Obesity and Its Impact on Adverse In-Hospital Outcomes in Hospitalized Patients With COVID-19

Karsten Keller; Ingo Sagoschen; Volker H Schmitt; Visvakanth Sivanathan; Christine Espinola-Klein; Carl J Lavie; Thomas Münzel; Lukas Hobohm

doi:10.3389/fendo.2022.876028

Obesity and Its Impact on Adverse In-Hospital Outcomes in Hospitalized Patients With COVID-19

Front Endocrinol (Lausanne). 2022 May 2:13:876028. doi: 10.3389/fendo.2022.876028. eCollection 2022.

Authors

Karsten Keller^{1

2

3}, Ingo Sagoschen¹, Volker H Schmitt^{1

4}, Visvakanth Sivanathan⁵, Christine Espinola-Klein^{1

2}, Carl J Lavie⁶, Thomas Münzel^{1

4}, Lukas Hobohm^{1

2}

Affiliations

¹ Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
² Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
³ Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.
⁴ German Center for Cardiovascular Research (DZHK)Partner Site Rhine Main, Mainz, Germany.
⁵ Department of Gastroenterology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
⁶ Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States.

Abstract

Background: An increasing level of evidence suggests that obesity not only is a major risk factor for cardiovascular diseases (CVDs) but also has adverse outcomes during COVID-19 infection.

Methods: We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany from January to December 2020 and stratified them for diagnosed obesity. Obesity was defined as body mass index ≥30 kg/m² according to the WHO. The impact of obesity on in-hospital case fatality and adverse in-hospital events comprising major adverse cardiovascular and cerebrovascular events (MACCE), acute respiratory distress syndrome (ARDS), venous thromboembolism (VTE), and others was analyzed.

Results: We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19 infection; among them, 9,383 (5.3%) had an additional obesity diagnosis. Although COVID-19 patients without obesity were older (72.0 [interquartile range (IQR) 56.0/82.0] vs. 66.0 [54.0/76.0] years, p < 0.001), the CVD profile was less favorable in obese COVID-19 patients (Charlson comorbidity index 4.44 ± 3.01 vs. 4.08 ± 2.92, p < 0.001). Obesity was independently associated with increased in-hospital case fatality (OR 1.203 [95% CI 1.131-1.279], p < 0.001) and MACCE (OR 1.168 [95% CI 1.101-1.239], p < 0.001), ARDS (OR 2.605 [95% CI 2.449-2.772], p < 0.001), and VTE (OR 1.780 [95% CI 1.605-1.973], p < 0.001) and also associated with increased necessity of treatment on intensive care unit (OR 2.201 [95% CI 2.097-2.310], p < 0.001), mechanical ventilation (OR 2.277 [95% CI 2.140-2.422], p < 0.001), and extracorporeal membrane oxygenation (OR 3.485 [95% CI 3.023-4.017], p < 0.001).

Conclusions: Obesity independently affected case fatality, MACCE, ARDS development, VTE, and other adverse in-hospital events in patients with COVID-19 infection. Obesity should be taken into account regarding COVID-19 prevention strategies, risk stratification, and adequate healthcare planning. Maintaining a healthy weight is important not only to prevent cardiometabolic diseases but also for better individual outcomes during COVID-19 infection.

Keywords: COVID-19; human resources; intensive and critical care; obesity; ventilation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Testing
COVID-19* / complications
COVID-19* / epidemiology
COVID-19* / therapy
Hospitals
Humans
Obesity / complications
Obesity / epidemiology
Respiratory Distress Syndrome* / epidemiology
Respiratory Distress Syndrome* / etiology
Respiratory Distress Syndrome* / therapy
SARS-CoV-2
Venous Thromboembolism* / epidemiology
Venous Thromboembolism* / etiology