Résumé
Introduction: Numerous studies have reported increased risk for adverse COVID-19 outcomes in patients with obesity. However, diagnosis through body mass index (BMI) does not acknowledge the health burden associated with adipose tissue dysfunction. We compared the predictive performance of the Edmonton Obesity Staging System (EOSS), a clinical scheme to assess the obesity-related comorbidity, for adverse COVID-19 outcomes to that of BMI. Methods: Multi-center case series of 1071 patients hospitalized for COVID-19 in 11 hospitals adapted as COVID-19 centres in Mexico. We classified patients into 5 EOSS stages, from no obesity-related risk factors in the medical, mental, and functional areas (stage 0), to severe disease in any of those areas (stage 4). We calculated adjusted risk factors and performed survival analyses for mechanical ventilation and death according to EOSS stages and BMI categories. Results: Compared to patients with normal weight, 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 class II and III obesity (HR 1,71, 95%CI 1.06-2.74, and 2.62, 95%CI 1.65-4.17). Death rates were lower in patients in EOSS stages 0 and 1 (HR 0.62, 95%CI 0.42-0.92) and higher in patients with class III obesity (HR 1.58, 95%CI 1.03-2.42). In the analysis of the group of patients with BMI ≥25 kg/m2, increasing EOSS stages were associated with increased HRs for intubation (EOSS stage 2 1.91, 95%CI 1.35-2.72, EOSS stage 3 1.74, 95%CI 1.06-2.85, and EOSS stage 4 3.75, 95%CI 2.38-5.90);by comparison, BMI group was only associated with intubation in individual with class III (40 kg/m2) (HR 2.24, 95%CI 1.50-3.34). Risk for death was increased in patients with EOSS stages 2 and 4 (EOSS stage 2 1.55, 95%CI 1.10-2.19, and EOSS stage 4 2.19, 95%CI 1.43-3.36) compared to EOSS 0 and 1, and in patients with class II and III obesity, compared to patients with overweight (class II HR 1.52, 95%CI 1.00-2.30 and class III 1.92, 95%CI 1.30-2.84). Conclusion: Risk for adverse COVID-19 outcomes was predicted better by the EOSS category, which was associated with the highest BMI class. Patients with overweight and obesity in EOSS stages 0 and 1 had lower risk for adverse outcomes than patients with normal weight, showing that BMI can assign “healthy” and “sick” category wrongly, and fails to identify pathways to guide chronic-disease management. Patients with EOSS stages 0 and 1 had the highest survival, followed by patients with normal weight, EOSS stage 3 and 2, and EOSS 4 had reduced survival starting from the first days of hospitalization. According to BMI, Class I and II obesity had the longest survival, followed by normal weight and overweight, and class III obesity had the lowest survival. Similarly, in the patients with a BMI ≥25 kg/m2, EOSS stages 0 and 1 had the highest survival, compared to EOSS stage 4, which had significantly lower survival. Class I and II obesity had longer survival than patients with overweight, and the lowest survival occurred in patients with class III obesity.