The obesity paradox: Analysis from the SMAtteo COvid-19 REgistry (SMACORE) cohort

https://doi.org/10.1016/j.numecd.2020.07.047Get rights and content

Highlights

  • Obesity has been suggested as a risk factor for a severe course of COVID-19.

  • Obesity was assessed as predictor of mortality and admission to intensive care.

  • 30-day mortality was not higher in obese patients with COVID-19.

  • However, obese patients more frequently required admission to intensive care.

Abstract

Background and aims

Obesity has been suggested as a possible risk factor for a more severe course of COVID-19; however, conclusive evidence is lacking and few studies have investigated the role of BMI as a risk factor for admission to intensive care unit (ICU) and mortality.

We retrospectively analyzed a COVID-19 cohort recruited during the first 40 days of the epidemic in Italy. We examined the association between obesity and 30-day mortality, admission to ICU, mortality and length of hospital stay in patients with COVID-19.

Methods and results

Demographic, clinical and outcome data were retrospectively analyzed in 331 patients with COVID-19 admitted to hospital between 21 February and 31 March 2020. The predictive effect of obesity on mortality was assessed using a Cox proportional-hazard regression model, its effect on ICU admission and mortality in the ICU using logistic regressions, and its effect on length of hospital stay using a linear regression.

Seventy-four of 331 patients had a BMI ≥30 kg/m2. Among obese patients, 21 (28.4%) required admission in ICU and 25 died (33.8%). After controlling for sex, age, comorbidities and clinical data, obesity was not significantly associated with mortality, mortality in ICU and length of hospital stay. The effect of obesity on ICU admission remained significant after controlling for sex, age, interstitial lung disease, heart disease and serum C-reactive protein.

Conclusions

Obese patients with COVID-19 were more likely to be admitted to ICU than non-obese patients. However, there were no significant differences in mortality between the two groups.

Keywords

COVID-19
SARS-CoV-2
Obesity
Severe disease
BMI
ICU

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1

These authors contributed equally to the work.

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