Work

Association of Higher Body Mass Index With Severe Coronavirus Disease 2019 (COVID-19) in Younger Patients

Year: 2020

Type: article

Abstract: TO THE EDITOR—The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant strain on healthcare systems and intensive care unit (ICU) resources worldwide. Advanced age is a well-recognized risk factor for development of severe disease [1, 2]; however, the impact of obesity on disease severity has not been thoroughly explored. Obesity was associated with increased severity and mortality in pandemic H1N1 influenza and other respiratory viruses [3, 4]. Lighter and colleagues [5] reported that obesity (defined as body mass index [BMI; in kg/m2] ≥30) was significantly associated with increased admission to the hospital and critical care. Simonnet and colleagues [6] found that severe obesity (BMI ≥35) was associated with increased requirement of mechanical ventilation. However, there have been limited data on the impact of obesity in Asian populations. It is known that Asian populations have higher disease risks at lower BMI thresholds, possibly due to variations in fat distribution and lipid metabolism [7, 8]. We hypothesized that a lower BMI cutoff level would be associated with severe disease manifestations of COVID-19 in our multiethnic Asian population in Singapore. We conducted a retrospective study of 182 patients with laboratory-confirmed COVID-19 (by polymerase chain reaction assay) admitted to the National Centre for Infectious Diseases, Singapore. All patients gave written consent (approved by National Healthcare Group Domain Specific Review Board, study reference 2012/00917). Clinical data were collected from medical records by study investigators. Ninety-one patients did not have either height or weight recorded and were excluded from analysis. Adverse outcomes analyzed were hypoxia requiring supplemental oxygen, ICU admission, mechanical ventilation, and mortality. In the study population, 51 (56.0%) had a BMI <25, 29 (31.9%) had a BMI of 25–30, 7 (7.7%) had a BMI of 30–35, and 4 (4.4%) had a BMI >35. There were no significant differences in baseline characteristics or clinical outcomes between patients with a BMI ≥25 and patients with a BMI <25 when all age groups were included (Table 1). However, similar to findings by Lighter and colleagues, a subgroup analysis of patients aged less than 60 years old found that a BMI ≥25 was significantly associated with pneumonia on chest radiograph on admission (P = .017), requiring low-flow supplemental oxygen (odds ratio [OR], 6.32; 95% confidence interval [CI], 1.23–32.34) and mechanical ventilation (OR, 1.16; 95% CI, 1.00–1.34). A BMI ≥25 was also associated with significantly higher serum lactate dehydrogenase levels (P = .011), which was associated with disease severity in COVID-19 [9]. Clinical Characteristics and Outcomes of Patients With Body Mass Index ≥25 and Body Mass Index ≤25, for All Age Groups and Those Aged ≤60 Years Continuous variables are reported as median (interquartile range), and discrete variables are reported as n (%). Comparison of discrete variables was with Fisher’s exact test or chi-square test as appropriate, and comparison of continuous variables was with Mann-Whitney U test. P values of < .05 were considered significant. Abbreviations: BMI, body mass index; ICU, intensive care unit. aLow-flow supplemental oxygen was defined as oxygen flow of ≤5 L/minute. bHigh-flow supplemental oxygen was defined as oxygen flow of ≥5 L/minute, or using a Venturi face mask or high-flow nasal cannula device. Clinical Characteristics and Outcomes of Patients With Body Mass Index ≥25 and Body Mass Index ≤25, for All Age Groups and Those Aged ≤60 Years Continuous variables are reported as median (interquartile range), and discrete variables are reported as n (%). Comparison of discrete variables was with Fisher’s exact test or chi-square test as appropriate, and comparison of continuous variables was with Mann-Whitney U test. P values of < .05 were considered significant. Abbreviations: BMI, body mass index; ICU, intensive care unit. aLow-flow supplemental oxygen was defined as oxygen flow of ≤5 L/minute. bHigh-flow supplemental oxygen was defined as oxygen flow of ≥5 L/minute, or using a Venturi face mask or high-flow nasal cannula device. These findings add to the growing literature highlighting obesity as a significant risk factor for the development of severe COVID-19, especially in younger patients aged less than 60 years old, and illustrate the importance of a lower BMI cutoff for risk stratification in Asian populations, similar to what is seen in other metabolic and cardiovascular diseases [7]. As the COVID-19 pandemic progresses, risk stratification for optimal resource allocation will be increasingly important, and this distinct risk group should be emphasized to avoid under-triaging and potentially adverse outcomes. Financial support. This work was supported by the National Medical Research Council COVID-19 Research Fund (grant number COVID19RF-001). Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Source: Clinical Infectious Diseases

DOI: 10.1093/cid/ciaa548

Authors: Sean Wei Xiang Ong, Barnaby Edward Young, Yee-Sin Leo, David Chien Lye

Institutions: Tan Tock Seng Hospital, National Centre for Infectious Diseases, Nanyang Technological University, National University of Singapore

Language: English

Topic: COVID-19 Clinical Research Studies

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funder: National Medical Research Council