Obesity, Inflammation Increase Risk for Critical Illness in COVID-19 Patients

April 15, 2020

In the US, where 40% of adults meet criteria for obesity, results of 2 new case series have important clinical implications for patient care during the pandemic.

Age, obesity, and chronic illness are leading risk factors for hospitalization and critical care among patients with COVID-19, according to results of new studies reported by 2 groups of researchers at NYU.

Obesity alone, concludes one team, appears to be a previously unrecognized factor for hospital admission and intensive care among patients aged <60 years, a group typically considered at lower risk for severe disease and complications.

Age, chronic illness, inflammation

In the largest case series from the US to date, researchers at the NYU Grossman School of Medicine in New York City, led by Christopher M. Petrilli, MD, performed a cross sectional analysis of all patients with confirmed COVID-19 at an academic health system in NYC between March 1 and April 2, 2020; follow up continued through April 7. The final analysis included 4103 cases.

Primary outcomes: hospitalization and critical illness (intensive care, mechanical ventilation, hospice and/or death)

Multivariable logistic regression was used to identify risk factors for adverse outcomes. 

Factors associated with the highest risk for hospitalization: age ≥75 years,  BMI >40, and history of heart failure.

Factors most highly associated with critical illness: Admission SaO2 <88%,  first d-dimer >2500, first ferritin >2500, and first C-reactive protein (CRP) >200.

In their discussion, the authors point to the particularly strong associations of older age, obesity, heart failure and chronic kidney disease with risk for hospitalization while  race, smoking status, chronic pulmonary disease, and other forms of heart disease exerted less influence.

The researchers describe the association of inflammatory markers with future critical vs non-critical illness as “striking” and underscore that early elevations in CRP and d-dimer had the strongest association with either the need for mechanical ventilation or mortality.

They conclude by saying that healthcare providers should consider routine measurement of inflammatory marker levels during hospitalizations for COVID-19.

Younger patients, higher BMI

In a separate study, Jennifer Lighter, MD, of the Department of Pediatrics, Division of Pediatric Infectious Diseases and colleagues from the Department of Infection Prevention and Control and Division of Infectious Diseases at NYU Langone Health, in New York found that patients age <60 years were at higher risk of being hospitalized for COVID=19 complications if they had obesity. The study looked at data from 3615 patients who presented to a large academic hospital system in NYC from March 4 to April 4, 2020.
___________________________________________________ The authors found significant difference in admission and ICU care only in patients aged <60 years with varying BMIs.  ___________________________________________________

Patients aged <60 years with a BMI 30-34 were 2.0 and 1.8 times more likely to be admitted to acute and critical care, respectively, compared to individuals with a BMI <30. Similarly, patients with a BMI >35 and aged <60 years were 2.2 and 3.6 times more likely to be admitted to acute and critical care compared to patients in the same age category who had BMI <30. (All results p<0.0001)

The authors state the results have important and practical clinical implications in the US where nearly 40% of adults have BMI >30.

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