Adiposity and Mortality among Patients Severely Ill with COVID-19 and non-COVID-19 Respiratory Conditions: A Cross-Context Comparison Study in the UK

Adiposity and Mortality among Patients Severely Ill with COVID-19 and non-COVID-19 Respiratory Conditions: A Cross-Context Comparison Study in the UK
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患有 COVID-19 和非 COVID-19 呼吸系统疾病的重症患者的肥胖和死亡率：英国的一项跨背景比较研究

DOI：
10.1101/2022.12.22.22283842
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发表时间：
2022
期刊：
--
影响因子：
--
通讯作者：
Bell J
Bell J
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--
作者：
Bell J

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目的通过检查不同时间和地理背景下（偏倚各不相同）的关联一致性，评估肥胖与COVID-19和非COVID-19呼吸系统疾病重症患者死亡率的因果关系设计前瞻性队列研究在英格兰、威尔士、和北方爱尔兰，由重症监护国家审计和研究中心病例组合计划监测19（N= 33，352; 2020年2月至2021年8月）和非COVID-19呼吸系统疾病（N= 24 739; 2018年2月至2019年8月）主要结局指标ICU入院后30天死亡率结果与非COVID-19呼吸道患者相比，COVID-19患者更年轻，白色种族更少，且多见于极度肥胖（体重指数（BMI）≥ 40 kg/m2）。COVID-19患者的合并症较少，但死亡率较高（35% vs.非COVID-19患者的死亡率为23%）。社会人口统计学和合并症因素及其与BMI和死亡率的相关性随日期的变化大于ICU入院的地理区域，特别是在COVID-19患者中。在COVID-19患者中，较高的BMI与轻微的超额死亡率相关（风险比（HR）/标准差（SD）=1.05; 95% CI=1.03，1.08），由极度肥胖驱动（HR/SD=1.21; 95% CI=1.13，1.31 vs.正常体重）。极端肥胖仅在2020年2月至4月期间与死亡率较高密切相关（HR=1.49，95% CI=1.27，1.73 vs.正常体重）;此后这种关联减弱（BMI-日期相互作用P=0.03）。在非COVID-19呼吸道患者中，BMI较高与死亡率较低相关（HR/SD=0.84; 95% CI=0.82，0.87），在所有超重/肥胖组中均观察到这一点。在大多数入院日期和地区，这些负肥胖-死亡率相关性是相似的。这些关联似乎容易受到两个患者组的混杂/选择偏倚的影响，质疑因果效应的存在或稳定性。在COVID-19患者中，不利的肥胖-死亡率关联因入院日期而异。在非COVID-19呼吸道患者中，有利的肥胖-死亡率相关性可能反映了合并症诱导的体重减轻。
ObjectiveTo assess the causality of adiposity for mortality among patients severely ill with COVID-19 and non-COVID-19 respiratory conditions by examining the consistency of associations across temporal and geographical contexts where biases varyDesignProspective cohort studySetting297 intensive care units (ICUs) in England, Wales, and Northern Ireland monitored by the Intensive Care National Audit and Research Centre Case Mix ProgrammeParticipantsPatients aged ≥16 years admitted to ICU with COVID-19 (N=33,352; Feb 2020-Aug 2021) and non-COVID-19 respiratory conditions (N=24,739; Feb 2018-Aug 2019)Main outcome measure30-day mortality post ICU admissionResultsCompared with non-COVID-19 respiratory patients, COVID-19 patients were younger, less often of a white ethnic group, and more often with extreme obesity (body mass index (BMI) ≥ 40kg/m2). COVID-19 patients had fewer comorbidities but higher mortality (35% vs. 23% mortality in non-COVID-19). Socio-demographic and comorbidity factors and their associations with BMI and mortality varied more by date than geographical region of ICU admission, particularly among COVID-19 patients. Among COVID-19 patients, higher BMI was associated with a small excess mortality (hazard ratio (HR) per standard deviation (SD)=1.05; 95% CI=1.03, 1.08), driven by extreme obesity (HR per SD=1.21; 95% CI=1.13, 1.31 vs. normal-weight). Extreme obesity was strongly associated with higher mortality only during Feb-April 2020 (HR=1.49, 95% CI=1.27, 1.73 vs. normal-weight); this association weakened thereafter (BMI-date interaction P=0.03). Among non-COVID-19 respiratory patients, higher BMI was associated with lower mortality (HR per SD=0.84; 95% CI=0.82, 0.87), seen across all overweight/obesity groups. These negative obesity-mortality associations were similar across most admission dates and regions.ConclusionsObesity is associated with higher mortality among COVID-19 patients, but lower mortality among non-COVID respiratory patients. These associations appear vulnerable to confounding/selection bias in both patient groups, questioning the existence or stability of causal effects. Among COVID-19 patients, unfavourable obesity-mortality associations differ by admission date. Among non-COVID-19 respiratory patients, favourable obesity-mortality associations may reflect comorbidity-induced weight loss.
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