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Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort.
Yates, Thomas; Zaccardi, Francesco; Islam, Nazrul; Razieh, Cameron; Gillies, Clare L; Lawson, Claire A; Chudasama, Yogini; Rowlands, Alex; Davies, Melanie J; Docherty, Annemarie B; Openshaw, Peter J M; Baillie, J Kenneth; Semple, Malcolm G; Khunti, Kamlesh.
  • Yates T; Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK. ty20@leicester.ac.uk.
  • Zaccardi F; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK. ty20@leicester.ac.uk.
  • Islam N; Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
  • Razieh C; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
  • Gillies CL; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • Lawson CA; Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK.
  • Chudasama Y; Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
  • Rowlands A; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK.
  • Davies MJ; Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
  • Docherty AB; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
  • Openshaw PJM; Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
  • Baillie JK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
  • Semple MG; Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
  • Khunti K; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK.
BMC Infect Dis ; 21(1): 717, 2021 Jul 31.
Article in English | MEDLINE | ID: covidwho-1394426
ABSTRACT

BACKGROUND:

Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched.

METHODS:

We used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC). Patients admitted to hospital with COVID-19 from 6th February to 12th October 2020 were included where there was a coded outcome following hospital admission. Obesity was determined by an assessment from a clinician and chronic disease by medical records. Chronic diseases included chronic cardiac disease, hypertension, chronic kidney disease, chronic pulmonary disease, diabetes and cancer. Mutually exclusive categories of obesity, with or without chronic disease, were created. Associations with in-hospital mortality were examined across sex and age categories.

RESULTS:

The analysis included 27,624 women with 6407 (23.2%) in-hospital deaths and 35,065 men with 10,001 (28.5%) in-hospital deaths. The prevalence of chronic disease in women and men was 66.3 and 68.5%, respectively, while that of obesity was 12.9 and 11.1%, respectively. Association of obesity and chronic disease status varied by age (p < 0.001). Under 50 years of age, obesity and chronic disease were associated with in-hospital mortality within 28 days of admission in a dose-response manner, such that patients with both obesity and chronic disease had the highest risk with a hazard ratio (HR) of in-hospital mortality of 2.99 (95% CI 2.12, 4.21) in men and 2.16 (1.42, 3.26) in women compared to patients without obesity or chronic disease. Between the ages of 50-69 years, obesity and chronic disease remained associated with in-hospital COVID-19 mortality, but survival in those with obesity was similar to those with and without prevalent chronic disease. Beyond the age of 70 years in men and 80 years in women there was no meaningful difference between those with and without obesity and/or chronic disease.

CONCLUSION:

Obesity and chronic disease are important risk factors for in-hospital mortality in younger age groups, with the combination of chronic disease and obesity being particularly important in those under 50 years of age. These findings have implications for targeted public health interventions, vaccination strategies and in-hospital clinical decision making.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: COVID-19 Subject: COVID-19 Type of study: Clinical Practice Guide / Observational study / Prognostic study / Risk factors Language: English Journal: BMC Infect Dis Clinical aspect: Etiology Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: COVID-19 Subject: COVID-19 Type of study: Clinical Practice Guide / Observational study / Prognostic study / Risk factors Language: English Journal: BMC Infect Dis Clinical aspect: Etiology Year: 2021
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