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. 2022 Dec:72:154162.
doi: 10.1016/j.jcrc.2022.154162. Epub 2022 Oct 8.

The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox

M Balik  1 , E Svobodova  2 , M Porizka  2 , M Maly  2 , P Brestovansky  2 , L Volny  2 , T Brozek  2 , T Bartosova  2 , I Jurisinova  2 , Z Mevaldova  2 , O Misovic  2 , A Novotny  2 , J Horejsek  2 , M Otahal  2 , M Flaksa  2 , Z Stach  2 , J Rulisek  2 , P Trachta  2 , J Kolman  2 , R Sachl  2 , J Kunstyr  2 , P Kopecky  2 , S Romaniv  2 , M Huptych  3 , M Svarc  4 , G Hodkova  4 , J Fichtl  4 , F Mlejnsky  4 , T Grus  5 , J Belohlavek  6 , M Lips  2 , J Blaha  2
Affiliations

The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox

M Balik et al. J Crit Care. 2022 Dec.

Abstract

Purpose: The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS.

Materials and methods: The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed.

Results: 292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome.

Conclusions: The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.

Keywords: Corticosteroids; Covid-19; Extracorporeal membrane oxygenation; Morbid obesity; Obesity; SARS-CoV-2 ARDS.

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Conflict of interest statement

Conflict of interest None.

Figures

Fig. 1
Fig. 1
Study flow chart.
Fig. 2
Fig. 2
Comparison of the long-term survival of obese patients vs non-obese patients (Kaplan-Meier curves with log rank test, p = 0.858).
Fig. 3
Fig. 3
Distribution of the body mass indexes (3A) among the 292 severe SARS-CoV-2 ARDS patients and their relationships to application of ECMO and the ICU mortality (3B) and the hospital mortality (3C).
Fig. 5
Fig. 5
The Mantel–Haenszel estimate of relative risk (RR) for adverse outcome (ICU mortality) compared between obese and non-obese patients.
Supplementary Fig. 4
Supplementary Fig. 4
(ESM): Impact of body mass index on the long-term outcome among ECMO patients (4A, p = 0.813) and the non-ECMO patients (4B, p = 0.648). Impact of age on the long-term outcome in the ECMO patients is shown in 4C (p = 0.082) and among the non-ECMO patients in 4D (p < 0.001), all Kaplan-Meier curves with log rank test.
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