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Multicenter Study
. 2022 Mar;46(3):661-668.
doi: 10.1038/s41366-021-01017-8. Epub 2022 Jan 1.

The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study

Marcela Rodríguez-Flores  1 , Eduardo W Goicochea-Turcott  2 , Leonardo Mancillas-Adame  3 , Nayely Garibay-Nieto  4 , Malaquías López-Cervantes  5 , Mario E Rojas-Russell  6 , Lilia V Castro-Porras  5 , Eduardo Gutiérrez-León  5 , Luis F Campos-Calderón  2 , Karen Pedraza-Escudero  4 , Karina Aguilar-Cuarto  4 , Eréndira Villanueva-Ortega  4 , Joselin Hernández-Ruíz  4 , Guadalupe Guerrero-Avendaño  4 , Sheyla M Monzalvo-Reyes  7 , Rafael García-Rascón  7 , Israel N Gil-Velázquez  7 , Dora E Cortés-Hernández  8 , Marcela Granados-Shiroma  8 , Brenda G Alvarez-Rodríguez  8 , Martha L Cabello-Garza  8 , Zaira L González-Contreras  8 , Esteban Picazo-Palencia  8 , Juana M Cerda-Arteaga  9 , Héctor R Pérez-Gómez  10 , Roberto Calva-Rodríguez  11 , Gerardo Sánchez-Rodríguez  11 , Leslie D Carpio-Vázquez  11 , María A Dávalos-Herrera  12 , Karla M Villatoro-de-Pleitez  12 , Melissa D Suárez-López  12 , María G Nevárez-Carrillo  12 , Karina Pérez-Alcántara  12 , Roopa Mehta  13 , Edurne Sandoval Diez  14 , Edward W Gregg  15
Affiliations
Multicenter Study

The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study

Marcela Rodríguez-Flores et al. Int J Obes (Lond). 2022 Mar.

Abstract

Background: Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes.

Methods: 1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category.

Results: The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02-1.97 and 2.78, 95% CI 1.83-4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06-2.74, and 2.62, 95% CI 1.65-4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42-0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03-2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50-3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight.

Conclusions: EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.

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Conflict of interest statement

MRF has received support from Medtronic, CONACYT, Novo Nordisk and Merck; EWGT has received support from Wyeth Science Centre; RM has received fees as speaker or advisor from Abbott, Amgen, Astra Zeneca, Boehringer Ingelheim, Janssen, Novo Nordisk, Sanofi and Silanes; LGMA has received fees from Novo Nordisk, Lilly, Merck and Sanofi. The rest of authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flow diagram of patients included in the study.
The patients were allocated in one of five stages according to their clinical features, and then reallocated after positive PCR result.
Fig. 2
Fig. 2. Survival analysis for invasive mechanical ventilation and mortality according to EOSS stage and to BMI classification.
The graphs on the left show the results according the EOSS stage and those on the right according to the BMI for each of the items analyzed, adjusted for age and sex.
See this image and copyright information in PMC

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