Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection: A Retrospective Cohort Study

• Published in: Annals of Internal Medicine 2020-11
• Main Authors: Anderson, Michaela R, Geleris, Joshua, Anderson, David R, Zucker, Jason, Nobel, Yael R, Freedberg, Daniel, Small-Saunders, Jennifer, Rajagopalan, Kartik N, Greendyk, Richard, Sae-Rom Chae, Natarajan, Karthik, Roh, David, Edwin, Ethan, Gallagher, Dympna, Podolanczuk, Anna, R. Graham Barr, Ferrante, Anthony W, Baldwin, Matthew R
• Format: Article
• Language: English
• DOI: 10.7326/M20-3214

Visual Abstract. BMI and Risk for Intubation or Death in SARS-CoV-2 Infection Obesity has been associated with COVID-19 and with pneumonia and acute respiratory distress syndrome but is also associated with comorbidities that place patients at higher risk. This study examines whether obesity is associated with intubation or death—as well as biomarkers of inflammation, cardiac injury, or fibrinolysis—in the context of COVID-19 disease independent of obesity-related comorbidities. * Download figure * Download PowerPoint Abstract Background: Obesity is a risk factor for pneumonia and acute respiratory distress syndrome. Objective: To determine whether obesity is associated with intubation or death, inflammation, cardiac injury, or fibrinolysis in coronavirus disease 2019 (COVID-19). Design: Retrospective cohort study. Setting: A quaternary academic medical center and community hospital in New York City. Participants: 2466 adults hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection over a 45-day period with at least 47 days of in-hospital observation. Measurements: Body mass index (BMI), admission biomarkers of inflammation (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), cardiac injury (troponin level), and fibrinolysis (D-dimer level). The primary end point was a composite of intubation or death in time-to-event analysis. Results: Over a median hospital length of stay of 7 days (interquartile range, 3 to 14 days), 533 patients (22%) were intubated, 627 (25%) died, and 59 (2%) remained hospitalized. Compared with overweight patients, patients with obesity had higher risk for intubation or death, with the highest risk among those with class 3 obesity (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]). This association was primarily observed among patients younger than 65 years and not in older patients (P for interaction by age = 0.042). Body mass index was not associated with admission levels of biomarkers of inflammation, cardiac injury, or fibrinolysis. Limitations: Body mass index was missing for 28% of patients. The primary analyses were conducted with multiple imputation for missing BMI. Upper bounding factor analysis suggested that the results are robust to possible selection bias. Conclusion: Obesity is associated with increased risk for intubation or death from COVID-19 in adults younger than 65 years, but not in adults aged 65 years or older. Primary Funding Source: National Institutes of He