Obesity, inflammatory and thrombotic markers, and major clinical outcomes in critically ill patients with COVID-19 in the US

Obesity (Silver Spring). 2021 Oct;29(10):1719-1730. doi: 10.1002/oby.23245. Epub 2021 Aug 6.

Abstract

Objective: This study aimed to determine whether obesity is independently associated with major adverse clinical outcomes and inflammatory and thrombotic markers in critically ill patients with COVID-19.

Methods: The primary outcome was in-hospital mortality in adults with COVID-19 admitted to intensive care units across the US. Secondary outcomes were acute respiratory distress syndrome (ARDS), acute kidney injury requiring renal replacement therapy (AKI-RRT), thrombotic events, and seven blood markers of inflammation and thrombosis. Unadjusted and multivariable-adjusted models were used.

Results: Among the 4,908 study patients, mean (SD) age was 60.9 (14.7) years, 3,095 (62.8%) were male, and 2,552 (52.0%) had obesity. In multivariable models, BMI was not associated with mortality. Higher BMI beginning at 25 kg/m2 was associated with a greater risk of ARDS and AKI-RRT but not thrombosis. There was no clinically significant association between BMI and inflammatory or thrombotic markers.

Conclusions: In critically ill patients with COVID-19, higher BMI was not associated with death or thrombotic events but was associated with a greater risk of ARDS and AKI-RRT. The lack of an association between BMI and circulating biomarkers calls into question the paradigm that obesity contributes to poor outcomes in critically ill patients with COVID-19 by upregulating systemic inflammatory and prothrombotic pathways.

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / virology
  • Aged
  • Biomarkers / metabolism
  • COVID-19 / epidemiology*
  • COVID-19 / virology
  • Critical Illness / epidemiology
  • Female
  • Humans
  • Inflammation / epidemiology*
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Respiratory Distress Syndrome / epidemiology
  • Respiratory Distress Syndrome / virology
  • SARS-CoV-2 / pathogenicity
  • Thrombosis / epidemiology*
  • United States / epidemiology

Substances

  • Biomarkers