Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry

Mohammad Abumayyaleh, Iván J Núñez Gil, Ibrahim El-Battrawy, Vicente Estrada, Víctor Manuel Becerra-Muñoz, Alvaro Aparisi, Inmaculada Fernández-Rozas, Gisela Feltes, Ramón Arroyo-Espliguero, Daniela Trabattoni, Javier López-País, Martino Pepe, Rodolfo Romero, Diego Raúl Villavicencio García, Carloalberto Biole, Thamar Capel Astrua, Charbel Maroun Eid, Emilio Alfonso, Lucia Fernandez-Presa, Carolina Espejo, Danilo Buonsenso, Sergio Raposeiras, Cristina Fernández, Carlos Macaya, Ibrahim Akin, HOPE COVID-19 investigators, Mohammad Abumayyaleh, Iván J Núñez Gil, Ibrahim El-Battrawy, Vicente Estrada, Víctor Manuel Becerra-Muñoz, Alvaro Aparisi, Inmaculada Fernández-Rozas, Gisela Feltes, Ramón Arroyo-Espliguero, Daniela Trabattoni, Javier López-País, Martino Pepe, Rodolfo Romero, Diego Raúl Villavicencio García, Carloalberto Biole, Thamar Capel Astrua, Charbel Maroun Eid, Emilio Alfonso, Lucia Fernandez-Presa, Carolina Espejo, Danilo Buonsenso, Sergio Raposeiras, Cristina Fernández, Carlos Macaya, Ibrahim Akin, HOPE COVID-19 investigators

Abstract

Background: Obesity has been described as a protective factor in cardiovascular and other diseases being expressed as 'obesity paradox'. However, the impact of obesity on clinical outcomes including mortality in COVID-19 has been poorly systematically investigated until now. We aimed to compare clinical outcomes among COVID-19 patients divided into three groups according to the body mass index (BMI).

Methods: We retrospectively collected data up to May 31st, 2020. 3635 patients were divided into three groups of BMI (<25 kg/m2; n = 1110, 25-30 kg/m2; n = 1464, and >30 kg/m2; n = 1061). Demographic, in-hospital complications, and predictors for mortality, respiratory insufficiency, and sepsis were analyzed.

Results: The rate of respiratory insufficiency was more recorded in BMI 25-30 kg/m2 as compared to BMI < 25 kg/m2 (22.8% vs. 41.8%; p < 0.001), and in BMI > 30 kg/m2 than BMI < 25 kg/m2, respectively (22.8% vs. 35.4%; p < 0.001). Sepsis was more observed in BMI 25-30 kg/m2 and BMI > 30 kg/m2 as compared to BMI < 25 kg/m2, respectively (25.1% vs. 42.5%; p = 0.02) and (25.1% vs. 32.5%; p = 0.006). The mortality rate was higher in BMI 25-30 kg/m2 and BMI > 30 kg/m2 as compared to BMI < 25 kg/m2, respectively (27.2% vs. 39.2%; p = 0.31) (27.2% vs. 33.5%; p = 0.004). In the Cox multivariate analysis for mortality, BMI < 25 kg/m2 and BMI > 30 kg/m2 did not impact the mortality rate (HR 1.15, 95% CI: 0.889-1.508; p = 0.27) (HR 1.15, 95% CI: 0.893-1.479; p = 0.27). In multivariate logistic regression analyses for respiratory insufficiency and sepsis, BMI < 25 kg/m2 is determined as an independent predictor for reduction of respiratory insufficiency (OR 0.73, 95% CI: 0.538-1.004; p = 0.05).

Conclusions: HOPE COVID-19-Registry revealed no evidence of obesity paradox in patients with COVID-19. However, Obesity was associated with a higher rate of respiratory insufficiency and sepsis but was not determined as an independent predictor for a high mortality.

Keywords: BMI; COVID-19; Obesity paradox; SARS-CoV-2.

Copyright © 2021 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow chart of study selection process.
Fig. 2
Fig. 2
Survival analysis in normal weight, overweight, and obese patients with COVID-19.
Fig. 3
Fig. 3
Predictors for mortality, sepsis, and respiratory insufficiency. Abbreviations: BMI, body mass index; SPO2, peripheral oxygen saturation; ECMO, extracorporeal membrane oxygenation.

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Source: PubMed

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