Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

References

    1. Schetz M., De Jong A., Deane A.M., Druml W., Hemelaar P., Pelosi P., et al. Obesity in the critically ill: a narrative review. Intensive Care Med. 2019;45(6):757–769. - PubMed
    1. Centre ICNAR ICNARC registry. 2021. https://wwwicnarcorg/Our-Audit/Audits/Cmp/Reports
    1. Chiumello D., Pozzi T., Storti E., Caccioppola A., Pontiroli A.E., Coppola S. Body mass index and acute respiratory distress severity in patients with and without SARS-CoV-2 infection. Br J Anaesth. 2020;125(4) e376-e7. - PMC - PubMed
    1. Legrand M. Complications in patients with COVID-19. JAMA Cardiol. 2021;6(3):359. - PubMed
    1. Madjid M., Solomon S.D., Vardeny O. Complications in patients with COVID-19-reply. JAMA Cardiol. 2021;6(3):360. - PubMed

Publication types

Substances