Observational Study

. 2023 Apr 1;51(4):484-491.

doi: 10.1097/CCM.0000000000005788. Epub 2023 Feb 10.

Age Moderates the Effect of Obesity on Mortality Risk in Critically Ill Patients With COVID-19: A Nationwide Observational Cohort Study

Corstiaan A den Uil^{1

2

3

4

5

6

7

8

9

10

11}, Fabian Termorshuizen^{4

5}, Wim J R Rietdijk⁶, Roos S G Sablerolles^{6

7}, Hugo P M van der Kuy⁶, Lenneke E M Haas⁸, Peter H J van der Voort⁹, Dylan W de Lange¹⁰, Peter Pickkers¹¹, Nicolette F de Keizer^{4

5}; Dutch COVID-19 Research Consortium

Collaborators, Affiliations

Collaborators

Dutch COVID-19 Research Consortium:
M S Arbous, M G W Barnas, D P Boer, R J Bosman, G B Brunnekreef, M Th de Bruin, M J de Graaff, R M de Jong, A R de Meijer, W de Ruijter, R de Waal, A Dijkhuizen, D A Dongelmans, T P J Dormans, A Draisma, I Drogt, B J W Eikemans, P W G Elbers, J L Epker, M L Erkamp, B Festen-Spanjer, T Frenzel, L Georgieva, N C Gritters, I Z Hené, M Hoeksema, J W M Holtkamp, M E Hoogendoorn, C J G M Jacobs, I T A Janssen, H Kieft, M P Koetsier, T J J Koning, H Kreeftenberg, N Kusadasi, J A Lens, J G Lutisan, D J Mehagnoul-Schipper, D Moolenaar, F Nooteboom, N Postma, R V Pruijsten, D Ramnarain, A C Reidinga, E Rengers, A A Rijkeboer, T Rijpstra, F W Rozendaal, R M Schnabel, V M Silderhuis, J J Spijkstra, P E Spronk, L F Te Velde, L C Urlings-Strop, A E van den Berg, R van den Berg, I C C van der Horst, E M van Driel, L van Gulik, F M van Iersel, M van Lieshout, J A H van Oers, E R van Slobbe-Bijlsma, M van Tellingen, J Vandeputte, D P Verbiest, D J Versluis, E Verweij, M Vrolijk-de Mos, R M J Wesselink

Affiliations

¹ Department of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands.
² Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
³ Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁴ National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.
⁵ Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, The Netherlands.
⁶ Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁷ Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁸ Department of Intensive Care, Diakonessenhuis, Utrecht, The Netherlands.
⁹ Department of Intensive Care, University Medical Center Groningen, Groningen, The Netherlands.
¹⁰ Department of Intensive Care, Dutch Poisons Information Center (DPIC), University Medical Center, Utrecht University, Utrecht, The Netherlands.
¹¹ Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.

PMID: 36762902
PMCID: PMC10012838
DOI: 10.1097/CCM.0000000000005788

Observational Study

Age Moderates the Effect of Obesity on Mortality Risk in Critically Ill Patients With COVID-19: A Nationwide Observational Cohort Study

Corstiaan A den Uil et al. Crit Care Med. 2023.

. 2023 Apr 1;51(4):484-491.

doi: 10.1097/CCM.0000000000005788. Epub 2023 Feb 10.

Authors

Collaborators

Dutch COVID-19 Research Consortium:
M S Arbous, M G W Barnas, D P Boer, R J Bosman, G B Brunnekreef, M Th de Bruin, M J de Graaff, R M de Jong, A R de Meijer, W de Ruijter, R de Waal, A Dijkhuizen, D A Dongelmans, T P J Dormans, A Draisma, I Drogt, B J W Eikemans, P W G Elbers, J L Epker, M L Erkamp, B Festen-Spanjer, T Frenzel, L Georgieva, N C Gritters, I Z Hené, M Hoeksema, J W M Holtkamp, M E Hoogendoorn, C J G M Jacobs, I T A Janssen, H Kieft, M P Koetsier, T J J Koning, H Kreeftenberg, N Kusadasi, J A Lens, J G Lutisan, D J Mehagnoul-Schipper, D Moolenaar, F Nooteboom, N Postma, R V Pruijsten, D Ramnarain, A C Reidinga, E Rengers, A A Rijkeboer, T Rijpstra, F W Rozendaal, R M Schnabel, V M Silderhuis, J J Spijkstra, P E Spronk, L F Te Velde, L C Urlings-Strop, A E van den Berg, R van den Berg, I C C van der Horst, E M van Driel, L van Gulik, F M van Iersel, M van Lieshout, J A H van Oers, E R van Slobbe-Bijlsma, M van Tellingen, J Vandeputte, D P Verbiest, D J Versluis, E Verweij, M Vrolijk-de Mos, R M J Wesselink

