Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid-19 related respiratory failure: clinical relevance and potential pathophysiological mechanism.

Abstract

Background/Objectives: Recent studies show that obesity is a risk factor for hospital admission and for critical care need in patients with coronavirus disease 2019 (COVID-19).The aim was to determine whether obesity is a risk factor for unfavourable health outcomes in patients affected by COVID-19 admitted to ICU and to compare the observed trend of C-Reactive Protein (CRP) and Creatine Phosphokinase (CPK), as potential pathophysiological mechanisms linking disease severity with Body Mass Index (BMI). Subjects/Methods: 95 consecutive patients with COVID-19 (78 males and 18 females) were admitted to ICU and included in the study.Height, weight, BMI, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores,CRP, CPK, as well as ICU and hospital length of stay and comorbidities were evaluated. Results: Participants with obesity had a lower 28 day survival rate from ICU admission than normal weight subjects. Cox proportional hazard model-derived estimates, adjusted for age, gender and comorbidity, confirmed the results of the survival analysis (HR:5.30,95%C.I.1.26-22.34). In the full adjusted model, age was independently associated with mortality (HR:1.13,95%C.I:1.05-1.21).Obese subjects showed longer hospital and ICU stay as compared with normal weight counterpart.Subjects with obesity showed significantly higher CRP and CPK levels than normal weight subjects. Conclusions: Our study shows that in COVID-19 subjects admitted to ICU obesity is a risk factor for unfavourable health outcomes with higher mortality and longer hospital stay. The increase in CRP and CPK levels observed in this population could at least in part explain the unfavourable outcomes observed in individuals with obesity. In those subjects, careful management of any medical signs or symptoms and prompt intervention in case of suspected SARS-CoV-2 infection is necessary to prevent the progression of the disease towards severe outcomes and the increase of hospital treatment costs.