COVID-19: Obesity increases risk of hospitalization

New York - In addition to cardiovascular disorders and diabetes, obesity is one of the risk factors for a severe course of COVID-19 disease. This emerges from a case series in medRxiv (2020; doi: 10.1101 / 2020.04.08.20057794).

More than 1/3 of all Americans are obese with a body mass index of more than 30 kg / m2. Obesity increases susceptibility to a number of diseases, and severe courses of COVID-19 appear to be no exception.

Of the 4,103 patients treated at any of the 4 clinics and 260 outpatient centers at NYU Langone Medical Center, 1,101 were obese. The share of 26.8% is thus below the national average, which could be related to the fact that the facility affiliated with the University of New York (NYU) treats better-off residents of the metropolis.

About half of the patients diagnosed with COVID-19 had to be hospitalized. These persons were older (on average 62 versus 41 years), more often male (62.6 versus 39.0%), they had more frequent chronic previous illnesses (71.9 versus 29.9%) and they were more often obese (39.8 versus 14.4%) than patients with COVID-19 who were not admitted to the hospital.

In a regression analysis by researchers at NYU's Grossman School of Medicine, obesity was one of the top risk factors for hospitalization by age. Leora Horwitz's team determined an odds ratio of 66.8 for an age over 75 years. The 65- to 74-year-olds also had a significantly higher risk of hospitalization with an odds ratio of 10.9. A BMI of over 40 kg / m2 (odds ratio 6.2) and a BMI of 30 to 40 kg / m2 (odds ratio 4.3) followed in the sequence.

Obesity was about as much a risk to patients as heart failure (odds ratio 4.3), but significantly more than lung diseases (odds ratio 1.3) or cancer (odds ratio 1.2). It was striking that, in addition to diabetes mellitus (odds ratio 2.8), chronic kidney disease (odds ratio 3.1) favored a severe course.

Obesity also increased the risk of a life-threatening course of COVID-19 that required intensive medical treatment (with or without ventilation) or hospice care and / or death. The odds ratio was 1.38 for a BMI of 30 to 40 kg / m2 and 1.73 for a BMI over 40 kg / m2.

It is unclear why more severe COVID-19 courses occur in obese patients. Horwitz suspects that the inflammatory reactions associated with (visceral) obesity play a role.

The predictors of a life-threatening course included - regardless of obesity - a low blood oxygen saturation of less than 88% (odds ratio 6.99) and a D-dimer of over 2500 ng / ml (odds ratio 6.9) Ferritin above 2,500 ng / ml (odds ratio 6.9) and a C-reactive protein above 200 mg / l (odds ratio 5.8) on admission.