Affiliations

¹ Department of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands.
² Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
³ Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁴ National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.
⁵ Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, The Netherlands.
⁶ Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁷ Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁸ Department of Intensive Care, Diakonessenhuis, Utrecht, The Netherlands.
⁹ Department of Intensive Care, University Medical Center Groningen, Groningen, The Netherlands.
¹⁰ Department of Intensive Care, Dutch Poisons Information Center (DPIC), University Medical Center, Utrecht University, Utrecht, The Netherlands.
¹¹ Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.

PMID: 36762902
PMCID: PMC10012838
DOI: 10.1097/CCM.0000000000005788

Abstract

Objectives: A high body mass index (BMI) is associated with an unfavorable disease course in COVID-19, but not among those who require admission to the ICU. This has not been examined across different age groups. We examined whether age modifies the association between BMI and mortality among critically ill COVID-19 patients.

Design: An observational cohort study.

Setting: A nationwide registry analysis of critically ill patients with COVID-19 registered in the National Intensive Care Evaluation registry.

Patients: We included 15,701 critically ill patients with COVID-19 (10,768 males [68.6%] with median [interquartile range] age 64 yr [55-71 yr]), of whom 1,402 (8.9%) patients were less than 45 years.

Interventions: None.

Measurements and main results: In the total sample and after adjustment for age, gender, Acute Physiology and Chronic Health Evaluation IV, mechanical ventilation, and use of vasoactive drugs, we found that a BMI greater than or equal to 30 kg/m 2 does not affect hospital mortality (adjusted odds ratio [OR adj ] = 0.98; 95% CI, 0.90-1.06; p = 0.62). For patients less than 45 years old, but not for those greater than or equal to 45 years old, a BMI greater than or equal to 30 kg/m 2 was associated with a lower hospital mortality (OR adj = 0.59; 95% CI, 0.36-0.96; p = 0.03).

Conclusions: A higher BMI may be favorably associated with a lower mortality among those less than 45 years old. This is in line with the so-called "obesity paradox" that was established for other groups of critically ill patients in broad age ranges. Further research is needed to understand this favorable association in young critically ill patients with COVID-19.

PubMed Disclaimer

Conflict of interest statement

Dr. Rietdijk, Sablerolles, and van der Kuy received funding for conducting COVID-19 research from the Leading Online Entrepreneur of the Year (LOEY) foundation. Drs. Termorshuizen’s and de Keizer’s institutions received funding from the National Intensive Care Evaluation (NICE) Foundation. Dr. Termorshuizen received funding from the Mental Health Care Institute Rivierduinen. Dr. de Keizer’s institution received funding from The Netherlands Organisation for Health Research and Development (ZonMw) COVID-19 Programme; she disclosed that she is a NICE board member. Although, the LOEY foundation and ZonMw provided a grant to conduct COVID-19 research, they were not involved in the design, execution, and/or publication of this study. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

**Figure 1.**
Post hoc analysis results: Odds ratios (ORs) and 95% CIs of the association between obesity and hospital mortality adjusted for several important clinical characteristics in younger (<45 yr) patients. APACHE = Acute Physiology and Chronic Health Evaluation, BMI = body mass index.

See this image and copyright information in PMC

Comment in

Obesity and Critical Illness-Associated Mortality: Paradox, Persistence and Progress.
Ripoll JG, Bittner EA. Ripoll JG, et al. Crit Care Med. 2023 Apr 1;51(4):551-554. doi: 10.1097/CCM.0000000000005787. Epub 2023 Mar 18. Crit Care Med. 2023. PMID: 36928016 No abstract available.

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Age Moderates the Effect of Obesity on Mortality Risk in Critically Ill Patients With COVID-19: A Nationwide Observational Cohort Study

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Age Moderates the Effect of Obesity on Mortality Risk in Critically Ill Patients With COVID-19: A Nationwide Observational Cohort Study

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