TY - JOUR
T1 - Body mass index and risk for intubation or death in SARS-CoV-2 infection
T2 - A retrospective cohort study
AU - Anderson, Michaela R.
AU - Geleris, Joshua
AU - Anderson, David R.
AU - Zucker, Jason
AU - Nobel, Yael R.
AU - Freedberg, Daniel
AU - Small-Saunders, Jennifer
AU - Rajagopalan, Kartik N.
AU - Greendyk, Richard
AU - Chae, S. R.
AU - Natarajan, Karthik
AU - Roh, David
AU - Edwin, Ethan
AU - Gallagher, Dympna
AU - Podolanczuk, Anna
AU - Barr, R. Graham
AU - Ferrante, Anthony W.
AU - Baldwin, Matthew R.
N1 - Publisher Copyright:
© 2020 American College of Physicians. All rights reserved.
PY - 2020/11/17
Y1 - 2020/11/17
N2 - Background: Obesity is a risk factor for pneumonia and acute respiratory distress syndrome. Objective: To determine whether obesity is associated with intubation or death, inflammation, cardiac injury, or fibrinolysis in coronavirus disease 2019 (COVID-19). Design: Retrospective cohort study. Setting: A quaternary academic medical center and community hospital in New York City. Participants: 2466 adults hospitalized with laboratoryconfirmed severe acute respiratory syndrome coronavirus 2 infection over a 45-day period with at least 47 days of in-hospital observation. Measurements: Body mass index (BMI), admission biomarkers of inflammation (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), cardiac injury (troponin level), and fibrinolysis (D-dimer level). The primary end point was a composite of intubation or death in time-to-event analysis. Results: Over a median hospital length of stay of 7 days (interquartile range, 3 to 14 days), 533 patients (22%) were intubated, 627 (25%) died, and 59 (2%) remained hospitalized. Compared with overweight patients, patients with obesity had higher risk for intubation or death, with the highest risk among those with class 3 obesity (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]). This association was primarily observed among patients younger than 65 years and not in older patients (P for interaction by age = 0.042). Body mass index was not associated with admission levels of biomarkers of inflammation, cardiac injury, or fibrinolysis. Limitations: Body mass index was missing for 28% of patients. The primary analyses were conducted with multiple imputation for missing BMI. Upper bounding factor analysis suggested that the results are robust to possible selection bias. Conclusion: Obesity is associated with increased risk for intubation or death from COVID-19 in adults younger than 65 years, but not in adults aged 65 years or older.
AB - Background: Obesity is a risk factor for pneumonia and acute respiratory distress syndrome. Objective: To determine whether obesity is associated with intubation or death, inflammation, cardiac injury, or fibrinolysis in coronavirus disease 2019 (COVID-19). Design: Retrospective cohort study. Setting: A quaternary academic medical center and community hospital in New York City. Participants: 2466 adults hospitalized with laboratoryconfirmed severe acute respiratory syndrome coronavirus 2 infection over a 45-day period with at least 47 days of in-hospital observation. Measurements: Body mass index (BMI), admission biomarkers of inflammation (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), cardiac injury (troponin level), and fibrinolysis (D-dimer level). The primary end point was a composite of intubation or death in time-to-event analysis. Results: Over a median hospital length of stay of 7 days (interquartile range, 3 to 14 days), 533 patients (22%) were intubated, 627 (25%) died, and 59 (2%) remained hospitalized. Compared with overweight patients, patients with obesity had higher risk for intubation or death, with the highest risk among those with class 3 obesity (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]). This association was primarily observed among patients younger than 65 years and not in older patients (P for interaction by age = 0.042). Body mass index was not associated with admission levels of biomarkers of inflammation, cardiac injury, or fibrinolysis. Limitations: Body mass index was missing for 28% of patients. The primary analyses were conducted with multiple imputation for missing BMI. Upper bounding factor analysis suggested that the results are robust to possible selection bias. Conclusion: Obesity is associated with increased risk for intubation or death from COVID-19 in adults younger than 65 years, but not in adults aged 65 years or older.
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U2 - 10.7326/M20-3214
DO - 10.7326/M20-3214
M3 - Article
C2 - 32726151
AN - SCOPUS:85096347963
SN - 0003-4819
VL - 173
SP - 782
EP - 790
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 10
ER -