30
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Severe obesity is associated with higher in-hospital mortality in a cohort of patients with COVID-19 in the Bronx, New York

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background & aims

          New York is the current epicenter of Coronavirus disease 2019 (COVID-19) pandemic. The underrepresented minorities, where the prevalence of obesity is higher, appear to be affected disproportionately. Our objectives were to assess the characteristics and early outcomes of patients hospitalized with COVID-19 in the Bronx and investigate whether obesity is associated with worse outcomes independently from age, gender and other comorbidities.

          Methods

          This retrospective study included the first 200 patients admitted to a tertiary medical center with COVID-19. The electronic medical records were reviewed at least three weeks after admission. The primary endpoint was in-hospital mortality.

          Results

          200 patients were included (female sex: 102, African American: 102). The median BMI was 30 kg/m 2. The median age was 64 years. Hypertension (76%), hyperlipidemia (46.2%), and diabetes (39.5%) were the three most common comorbidities. Fever (86%), cough (76.5%), and dyspnea (68%) were the three most common symptoms. 24% died during hospitalization (BMI < 25 kg/m 2: 31.6%, BMI 25–34 kg/m 2: 17.2%, BMI ≥ 35 kg/m 2: 34.8%, p = 0.03). Increasing age (analyzed in quartiles), male sex, BMI ≥ 35 kg/m 2 (reference: BMI 25–34 kg/m 2), heart failure, CAD, and CKD or ESRD were found to have a significant univariate association with mortality. The multivariate analysis demonstrated that BMI ≥ 35 kg/m 2 (reference: BMI 25–34 kg/m 2, OR: 3.78; 95% CI: 1.45–9.83; p = 0.006), male sex (OR: 2.74; 95% CI: 1.25–5.98; p = 0.011) and increasing age (analyzed in quartiles, OR: 1.73; 95% CI: 1.13–2.63; p = 0.011) were independently associated with higher in-hospital mortality. Similarly, age, male sex, BMI ≥ 35 kg/m 2 and current or prior smoking were significant predictors for increasing oxygenation requirements in the multivariate analysis, while male sex, age and BMI ≥ 35 kg/m 2 were significant predictors in the multivariate analysis for the outcome of intubation.

          Conclusions

          In this cohort of hospitalized patients with COVID-19 in a minority-predominant population, severe obesity, increasing age, and male sex were independently associated with higher in-hospital mortality and in general worse in-hospital outcomes.

          Highlights

          • Severe obesity, male sex, and increasing age were found to be independently associated with higher in-hospital mortality.

          • Former or current smoking was found to be independently associated to increasing oxygen requirements.

          • Our study population comes from the Bronx, New York, one of the most underserved areas in the United States.

          Related collections

          Most cited references11

          • Record: found
          • Abstract: found
          • Article: found

          Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

          In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China

            Abstract Background Since December 2019, novel coronavirus (SARS-CoV-2)-infected pneumonia (COVID-19) occurred in Wuhan, and rapidly spread throughout China. This study aimed to clarify the characteristics of patients with refractory COVID-19. Methods In this retrospective single-center study, we included 155 consecutive patients with confirmed COVID-19 in Zhongnan Hospital of Wuhan University from January 1st to February 5th. The cases were divided into general and refractory COVID-19 groups according to the clinical efficacy after hospitalization, and the difference between groups were compared. Results Compared with general COVID-19 patients (45.2%), refractory patients had an older age, male sex, more underlying comorbidities, lower incidence of fever, higher levels of maximum temperature among fever cases, higher incidence of breath shortness and anorexia, severer disease assessment on admission, high levels of neutrophil, aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and C-reactive protein, lower levels of platelets and albumin, and higher incidence of bilateral pneumonia and pleural effusion (P<0.05). Refractory COVID-19 patients were more likely to receive oxygen, mechanical ventilation, expectorant, and adjunctive treatment including corticosteroid, antiviral drugs and immune enhancer (P<0.05). After adjustment, those with refractory COVID-19 were also more likely to have a male sex and manifestations of anorexia and fever on admission, and receive oxygen, expectorant and adjunctive agents (P<0.05) when considering the factors of disease severity on admission, mechanical ventilation, and ICU transfer. Conclusion Nearly 50% COVID-19 patients could not reach obvious clinical and radiological remission within 10 days after hospitalization. The patients with male sex, anorexia and no fever on admission predicted poor efficacy.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Obesity, inflammation and the immune system.

              Obesity shares with most chronic diseases the presence of an inflammatory component, which accounts for the development of metabolic disease and other associated health alterations. This inflammatory state is reflected in increased circulating levels of pro-inflammatory proteins, and it occurs not only in adults but also in adolescents and children. The chronic inflammatory response has its origin in the links existing between the adipose tissue and the immune system. Obesity, like other states of malnutrition, is known to impair the immune function, altering leucocyte counts as well as cell-mediated immune responses. In addition, evidence has arisen that an altered immune function contributes to the pathogenesis of obesity. This review attempts to briefly comment on the various plausible explanations that have been proposed for the phenomenon: (1) the obesity-associated increase in the production of leptin (pro-inflammatory) and the reduction in adiponectin (anti-inflammatory) seem to affect the activation of immune cells; (2) NEFA can induce inflammation through various mechanisms (such as modulation of adipokine production or activation of Toll-like receptors); (3) nutrient excess and adipocyte expansion trigger endoplasmic reticulum stress; and (4) hypoxia occurring in hypertrophied adipose tissue stimulates the expression of inflammatory genes and activates immune cells. Interestingly, data suggest a greater impact of visceral adipose tissue and central obesity, rather than total body fat, on the inflammatory process. In summary, there is a positive feedback loop between local inflammation in adipose tissue and altered immune response in obesity, both contributing to the development of related metabolic complications.
                Bookmark

                Author and article information

                Contributors
                Journal
                Metabolism
                Metab. Clin. Exp
                Metabolism
                Elsevier Inc.
                0026-0495
                1532-8600
                16 May 2020
                July 2020
                16 May 2020
                : 108
                : 154262
                Affiliations
                [a ]Division of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
                [b ]Albert Einstein College of Medicine, Bronx, NY, USA
                [c ]Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
                [d ]Department of Economics, University of Piraeus, Piraeus, Greece
                [e ]Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
                Author notes
                [* ]Corresponding author at: Division of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA. leonidas.palaiodimos@ 123456gmail.com
                Article
                S0026-0495(20)30126-8 154262
                10.1016/j.metabol.2020.154262
                7228874
                32422233
                92eb7879-5170-45e0-aa57-a7408a78e21f
                © 2020 Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 6 May 2020
                : 12 May 2020
                : 14 May 2020
                Categories
                Article

                Molecular biology
                covid-19, coronavirus disease 2019,sars-cov-2, acute respiratory syndrome coronavirus 2,bmi, body mass index,or, odds ratio,ci, confidence interval,emr, electronic medical record,snf, skilled nursing facility,covid-19,sars-cov-2,coronavirus,obesity,mortality,bronx,new york,pandemic,risk factor

                Comments

                Comment on this article