The impact of obesity on COVID-19 complications: a retrospective cohort study
The impact of obesity on COVID-19 complications: a retrospective cohort study
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DOI：
10.1038/s41366-020-0648-x
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发表时间：
2020-07-25
影响因子：
4.9
通讯作者：
Breitman, Igal
中科院分区：
文献类型：
--
作者：
Nakeshbandi, Mohamed;Maini, Rohan;Breitman, Igal
肥胖是纽约市的一种流行病，纽约市是冠状病毒大流行的全球中心。先前的研究表明，肥胖是COVID-19不良结局的可能风险因素。目的阐明肥胖与COVID-19结局之间的关系。设计对2020年3月10日至4月13日期间接受测试的COVID-19住院患者进行回顾性队列研究。设置SUNY Downstate Health Sciences University，一家位于纽约的COVID专用医院。参与者总共对684名患者进行了COVID-19检测，并对504名患者进行了分析。根据BMI将患者分为三组：正常（BMI 18.50-24.99）、超重（BMI 25.00-29.99）和肥胖（BMI >= 30.00）。主要结果是30天住院死亡率，次要结果是插管、急性肾损伤（阿基）、急性呼吸窘迫综合征（ARDS）和急性心脏损伤（ACI）。结果BMI正常者139例（27%），超重者150例（30%），肥胖者215例（43%）。在控制了年龄、性别、糖尿病、高血压和qSOFA评分后，超重组（RR 1.4，95%CI 1.1-1.9）和肥胖组（RR 1.3，95%CI 1.0-1.7）的死亡风险显著高于BMI正常组。同样，与BMI正常的患者相比，超重组（RR 2.0，95% CI 1.2-3.3）和肥胖组（RR 2.4，95% CI 1.5-4.0）的插管相对风险显著增加。肥胖不影响阿基、ACI或ARDS的发生率。此外，肥胖似乎显著增加了男性的死亡风险（RR 1.4，95%CI 1.0- 2.0，P = 0.03），但在女性中没有增加（RR 1.2，95%CI 0.77- 1.9，P = 0.40）。结论本研究揭示，与BMI正常的患者相比，患有COVID-19的超重和肥胖患者的死亡率和插管风险增加。这些发现支持了肥胖是COVID-19并发症的风险因素的假设，并应成为COVID-19管理的考虑因素。
Background Obesity is an epidemic in New York City, the global epicenter of the coronavirus pandemic. Previous studies suggest that obesity is a possible risk factor for adverse outcomes in COVID-19. Objective To elucidate the association between obesity and COVID-19 outcomes. Design Retrospective cohort study of COVID-19 hospitalized patients tested between March 10 and April 13, 2020. Setting SUNY Downstate Health Sciences University, a COVID-only hospital in New York. Participants In total, 684 patients were tested for COVID-19 and 504 were analyzed. Patients were categorized into three groups by BMI: normal (BMI 18.50-24.99), overweight (BMI 25.00-29.99), and obese (BMI >= 30.00). Measurements Primary outcome was 30-day in-hospital mortality, and secondary outcomes were intubation, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and acute cardiac injury (ACI). Results There were 139 patients (27%) with normal BMI, 150 patients who were overweight (30%), and 215 patients with obesity (43%). After controlling for age, gender, diabetes, hypertension, and qSOFA score, there was a significantly increased risk of mortality in the overweight (RR 1.4, 95% CI 1.1-1.9) and obese groups (RR 1.3, 95% CI 1.0-1.7) compared with those with normal BMI. Similarly, there was a significantly increased relative risk for intubation in the overweight (RR 2.0, 95% CI 1.2-3.3) and obese groups (RR 2.4, 95% CI 1.5-4.0) compared with those with normal BMI. Obesity did not affect rates of AKI, ACI, or ARDS. Furthermore, obesity appears to significantly increase the risk of mortality in males (RR 1.4, 95% CI 1.0-2.0,P = 0.03), but not in females (RR 1.2, 95% CI 0.77-1.9,P = 0.40). Conclusion This study reveals that patients with overweight and obesity who have COVID-19 are at increased risk for mortality and intubation compared to those with normal BMI. These findings support the hypothesis that obesity is a risk factor for COVID-19 complications and should be a consideration in management of COVID-19.