Coronavirus (SARS-CoV-2) and the risk of obesity for critically illness and ICU admitted: Meta-analysis of the epidemiological evidence

Silvia Helena de Carvalho Sales-Peres, Lucas José de Azevedo-Silva, Rafaela Carolina Soares Bonato, Matheus de Carvalho Sales-Peres, Ana Carolina da Silvia Pinto, Joel Ferreira Santiago Junior, Silvia Helena de Carvalho Sales-Peres, Lucas José de Azevedo-Silva, Rafaela Carolina Soares Bonato, Matheus de Carvalho Sales-Peres, Ana Carolina da Silvia Pinto, Joel Ferreira Santiago Junior

Abstract

Objectives: To investigate the relationship between coronavirus disease 2019 (COVID-19) and obesity in critically ill patients admitted to the intensive care unit (ICU).

Methods: We systematically searched PubMed, SCOPUS, Embase, LILACS, and Web of Science for studies published up to April 27, 2020. The outcome of interest was composite poor outcome, comprising mortality and severe COVID-19. We used a standardized data extraction form to collect information from published reports of eligible studies. Heterogeneity and publication bias were assessed using I2 statistic and funnel plots, respectively.

Results: Nine studies including 6577 patients were selected for evaluation. The COVID-19 patients were 59.80% male and had comorbidities such as hypertension (51.51%), diabetes (30.3%), cardiovascular disease (16.66%), lung disease (15.99%), renal disease (7.49%), cancer (5.07%), and immunosuppression (1.8%). For patients with severe complications, the overall pooled event rates were 56.2% (random; 95% CI: 35.3-75.1; p = 0.015; I2 = 71.461) for obesity, 23.6% (random; 95% CI: 17.9-30.5; p = 0.000; I2 = 87.705) for type 2 diabetes, 45.9% (random; 95% CI: 38.0-53.9; p = 0.000; I2 = 90.152) for hypertension, 20.0% (random; 95% CI: 7.9-42.0; p = 0.000; I2 = 94.577) for smoking, 21.6% (random; 95% CI: 14.1-31.4%; p = 0.000, I2 = 92.983) for lung diseases, and 20.6% (random; 95% CI: 15.2-27.5; p = 0.000, I2 = 85.735) for cardiovascular diseases.

Discussion: This systematic review indicated the relationship between obesity, ICU admission, severe COVID-19, and disease progression in patients with COVID-19. Obese patients with hypertension, type 2 diabetes, smoking habit, lung disease, and/or cardiovascular disease should be cared for with increased attention.

Keywords: COVID-19; Hospitalization; ICU; Intubation; Obesity; SARS-CoV-2.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2020 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
PRISMA 2009 flow diagram.
Fig. 2
Fig. 2
Forest plots for severe complications in obese and non-obese individuals (a); obese individuals with severe complications (b); hypertension patients (c); type 2 diabetes patients (d); lung disease patients (e); smoker patients (f); cardiovascular disease patients (g).
Fig. 3
Fig. 3
Funnel plots of standard error by log risk ratio (X: log risk event; Y: standard error): Severe complications in obese individuals and non-obese individuals (a); severe complications in obese individuals (b); patients with hypertension (c); patients with type 2 diabetes mellitus (d); smoker patients (e); patients with lung diseases (f); patients with cardiovascular diseases (g).

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