The Independent Risk of Obesity and Diabetes and Their Interaction in COVID-19: A Retrospective Cohort Study
The Independent Risk of Obesity and Diabetes and Their Interaction in COVID-19: A Retrospective Cohort Study
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DOI：
10.1002/oby.23172
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发表时间：
2021-04-28
期刊：
影响因子：
6.9
通讯作者：
Shukla, Alpana P.
中科院分区：
文献类型：
--
作者：
Tchang, Beverly G.;Askin, Gulce;Shukla, Alpana P.
目的探讨糖尿病或肥胖是否是2019年重症冠状病毒病(新冠肺炎)患者预后的独立危险因素，并探讨一种情况下的风险是否受另一种情况的影响。方法采用多因素COX回归分析方法对新冠肺炎患者进行回顾性队列研究，以确定糖尿病和肥胖对气管插管、重症监护病房入院或住院死亡率的独立影响。结果3533例患者中，糖尿病患者1134例(32%)，肥胖患者1256例(36%)，两者兼有430例(12%)。糖尿病和肥胖与综合预后独立相关(危险比[HR]1.14[95%CI：1.01-1.30]和HR 1.22[95%CI：1.05-1.43])。糖尿病和肥胖之间的潜在交互作用有统计学趋势(P=0.20)。分层分析显示，与正常体重相比，糖尿病患者(HR 1.34[95%CI：1.04~1.74])和非DM患者(HR 1.18[95%CI：0.96~1.43])发生肥胖的风险增加。结论DM和肥胖是影响新冠肺炎严重程度的独立危险因素。分层分析表明，与非糖尿病患者相比，肥胖可能会给糖尿病患者带来更大的风险，这种关系需要进一步探索。
Objective This study aimed to assess whether diabetes mellitus (DM) or obesity is an independent risk factor for severe coronavirus disease 2019 (COVID-19) outcomes and to explore whether the risk conferred by one condition is modified by the other.Methods This retrospective cohort study of inpatient adults with COVID-19 used multivariable Cox regression to determine the independent effects of DM and obesity on the composite outcome of intubation, intensive care unit admission, or in-hospital mortality. Effect modification between DM and obesity was assessed with a statistical interaction term and an exploration of stratum-specific effects.Results Out of 3,533 patients, a total of 1,134 (32%) had DM, 1,256 (36%) had obesity, and 430 (12%) had both. DM and obesity were independently associated with the composite outcome (hazard ratio [HR] 1.14 [95% CI: 1.01-1.30] and HR 1.22 [95% CI: 1.05-1.43], respectively). A statistical trend for potential interaction between DM and obesity was observed (P = 0.20). Stratified analyses showed potential increased risk with obesity compared with normal weight among patients with DM (HR 1.34 [95% CI: 1.04-1.74]) and patients without DM (HR 1.18 [95% CI: 0.96-1.43]).Conclusions DM and obesity are independent risk factors associated with COVID-19 severity. Stratified analyses suggest that obesity may confer greater risk to patients with DM compared with patients without DM, and this relationship requires further exploration.