Link Between Obesity and The Severity of COVID-19 Infection: A Multicenter Retrospective Study in Dubai
Abstract
Background: Obesity is a major contributing factor for poor prognosis in many diseases and COVID-19 is no exception. Studies regarding the relationship between obesity and poor COVID-19 disease severity and outcome are however lacking in the gulf region. This study aimed to examine links between BMI and high mortality rate, duration of intensive care unit admission, and time on mechanical ventilation support among COVID-19 patients under the care of Dubai Health Authority (DHA) in the United Arab Emirates.
Subjects dan Method: This was a retrospective, descriptive, record-based study of 637 patients admitted with confirmed SARS-CoV-2 PCR at three tertiary hospitals in Dubai, UAE. Demographic and clinical data were obtained from March 1st, 2020, through June 1st, 2020, all patients aged 18 and above were included, pregnant ladies were excluded. The dependent variables were ICU admission, COVID severity, need of respiratory support, viral clearance. The independent variables were the disease outcome between the obese and non-obese. The data were analyzed using chi-square test.
Results: Total 200 (31.4%) were obese, while 435 (68.3%) were not obese. Most patients (81%) were male patients. Data Analysis reveals that obesity is associated with the risk of ICU admissions (OR=2.88, 95%CI=1.9 to 4.37; p<0.001). The findings also indicate that Covid-19 obese patients required higher respiratory support devices compared to non-obese patients (35.8% vs 16.3%, respectively) (OR= 2.87, 95%CI=1.93 to 4.27; p<0.001). Clinical severity at day 7th of hospital admissions among obese patients was direr compared to non-obese patients (34.5% vs 15.9%, respectively) (OR=2.79, 95%CI=1.87 to 4.16; p<0.001). Mortality rate at day 14 of admission were found higher among obese group too (9.5% vs 3.4%) (OR=2.95, 95%CI=1.46to 5.94; p= 0.020).
Conclusion: This study indicates that COVID-19 patients with obesity (BMI more than 30 kg/m2) are found to have severer respiratory manifestations, higher mortality rate, prolonged periods of intensive care unit admission, and utilization of invasive mechanical ventilation.
References
Cai Q, Chen F, Wang T, Luo F, Liu X, Wu Q, He Q, et al. (2020). Obesity and COVID-19 severity in a designated hospital in Shenzhen, China. Diabetes Care. 43(7): 1392-1398. doi: 10.2337/dc20-0576.
CDC (2018). People at high risk for flu complications. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/flu/high-risk/index.htm.
Dehingia N, Raj A (2020). Sex differences in COVID-19 case fatality: do we know enough? The Lancet Glob Health. 9(1):e14-e15. doi: 10.1016/S2214-109-X(20)30464-2.
DHA-Dubai Health Authority. Dha.gov.ae. Retrieved from https://www.dha.gov. ae/en/Pages/DHAHome.aspx#.
Ekiz T, Pazarl? AC (2020). Relationship between COVID-19 and obesity. Diabetes Metab Syndr. 14(5): 761-763. doi: 10.1016/j.dsx.2020.05.047.
Jia X, Yin C, Lu S, Chen Y, Liu Q, Bai J, Lu Y (2020). Two things about covid-19 might need attention. Preprints. doi: 10.20944/preprints202002.0315.v1.
Kass DA, Duggal P, Cingolani O (2020). Obesity could shift severe COVID-19 disease to younger ages. Lancet. 395(10236): 1544-1545. doi: 10.1016/S0140-6736(20)31024-2.
Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, Huan Y, et al. (2005). A crucial role of angiotensin-converting enzyme 2 (ACE2) in SARS coronavirus
Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, Vugia D, et al. (2009). Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA. 302(17): 1896-1902. doi: 10.1001/jama.2009.1583.
Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, Labreuche J, et al. (2020). High prevalence of obesity in severe acute respiratory syndrome coronavirus?2 (SARS?CoV?2) requiring invasive mechanical ventilation. Obesity (Silver
Spring). 28(7): 1195-1199. doi: 10.1002/oby.22831.
Tartof SY, Qian L, Hong V, Wei R, Nadjafi RF, Fischer H, Li Z, et al. (2020). Obesity and mortality among patients diagnosed with COVID-19: Results from an integrated health care organization. Ann Intern Med. doi: 10.7326/M20-3742.
UAE (2020). Coronavirus (COVID-19). Retrieved from https://covid19.ncema.gov.ae/en.
WHO (2020). Coronavirus disease (COVID-19) - Events as They Happen. Retrieved from https://www.who.int/ emergencies/diseases/novel-corona-virus-2019/events-as-they-happen.
World Bank Open Data|Data, n.d. Retrieved from https://data.worldbank.org/.
WHO (2020). Coronavirus disease (COVID -19) Situation Reports.
World Population Growth - Our World in Data, n.d. Retrieved from https://ourworldindata.org/world-population-growth.
You H, Wu X, Guo X (2020). Distribution of covid-19 morbidity rate in association with social and economic factors in wuhan, china: Implications for urban development. Int. J. Environ. Res. Public Health 17 (10): 3417. doi: 10.3390/ijerph17103417.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3.
