Body Mass Index Is A Predictor of Mortality and Adverse Cardiorespiratory Outcomes in Patients Hospitalized for SARS-COV-2 Infection

ABSTRACT

Objectives: We aimed to evaluate the association of body mass index (BMI) with in-hospital mortality and cardiorespiratory outcomes in patients admitted with COVID-19 infection. Methods: This data was collected from an academic tertiary referral center in upstate New York. Retrospective cohort analysis was conducted on patients admitted with COVID-19 infection (n=194). BMI was calculated and patients were stratified into two categories 'healthy' (BMI=18.5-24.5) and 'overweight' (BMI>25). Cardiorespiratory outcomes were classified as in-hospital mortality, need for vasopressors, mechanical ventilation, and hemodialysis. Transthoracic echocardiography was performed to evaluate for left ventricular (LV) ejection fraction, right ventricular (RV) systolic function and RV dilation. Cardiovascular (CV) risk factors such as history of COPD, Diabetes, HTN, CAD and cigarette smoking were analyzed. LDH, troponin, CRP and ferritin levels were also noted. Results: Out of 194 patients, 68% were overweight with a mean BMI of 29.8 +/-9.5 kg/m2 and a mean age of 66 +/-16, 75% of females and 63% of males were overweight. Mortality rate was 31% in overweight patients compared to 17% in healthy subset (p<0.04). The rate of need for mechanical ventilation was higher in overweight group as well (34% vs. 17%, p<0.02). There was no significant difference between the cohorts in terms of vasopressor and hemodialysis requirement (p=0.09 and 0.2 respectively). RV systolic function was depressed in 21% of overweight cohort vs. 8% of healthy patients (p<0.02) while RV dilatation was seen in 15% of overweight patients compared with 5% of healthy patients (p<0.03). There was no significant difference in LV ejection fraction between the groups. LDH was more frequently elevated in overweight cohort with a mean level of 346 +/-185 IU/L (p<0.01). No significant difference in rest of the laboratory analysis or CV risk factors were found. Conclusion: Elevated BMI (>25) is associated with a statistically significant increase in in-hospital mortality, need for mechanical ventilation, right ventricular abnormalities, and LDH levels in patients hospitalized with COVID-19 infection.