Severe Obesity Is Associated With Higher In-Hospital Mortality In A Cohort Of Bronx COVID-19 Patients

Published on May 20, 2020, 2:53 pm
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A team of researchers at Montefiore Medical Center, Albert Einstein College of Medicine, just published a manuscript about the independent association of severe obesity and death from COVID-19 in the first 200 patients that were admitted for COVID-19 in the Montefiore Medical Center in the Bronx.

The team’s work was published in Metabolism, a prestigious journal in the field of obesity and metabolism, in cooperation with the leader in obesity research nationally, Dr. Mantzoros from Harvard.

Abstract

Background & Aims

New York is the current epicenter of Coronavirus disease 2019 (COVID-19) pandemic. The underrepresented minorities, where the prevalence of obesity is higher, appear to be affected disproportionately. Our objectives were to assess the characteristics and early outcomes of patients hospitalized with COVID-19 in the Bronx and investigate whether obesity is associated with worse outcomes independently from age, gender and other comorbidities.

Methods

This retrospective study included the first 200 patients admitted to a tertiary medical center with COVID-19. The electronic medical records were reviewed at least three weeks after admission. The primary endpoint was in-hospital mortality.

Results

200 patients were included (female sex: 102, African American: 102). The median BMI was 30 kg/m2. The median age was 64 years. Hypertension (76%), hyperlipidemia (46.2%), and diabetes (39.5%) were the three most common comorbidities. Fever (86%), cough (76.5%), and dyspnea (68%) were the three most common symptoms. 24% died during hospitalization (BMI<25 kg/m2: 31.6%, BMI 25-34 kg/m2: 17.2%, BMI≥35 kg/m2: 34.8%, p= 0.03). Increasing age (analyzed in quartiles), male sex, BMI≥35 kg/m2 (reference: BMI 25-34 kg/m2), heart failure, CAD, and CKD or ESRD were found to have a significant univariate association with mortality. The multivariate analysis demonstrated that BMI≥35 kg/m2 (reference: BMI 25-34 kg/m2, OR: 3.78; 95% CI: 1.45 – 9.83; p=0.006), male sex (OR: 2.74; 95% CI: 1.25 – 5.98; p=0.011) and increasing age (analyzed in quartiles, OR: 1.73; 95% CI: 1.13 – 2.63; p=0.011) were independently associated with higher in-hospital mortality. Similarly, age, male sex, BMI≥35 kg/m2 and current or prior smoking were significant predictors for increasing oxygenation requirements in the multivariate analysis, while male sex, age and BMI≥35 kg/m2 were significant predictors in the multivariate analysis for the outcome of intubation.

Conclusions

In this cohort of hospitalized patients with COVID-19 in a minority-predominant population, severe obesity, increasing age, and male sex were independently associated with higher in-hospital mortality and in general worse in-hospital outcomes.

The manuscript and its highlights are available here, along with some interesting and informative graphs.

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