Mayank Sharma, MBBS
Research Fellow
n/a, Minnesota, United States
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Vikas Bansal, MPH, MBBS
Research Fellow
Mayo Clinic
Rochester, Minnesota
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Marija Bogojevic, MD,
Resident Physician
Montefiore New Rochelle Hospital, Minnesota, United States
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Romil Singh, MD
Resident
n/a
Rochester, Minnesota, United States
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Abigail La Nou, MD
Medical Doctor
Mayo Clinic Health System in Eau Claire, United States
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Allison LeMahieu, BS, MS
Biostatistician
Mayo Clinic
Rochester, Minnesota, United States
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Andrew Hanson, MS
Biostatistician
Mayo Clinic
Rochester, Minnesota, United States
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Phillip Schulte, MD
Senior Associate Consultant II
n/a
Rochester, Minnesota, United States
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Neha Deo, BS
Medical Student
Mayo Clinic Alix School of Medicine
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Simon Zec, MD (he/him/his)
Research Fellow, Pulmonary and Critical Care Medicine
Mayo Clinic
Rochester, Minnesota, United States
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Vishakha Kumar, MD, MBA
Society of Critical Care Medicine
Mount Prospect, Illinois
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Allan Walkey, MD (he/him/his)
Professor of Medicine
Boston University
Boston, Massachusetts, United States
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Rahul Kashyap, MD, MBA,
Medical Director Research
Wellspan Health-York Hospital
York, Pennsylvania
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Ognjen Gajic, MD
Professor
Mayo Clinic
Rochester, Minnesota, United States
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Andres Acosta, MD Ph.D, n/a
Gastroenterologist
Mayo Clinic, United States
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Juan Pablo Domecq Garces, MD
Assistant Professor of Medicine
Mayo Clinic College of Medicine
North Mankato, Minnesota, United States
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Title: Association of obesity and COVID-19 induced diarrhea: Results from the SCCM Discovery VIRUS Registry
Introduction:
While obesity is associated with the severity of COVID-19 disease, it is unclear whether gut mechanisms in patients with obesity predispose to increased susceptibility to SARS-CoV-2. Obesity is associated with cell-specific overexpression of COVID-19 entry factors in the gut, specifically mucin producing cells. Thus, we aimed to investigate whether adults obese patients with COVID-19 may be more susceptible to developed diarrhea as a surrogate for an enhanced expression of these SARS-CoV2 entry cofactors.
Methods:
This was an observational cohort analysis of adult, hospitalized, patients enrolled in the SCCM Discovery VIRUS Registry. Patients were classified as non-obese and obese (BMI≥30 kg/m2); and further categorized into Obesity class 1 (BMI 30 to 34.9 kg/m2), class 2 (BMI 35 to 39.9 kg/m2), and class 3 (BMI ≥40 kg/m2); and the percentage of patients presenting with diarrhea was compared between these groups. To increase the reliability of recorded symptoms, institutions that had < 75% of patients with symptom data available were excluded from the analysis. Models were fitted using generalized estimating equations to account for clustering of patients within sites.
Results:
A total of 4,972 patients were included in the analysis, with a median age of 66.8 years and 44% females. Of these, 2330 were obese; as 47%, 25%, and 28% belonging to class 1, class 2, and class 3 categories, respectively. In the univariate analysis frequency of diarrhea was significantly greater in obese patients (516 [22%] vs 412 [16%], p-value< 0.001). After adjusting for age, sex, and comorbidities patients with obesity had greater odds of presenting with diarrhea (Adjusted Odds Ratio, AOR: 1.25, 95% Confidence Interval, CI: 1.11 – 1.41) compared to the non-obese group. Upon sub-group analysis, the odds of presenting with diarrhea were not associated with the severity of obesity.
Conclusions:
Our multivariate analysis from a large multinational registry showed that diarrhea was more common in obese patients than non-obese patients. This is providing clinical data that the overexpression of mucin producing goblets cells found in obese patients is a physiopathologic mechanism that explains the higher rate of SARS CoV-2 infection in these patients.