DERIVATION OF A RISK SCORE TO PREDICT SEVERE COVID-19 PNEUMONIA IN HOSPITALIZED PATIENTS WITH OVERWEIGHT OR OBESITY

ABSTRACT

Background Although a higher body mass index (BMI) has been reported to be associated with severe COVID-19 pneumonia (severe disease), it is unclear if metabolic status plays a role. Being metabolically unhealthy (MU) is defined as having either hypertension, hyperlipidemia, type 2 diabetes mellitus/pre-diabetes, or non-alcoholic fatty liver disease. We aimed to derive a risk score to predict severe disease in patients with obesity or overweight according to metabolic status. Methods A retrospective study was performed for patients hospitalized with COVID-19 pneumonia between March 2020 and August 2021 at a single tertiary center. Patients were excluded if they were immunocompromised or had a BMI < 25.0. Wilcoxon rank sum test or Fisher's Exact test were performed. Univariate logistic regression was performed followed by multivariate logistic regression to derive a risk score to predict severe disease. Variables with the highest p-values were sequentially removed until removal led to less than a 1-point reduction (improvement) in the Akaike information criterion. Accuracy of the model was calculated using bootstrap resampling estimates of the area under the receiver operating characteristic curve (AUROCC). Results 334 of 450 patients hospitalized with COVID-19 pneumonia (74.2%) were MU. Older age, higher BMI, being a former smoker, and having been vaccinated for SARS-CoV-2 were associated with being MU. There was no difference in treatments for COVID-19 pneumonia according to metabolic status. Patients who were MU had a higher death rate (10.5% vs. 2.6%) and longer total length of stay (median 6 vs. 5 days). Figure 1. On univariate analysis, age at admission, male gender, Asian race, hypertension, and type 2 diabetes mellitus were significant predictors of severe disease, whereas being MU was not, p=0.27. On multivariate logistic regression, older age, male gender, and Asian race were associated with having severe disease. Not being vaccinated was associated with a doubled odds of severe disease (OR 2.24, 95% CI 1.07, 4.59). Figure 2. The AUROCC of the final model was 0.66 (95% CI 0.60 to 0.71). The risk score at the lowest quintile had a 33.1% to 65.5% predicted risk and a 58.7% observed risk of severe disease, whereas at the highest quintile there was an 85.7% to 97.7% predicted risk and an 89.7% observed risk of severe disease in our cohort. Conclusion In this retrospective study of hospitalized patients with COVID-19 pneumonia, being MU was not a predictor of severe disease, even though mortality rate and total length of stay were higher in this group despite having higher rates of vaccination. Older age at admission, male gender, Asian race, and being unvaccinated were associated with severe disease. Using this risk score may help to predict severe disease in hospitalized patients with obesity or overweight. External validation is recommended (Table Presented)(Table Presented)