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Ann Intern Med ; 173(10): 782-790, 2020 11 17.
Article in English | MEDLINE | ID: covidwho-690212


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 laboratory-confirmed 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. PRIMARY FUNDING SOURCE: National Institutes of Health.

Betacoronavirus , Body Mass Index , Coronavirus Infections/epidemiology , Intubation, Intratracheal/statistics & numerical data , Obesity/epidemiology , Pneumonia, Viral/epidemiology , Academic Medical Centers , Age Factors , Aged , Biomarkers/blood , Blood Sedimentation , C-Reactive Protein/analysis , COVID-19 , Cohort Studies , Female , Fibrin Fibrinogen Degradation Products/analysis , Hospitalization , Hospitals, Community , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , New York City/epidemiology , Pandemics , Proportional Hazards Models , Retrospective Studies , SARS-CoV-2 , Troponin/blood