ABSTRACT
Study Objective: Currently there is conflicting evidence regarding the impact of obesity on patient outcomes in COVID-19 pneumonia. Specifically, obesity may be associated with severe pneumonia, hypoxia, intubation and mortality. The CXR opacity scoring system has been shown to characterize pneumonia severity in COVID-19 patients. The aim of this study is to evaluate the association between obesity, pneumonia severity and mortality. Methods: A retrospective chart review was conducted for April 2020 at an urban ED located in a medically underserved region. Inclusion criteria consisted of adult ED patients who were admitted with COVID-19 pneumonia. An EM attending and senior resident determined the CXR opacity scores in severity ranging from 0 to 6. Scores ≥ 3 indicate a severe pneumonia. Inter-rater agreement was determined based on the kappa coefficient. Demographic information, Pulse Oximetry (PO), Body Mass Index (BMI), intubation requirement and mortality were analyzed using chi-square and student's t-test. Results: 306 patients met inclusion criteria. The mean age was 61.9 ± 14.7 years and there were 40.2% male patients. The mean BMI and PO were 30.1 ± 6.4 and 88.7 ± 3.9, respectively. Pneumonia on CXR was 85.3% bilateral, 6.5% left and 8.2% right. 43.5% of patients were given CXR opacity scores ≥ 3 for severe pneumonia. The kappa coefficient for CXR opacity scoring agreement was 0.47. Patients were categorized as BMI ≤ 25 (63, 20%), > 25-30 (101, 33%), > 30-35 (82, 27%), > 35-40 (32, 10.5%), > 40 (23, 7.5%) and undetermined (5, 2%). There were 84 (27.4%) patients with hypoxia determined with triage PO ≤ 85. We found that 48 (16%) patients were intubated in the ED. The overall in-hospital mortality was 21%. There was no association between BMI and hypoxia (P=0.38), CXR opacity score (P=0.71), intubation (P=0.67) or mortality (P=0.39). Conclusion: In our ED cohort of COVID-19 pneumonia patients, we found that obesity was not associated with severity of pneumonia, hypoxia, intubation or mortality. Further research is therefore needed to fully understand the role of obesity in COVID-19 outcomes.