Sex-specific impact of severe obesity in the outcomes of hospitalized patients with COVID-19: a large retrospective study from the Bronx, New York

Abstract

It has been demonstrated that obesity is an independent risk factor for worse outcomes in patients with COVID-19. Our objectives were to investigate which classes of obesity are associated with higher in-hospital mortality and to assess the association between obesity and systemic inflammation. This was a retrospective study which included consecutive hospitalized patients with COVID-19 in a tertiary center. Three thousand five hundred thirty patients were included in this analysis (female sex: 1579, median age: 65 years). The median body mass index (BMI) was 28.8 kg/m². In the overall cohort, a J-shaped association between BMI and in-hospital mortality was depicted. In the subgroup of men, BMI 35-39.9 kg/m² and BMI ≥40 kg/m² were found to have significant association with higher in-hospital mortality, while only BMI ≥40 kg/m² was found significant in the subgroup of women. No significant association between BMI and IL-6 was noted. Obesity classes II and III in men and obesity class III in women were independently associated with higher in-hospital mortality in patients with COVID-19. The male population with severe obesity was the one that mainly drove this association. No significant association between BMI and IL-6 was noted.

Keywords: COVID-19; IL-6; Inflammation; Mortality; Novel coronavirus; Obesity; Observational study; Risk factor; SARS-CoV-2.

Fig. 1

The Association of median IL-6 level and Survival Status, Sex, Age, and BMI. Notes: (1) BMI in kg/m2, IL-6 in pg/mL, age in years. Abbreviations: BMI=body mass index, IL-6=interleukin 6

Fig. 2

The average predicted probabilities (marginal effects) with 95% CIs of mortality per BMI group. Abbreviation: BMI=body mass index (expressed in kg/m2)