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. 2021 Mar 24;13(6):7767-7780.
doi: 10.18632/aging.202813. Epub 2021 Mar 24.

Association of body mass index with severity and mortality of COVID-19 pneumonia: a two-center, retrospective cohort study from Wuhan, China

Xiaodong Wu  1 , Chenghong Li  2 , Shi Chen  2 , Xin Zhang  3 , Feilong Wang  1 , Ting Shi  4 , Qiang Li  1 , Lin Lin  5   6
Affiliations

Association of body mass index with severity and mortality of COVID-19 pneumonia: a two-center, retrospective cohort study from Wuhan, China

Xiaodong Wu et al. Aging (Albany NY). .

Abstract

In this study, we aimed to investigate the relationship between body mass index (BMI) and multiple severe outcomes of the coronavirus disease 2019 (COVID-19) pneumonia. A total of 1091 patients hospitalized with COVID-19 pneumonia were included from Wuhan, China. Overall, 2.8% (n = 31) received invasive mechanical ventilation (IMV), 10.8% (n = 118) were admitted to the intensive care unit (ICU), 6.4% (n = 70) developed acute respiratory distress syndrome (ARDS), and 4.4% (n = 48) died. Multivariable-adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) of IMV therapy, ICU admission and ARDS associated with obesity were 2.86 (1.16-7.05), 2.62 (1.52-4.49) and 3.15 (1.69-5.88), respectively; underweight was significantly associated with death (HR 3.85, 95%CI 1.26-11.76). Restricted cubic spline analyses suggested U-shaped associations of BMI with ICU admission and death, but linear relationships of BMI with IMV therapy and ARDS. In conclusion, obesity had an increased risk of IMV therapy, ICU admission and ARDS, while underweight was associated with higher mortality in COVID-19 pneumonia. U-shaped associations of BMI with ICU admission and death, and linear relationships of BMI with IMV therapy and ARDS, were found. These findings indicate that extra caution should be taken when treating COVID-19 patients with underweight and obesity.

Keywords: COVID-19; SARS-CoV-2; body mass index; obesity; outcome.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors have no potential conflicts of interest to report.

Figures

Figure 1
Figure 1
Proportions of COVID-19 pneumonia patients with the outcomes according to BMI categories. ARDS, acute respiratory distress syndrome. BMI, body mass index. COVID-19, coronavirus disease 2019. IMV, invasive mechanical ventilation. ICU, intensive care unit.
Figure 2
Figure 2
Multivariable-adjusted HRs (95% CIs) for the associations of IMV therapy (A), ICU admission (B), ARDS (C) and death (D) with BMI. HRs (95% CIs) were adjusted for age, sex, neutrophil counts, lymphocyte counts, platelet counts, hs-CRP, and cancer (yes/no). ARDS, acute respiratory distress syndrome. BMI, body mass index. ICU, intensive care unit. IMV, invasive mechanical ventilation. Red line, HR; dotted grey lines, 95% CI.
See this image and copyright information in PMC

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