Diabetes and Overweight/Obesity Are Independent, Nonadditive Risk Factors for In-Hospital Severity of COVID-19: An International, Multicenter Retrospective Meta-analysis.
Diabetes and Overweight/Obesity Are Independent, Nonadditive Risk Factors for In-Hospital Severity of COVID-19: An International, Multicenter Retrospective Meta-analysis.
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DOI：
10.2337/dc20-2676
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发表时间：
2021-06
期刊：
影响因子：
16.2
通讯作者：
International BMI-COVID consortium
中科院分区：
文献类型：
--
作者：
Longmore DK;Miller JE;Bekkering S;Saner C;Mifsud E;Zhu Y;Saffery R;Nichol A;Colditz G;Short KR;Burgner DP;International BMI-COVID consortium
肥胖是2019年严重冠状病毒病（COVID-19）的既定风险因素，但超重和/或糖尿病的影响仍不清楚。在一项多中心的国际研究中，我们调查了超重、肥胖和糖尿病是否与COVID-19的严重程度独立相关，以及糖尿病患者的BMI相关风险是否增加。我们回顾性地提取了来自11个国家18个研究中心的COVID-19住院成人患者的医疗保健记录和区域数据库的数据。我们使用标准化的定义和分析来生成特定于研究中心的估计值，根据BMI类别（参考、超重、肥胖）对每种结局（补充供氧/无创呼吸支持、有创机械呼吸支持和住院死亡率）的几率进行建模，并对年龄、性别和预先指定的合并症进行调整。对既存糖尿病患者进行亚组分析。在荟萃分析中合并了研究中心特定的估计值。在7，244例患者（65.6%超重/肥胖）中，超重患者更可能需要氧气/无创呼吸支持（随机效应校正比值比[aOR]，1.44; 95% CI 1.15-1.80）和有创机械呼吸支持（aOR，1.22; 95% CI 1.03-1.46）。超重与住院死亡率之间无相关性（aOR，0.88; 95%CI 0.74-1.04）。在肥胖或糖尿病患者中观察到类似的效果。在亚组分析中，在糖尿病和超重或肥胖患者中，任何结局的aOR均未额外增加。在因COVID-19住院的成人中，超重、肥胖和糖尿病与需要呼吸支持的几率增加有关，但与死亡无关。在糖尿病患者中，严重COVID-19的几率并没有增加超过BMI相关风险。
Obesity is an established risk factor for severe coronavirus disease 2019 (COVID-19), but the contribution of overweight and/or diabetes remains unclear. In a multicenter, international study, we investigated if overweight, obesity, and diabetes were independently associated with COVID-19 severity and whether the BMI-associated risk was increased among those with diabetes. We retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries. We used standardized definitions and analyses to generate site-specific estimates, modeling the odds of each outcome (supplemental oxygen/noninvasive ventilatory support, invasive mechanical ventilatory support, and in-hospital mortality) by BMI category (reference, overweight, obese), adjusting for age, sex, and prespecified comorbidities. Subgroup analysis was performed on patients with preexisting diabetes. Site-specific estimates were combined in a meta-analysis. Among 7,244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/noninvasive ventilatory support (random effects adjusted odds ratio [aOR], 1.44; 95% CI 1.15–1.80) and invasive mechanical ventilatory support (aOR, 1.22; 95% CI 1.03–1.46). There was no association between overweight and in-hospital mortality (aOR, 0.88; 95% CI 0.74–1.04). Similar effects were observed in patients with obesity or diabetes. In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity. In adults hospitalized with COVID-19, overweight, obesity, and diabetes were associated with increased odds of requiring respiratory support but were not associated with death. In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk.
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影响因子：
6.9
作者：
Paich, Heather A.;Sheridan, Patricia A.;Handy, Jean;Karlsson, Erik A.;Schultz-Cherry, Stacey;Hudgens, Michael G.;Noah, Terry L.;Weir, Samuel S.;Beck, Melinda A.
通讯作者：
Beck, Melinda A.
影响因子：
16.2
作者：
Selvin, Elizabeth;Juraschek, Stephen P.
通讯作者：
Juraschek, Stephen P.
影响因子：
8.9
作者：
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通讯作者：
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DOI：
10.1073/pnas.2011086117
发表时间：
2020-09-01
影响因子：
11.1
作者：
Hamer, Mark;Gale, Catharine R.;Batty, G. David
通讯作者：
Batty, G. David
影响因子：
4.8
作者：
Harris, Ross J.;Bradburn, Michael J.;Sterne, Jonathan A. C.
通讯作者：
Sterne, Jonathan A. C.