan[SUP] 1 [/SUP], David Roh[SUP] 1 [/SUP], Ethan Edwin[SUP] 1 [/SUP], Dympna Gallagher[SUP] 4 [/SUP], Anna Podolanczuk[SUP] 1 [/SUP], R Graham Barr[SUP] 5 [/SUP], Anthony W Ferrante[SUP] 1 [/SUP], Matthew R Baldwin[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Obesity is a risk factor for pneumonia and acute respiratory distress syndrome.
Objective: To determine whether obesity is associated with intubation or death, inflammation, cardiac injury, or fibrinolysis in coronavirus disease 2019 (COVID-19).
Design: Retrospective cohort study.
Setting: A quaternary academic medical center and community hospital in New York City.
Participants: 2466 adults hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection over a 45-day period with at least 47 days of in-hospital observation.
Measurements: Body mass index (BMI), admission biomarkers of inflammation (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), cardiac injury (troponin level), and fibrinolysis (D-dimer level). The primary end point was a composite of intubation or death in time-to-event analysis.
Results: Over a median hospital length of stay of 7 days (interquartile range, 3 to 14) days, 533 patients (22%) were intubated, 627 (25%) died, and 59 (2%) remained hospitalized. Compared with overweight patients, patients with obesity had higher risk for intubation or death, with the highest risk among those with class 3 obesity (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]). This association was primarily observed among patients younger than 65 years and not in older patients (P for interaction by age = 0.042). Body mass index was not associated with admission levels of biomarkers of inflammation, cardiac injury, or fibrinolysis.
Limitations: Body mass index was missing for 28% of patients. The primary analyses were conducted with multiple imputation for missing BMI. Upper bounding factor analysis suggested that the results are robust to possible selection bias.
Conclusion: Obesity is associated with increased risk for intubation or death from COVID-19 in adults younger than 65 years, but not in adults aged 65 years or older.
. 2020 Jul 29.
doi: 10.7326/M20-3214. Online ahead of print.
Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection: A Retrospective Cohort Study
Michaela R Anderson[SUP] 1 [/SUP], Joshua Geleris[SUP] 1 [/SUP], David R Anderson[SUP] 2 [/SUP], Jason Zucker[SUP] 1 [/SUP], Yael R Nobel[SUP] 1 [/SUP], Daniel Freedberg[SUP] 1 [/SUP], Jennifer Small-Saunders[SUP] 1 [/SUP], Kartik N Rajagopalan[SUP] 1 [/SUP], Richard Greendyk[SUP] 3 [/SUP], Sae-Rom Chae[SUP] 1 [/SUP], Karthik Natarajan[SUP] 1 [/SUP], David Roh[SUP] 1 [/SUP], Ethan Edwin[SUP] 1 [/SUP], Dympna Gallagher[SUP] 4 [/SUP], Anna Podolanczuk[SUP] 1 [/SUP], R Graham Barr[SUP] 5 [/SUP], Anthony W Ferrante[SUP] 1 [/SUP], Matthew R Baldwin[SUP] 1 [/SUP]
Affiliations
- PMID: 32726151
- DOI: 10.7326/M20-3214
Abstract
Background: Obesity is a risk factor for pneumonia and acute respiratory distress syndrome.
Objective: To determine whether obesity is associated with intubation or death, inflammation, cardiac injury, or fibrinolysis in coronavirus disease 2019 (COVID-19).
Design: Retrospective cohort study.
Setting: A quaternary academic medical center and community hospital in New York City.
Participants: 2466 adults hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection over a 45-day period with at least 47 days of in-hospital observation.
Measurements: Body mass index (BMI), admission biomarkers of inflammation (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), cardiac injury (troponin level), and fibrinolysis (D-dimer level). The primary end point was a composite of intubation or death in time-to-event analysis.
Results: Over a median hospital length of stay of 7 days (interquartile range, 3 to 14) days, 533 patients (22%) were intubated, 627 (25%) died, and 59 (2%) remained hospitalized. Compared with overweight patients, patients with obesity had higher risk for intubation or death, with the highest risk among those with class 3 obesity (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]). This association was primarily observed among patients younger than 65 years and not in older patients (P for interaction by age = 0.042). Body mass index was not associated with admission levels of biomarkers of inflammation, cardiac injury, or fibrinolysis.
Limitations: Body mass index was missing for 28% of patients. The primary analyses were conducted with multiple imputation for missing BMI. Upper bounding factor analysis suggested that the results are robust to possible selection bias.
Conclusion: Obesity is associated with increased risk for intubation or death from COVID-19 in adults younger than 65 years, but not in adults aged 65 years or older.