Romil Singh, MD
Resident
n/a
Rochester, Minnesota, United States
Disclosure information not submitted.
Sawai Rathore
Mr.
Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India, United States
Disclosure information not submitted.
Hira Khan, MD
Dr.
Islamic International Medical College, Rawalpindi, Pakistan, United States
Disclosure information not submitted.
Smruti Karale, MBBS
Dr.
Government Medical College-Kolhapur, Kolhapur, Maharashtra, India, United States
Disclosure information not submitted.
Abhishek Bhurwal, MBBS
Dr.
Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey, USA, United States
Disclosure information not submitted.
Nirpeksh Jain, MBBS
Dr.
Marshfield Clinic, Marshfield, Wisconsin, USA, United States
Disclosure information not submitted.
Ishita Mehra, MD, MBBS, MD
Resident Physician
North Alabama Medical Center
Florence, Alabama
Disclosure information not submitted.
Sohini Anand, MBBS
Dr.
Patliputra Medical College and Hospital, Dhanbad, Jharkhand, India, United States
Disclosure information not submitted.
Sanjana Allam, MBBS
Medical Student
Gandhi Medical College, Secunderabad, India, United States
Disclosure information not submitted.
Anastasios Panagopoulos, MD
Dr.
University of Nebraska Medical Center, Omaha, NE, USA, United States
Disclosure information not submitted.
Vishwanath Pattan, MD
Attending Physician
Wyoming Medical Center
Casper, Wyoming, United States
Disclosure information not submitted.
Rahul Kashyap, MD, MBA,
Medical Director Research
Wellspan Health-York Hospital
York, Pennsylvania
Disclosure information not submitted.
Vikas Bansal, MPH, MBBS
Research Fellow
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Title:The Association of Obesity with COVID-19 Severity and Mortality: Systemic Review and Meta-Regression
Introduction: Obesity affects the course of critical illnesses. Our aim is to estimate the association of obesity with severity and all-cause mortality in coronavirus disease 2019 (COVID-19) patients.
Methods: A systematic search was conducted from the inception of the COVID-19 pandemic through January 31st, 2021 on databases including Medline (PubMed), Embase, Science Web, and Cochrane Registry. Preprint servers were also scanned. Articles focusing on the association of obesity and outcome in COVID-19 patients were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. Mantel-Haenszel odds ratios were generated to describe the overall effect side. To account for between study results variations, multivariate meta-regression was performed. The severity in hospitalized COVID-19 patients, such as the requirement of invasive mechanical ventilation and intensive care unit admission with obesity was the chief outcome. All-cause mortality in COVID-19 hospitalized patients with obesity was the secondary outcome.
Results and conclusions: A total of 576,784 patients from 100 studies were included in this meta-analysis. Obesity was associated with an increased risk of severe disease (RR=1.46, 95% CI 1.34-1.60, I2 = 92 %). Similarly, high mortality was observed in obese patients with COVID-19 disease (RR=1.12, 95% CI 1.06-1.19, I2 = 88%). In multivariate meta-regression on severity, the covariate of female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2= 50% of the between-study heterogeneity for severity. Aforementioned covariates, except for older age, were found to be significant for mortality, and these covariates collectively explained R2=53% of the between-study variability for mortality. Furthermore, we performed a sensitivity analysis according to body mass index categories; and did not find any difference in risk of mortality or severity.
Our findings suggest that obesity is significantly associated with increased severity and higher mortality in COVID-19. Therefore, the inclusion of obesity or body mass in prognostic scores would be vital to improving patient outcomes. This might also serve as a call to further delve into its pathophysiology and identify potential pharmacological targets.