Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection A Retrospective Cohort Study
Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection A Retrospective Cohort Study
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DOI：
10.7326/m20-3214
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发表时间：
2020-11-17
影响因子：
39.2
通讯作者：
Baldwin, Matthew R.
中科院分区：
文献类型：
--
作者：
Anderson, Michaela R.;Geleris, Joshua;Baldwin, Matthew R.
目的：确定肥胖是否与冠状病毒疾病中的插管或死亡、炎症、心脏损伤或纤维蛋白溶解相关2019（COVID-19）。设计：回顾性队列研究。地点：纽约市的一家四级学术医疗中心和社区医院。参与者：2466名成年人因实验室确诊的严重急性呼吸综合征冠状病毒2型感染住院，测量：体重指数（BMI），入院时炎症生物标志物（C-反应蛋白[CRP]水平和红细胞沉降率[ESR]），心脏损伤（肌钙蛋白水平）和纤溶（D-二聚体水平）。主要终点是一个复合的插管或死亡的时间到事件analysis.Results：在平均住院时间为7天（四分位数范围，3至14天），533例（22%）插管，627（25%）死亡，59（2%）仍然住院。与超重患者相比，肥胖患者的插管或死亡风险更高，3级肥胖患者的风险最高（风险比，1.6 [95%CI，1.1至2.1]）。这种相关性主要在65岁以下的患者中观察到，而在老年患者中未观察到（年龄相互作用P = 0.042）。体重指数与入院时炎症、心脏损伤或纤维蛋白溶解的生物标志物水平无关。局限性：28%的患者体重指数缺失。对缺失的BMI进行多重插补进行主要分析。上限因子分析表明，结果对可能的选择偏倚具有稳健性。结论：肥胖与年龄小于65岁的成年人插管或死于COVID-19的风险增加相关，但与年龄大于65岁的成年人无关。
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.