ABSTRACT
BACKGROUND: Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes. METHODS: 1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category. RESULTS: The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02-1.97 and 2.78, 95% CI 1.83-4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06-2.74, and 2.62, 95% CI 1.65-4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42-0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03-2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50-3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight. CONCLUSIONS: EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.
Subject(s)
COVID-19 , Obesity , Adult , Aged , COVID-19/complications , COVID-19/epidemiology , COVID-19/mortality , Comorbidity , Female , Hospitalization , Humans , Male , Middle Aged , Obesity/complications , Obesity/epidemiology , Obesity/physiopathology , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
On January 15, 2020, the World Health Organization (WHO) made the first recommendations regarding the epidemiological surveillance of a new coronavirus detected on December 31, 2019 in the Hubei province of Wuhan city, China --which later (January 7, 2020) was identified as a new coronavirus, or an emerging corona-virus, initially called "2019-nCoV"-- and issued the first case definitions, when was detected 27 cases of acute respiratory syndrome of unknown etiology. This virus would eventually be called "COVID-19" or "SARS-CoV-2". It's spread around the world did not take long, and despite the fact that the WHO delayed declaring this outbreak as a pandemic event, it finally did so on March 11 of the current year. The Mexican Academy of Pediatrics (advisory body of the Secretary of Health) considered made up prudent to compile the facts to issue, as soon as possible, an expanded overview of infection-disease by this emerging virus and, at the same time, as its main objective is to contribute, support and work together with the Secretary of Health to combat the SARS-CoV-2 epidemic in order to provide the best care and treatment measures to mitigate its spread throughout the Mexican territory. (English) [ABSTRACT FROM AUTHOR] El 15 de enero de 2020, la Organización Mundial de la Salud (OMS) realizó las primeras recomendaciones respecto a la vigilancia epidemiológica de un nuevo co-ronavirus, detectado el 31 de diciembre de 2019 en la provincia de Hubei, ciudad de Wuhan, en China --que, posteriormente (07 de enero de 2020) fue identificado como un nuevo coronavirus, o bien, un coronavirus emergente, inicialmente denominado "2019-nCoV"--, y emitió las primeras definiciones de caso, tras haberse detectado en 27 sujetos con síndrome respiratorio agudo de etiología desconocida. Dicho virus, a la postre, se denominaría "COVID-19" o "SARS-CoV-2". Su diseminación en todo el mundo no tardó mucho, y a pesar de que la OMS retrasó la declaración del brote como un evento pandémico, finalmente lo hizo el 11 de marzo del año en curso. La Academia Mexicana de Pediatría (órgano asesor de la Secretaría de Salud) consideró prudente hacer una recopilación de los hechos para emitir, en lo posible, un panorama ampliado de la infección-enfermedad por este virus emergente y, a la vez, se planteó como principal objetivo contribuir, apoyar y trabajar en conjunto con la Secretaría de Salud para enfrentar la epidemia asociada con el SARS-CoV-2 para que se implementen las mejores medidas de atención y tratamiento a fin de mitigar su diseminación en el territorio mexicano. (Spanish) [ABSTRACT FROM AUTHOR] Copyright of Revista de Enfermedades Infecciosas en Pediatria is the property of Ediciones Franco S.A. de C.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)