Understanding the Link Between Obesity and Severe COVID-19 Outcomes: Causal Mediation by Systemic Inflammatory Response.
J Clin Endocrinol Metab
; 107(2): e698-e707, 2022 01 18.
Article
in English
| MEDLINE | ID: covidwho-1394502
ABSTRACT
BACKGROUND:
Obesity is an established risk factor for severe COVID-19 outcomes. The mechanistic underpinnings of this association are not well-understood.OBJECTIVE:
To evaluate the mediating role of systemic inflammation in obesity-associated COVID-19 outcomes.METHODS:
This hospital-based, observational study included 3828 SARS-CoV-2-infected patients who were hospitalized February to May 2020 at Massachusetts General Hospital (MGH) or Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP). We use mediation analysis to evaluate whether peak inflammatory biomarkers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], D-dimer, ferritin, white blood cell count and interleukin-6) are in the causal pathway between obesity (BMI ≥ 30) and mechanical ventilation or death within 28 days of presentation to care.RESULTS:
In the MGH cohort (n = 1202), obesity was associated with greater likelihood of ventilation or death (ORâ =â 1.73; 95% CIâ =â [1.25, 2.41]; Pâ =â 0.001) and higher peak CRP (Pâ <â 0.001) compared with nonobese patients. The estimated proportion of the association between obesity and ventilation or death mediated by CRP was 0.49 (Pâ <â 0.001). Evidence of mediation was more pronounced in patientsâ <â 65 years (proportion mediatedâ =â 0.52 [Pâ <â 0.001] vs 0.44 [Pâ =â 0.180]). Findings were more moderate but consistent for peak ESR. Mediation by other inflammatory markers was not supported. Results were replicated in CUIMC/NYP cohort (nâ =â 2626).CONCLUSION:
Findings support systemic inflammatory pathways in obesity-associated severe COVID-19 disease, particularly in patientsâ <â 65 years, captured by CRP and ESR. Contextualized in clinical trial findings, these results reveal therapeutic opportunity to target systemic inflammatory pathways and monitor interventions in high-risk subgroups and particularly obese patients.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Systemic Inflammatory Response Syndrome
/
COVID-19
/
Obesity
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Long Covid
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
J Clin Endocrinol Metab
Year:
2022
Document Type:
Article
Affiliation country:
Clinem
Similar
MEDLINE
...
LILACS
LIS