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Vol. 48. Issue 3.
Pages 142-154 (March 2024)
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Vol. 48. Issue 3.
Pages 142-154 (March 2024)
Original article
Association of obesity on the outcome of critically ill patients affected by COVID-19
Asociación de la obesidad en la evolución de los pacientes críticos afectados por COVID-19
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675
Alejandro Rodrígueza,b,1,
Corresponding author
ahr1161@yahoo.es

Corresponding author.
, Ignacio Martín-Loechesc,1, Gerard Morenoa, Emili Díazd, Cristina Ferréa, Melina Salgadoa, Judith Marín-Corrale, Angel Estellaf, Jordi Solé-Violáng, Sandra Treflera, Rafael Zaragozah, Lorenzo Sociasi, Marcio Borges-Sai, Marcos I Restrepoj, Juan J Guardiolak, Luis F Reyesl, Antonio Albaya-Morenom, Alfonso Canabal Berlangan, María del Valle Ortizo, Juan Carlos Ballesterosp..., Susana Sancho Chinestaq, Juan Carlos Pozo Laderasr, Josep Gómezs, María Bodía,b, on behalf COVID-19/SEMCYUC Working group 2Ver más
a Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
b Universidad Rovira & Virgili/Institut d’Investigació Sanitaria Pere Virigili/CIBERES, Tarragona, Spain
c Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, Dublin, Ireland
d Critical Care Department, Hospital Parc Tauli, Sabadell, Spain
e Critical Care Department, Hospital del Mar, Barcelona, Spain
f Critical Care Department, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
g Critical Care Department, Hospital Universitario Dr. Negrin/Universidad Fernando Pessoa, Las Palmas de Gran Canaria, Spain
h Critical Care Department, Hospital Dr. Peset, Valencia, Spain
i Critical Care Department, Hospital Son Llatzer, Palma de Mallorca, Spain
j Medical Intensive Care Unit South Texas Veterans Health Care System Audie L. Murphy Division/University of Texas Health San Antonio, San Antonio, TX, USA
k Robley Rex VA Medical Center/University of Louisville, Louisville, USA
l Unisabana Center for Translational Science, Universidad de La Sabana, Clinica Universidadde La Sabana, Chía, Colombia/Pandemic Sciences Institute, University of Oxford, Oxford, UK
m Critical Care Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
n Critical Care Department, Hospital de La Princesa, Madrid, Spain
o Critical Care Department, Hospital Universitario de Burgos, Burgos, Spain
p Critical Care Department, Hospital Clínico de Salamanca, Salamanca, Spain
q Critical Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
r Critical Care Department, Hospital Universitario Reina Sofía, Córdoba, Spain
s Technical Secretary, Hospital Universitario de Tarragona Joan XXIII/URV, Tarragona, Spain
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Tables (3)
Table 1. Characteristics of 5186 critically ill patients included in the study according to presence of obesity (BMI ≥ 30) or not.
Table 2. Characteristics of 5186 critically ill patients included according to BMI categories.
Table 3. Characteristics of 5186 critically ill patients included in the study according to ICU outcome.
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Abstract
Objective

To evaluate the impact of obesity on ICU mortality.

Design

Observational, retrospective, multicentre study.

Setting

Intensive Care Unit (ICU).

Patients

Adults patients admitted with COVID-19 and respiratory failure.

Interventions

None.

Primary variables of interest

Collected data included demographic and clinical characteristics, comorbidities, laboratory tests and ICU outcomes. Body mass index (BMI) impact on ICU mortality was studied as (1) a continuous variable, (2) a categorical variable obesity/non-obesity, and (3) as categories defined a priori: underweight, normal, overweight, obesity and Class III obesity. The impact of obesity on mortality was assessed by multiple logistic regression and Smooth Restricted cubic (SRC) splines for Cox hazard regression.

Results

5,206 patients were included, 20 patients (0.4%) as underweight, 887(17.0%) as normal, 2390(46%) as overweight, 1672(32.1) as obese and 237(4.5%) as class III obesity. The obesity group patients (n = 1909) were younger (61 vs. 65 years, p < 0.001) and with lower severity scores APACHE II (13 [9–17] vs. 13[10−17, p < 0.01) than non-obese. Overall ICU mortality was 28.5% and not different for obese (28.9%) or non-obese (28.3%, p = 0.65). Only Class III obesity (OR = 2.19, 95%CI 1.44–3.34) was associated with ICU mortality in the multivariate and SRC analysis.

Conclusions

COVID-19 patients with a BMI > 40 are at high risk of poor outcomes in the ICU. An effective vaccination schedule and prolonged social distancing should be recommended.

Keywords:
Obesity
COVID-19
Prognosis
Resumen
Objetivo

Evaluar el impacto de la obesidad en la mortalidad de la UCI.

Diseño

Estudio observacional, retrospectivo y multicéntrico.

Ámbito

Unidad de Cuidados Intensivos (UCI).

Pacientes

Pacientes adultos con COVID-19 e insuficiencia respiratoria.

Intervenciones

Ninguna.

Variables de interés principales

Características demográficas y clínicas, comorbilidades, pruebas de laboratorio y evolución en la UCI. El impacto del índice de masa corporal (IMC) sobre la mortalidad se estudió como (1) una variable continua, (2) una variable categórica obesidad/no obesidad, y (3) como categorías definidas a priori: bajo peso, normal, sobrepeso, obesidad y obesidad clase III. El impacto de la obesidad se evaluó mediante regresión logística múltiple y splines cúbicos suaves restringidos (SRC) para la regresión de riesgos de Cox.

Resultados

Se incluyeron 5.206 pacientes, 20 (0,4%) con bajo peso, 887 (17,0%) con peso normal, 2.390 (46%) con sobrepeso, 1.672 (32,1%) con obesidad y 237 (4,5%) con obesidad clase III. Los pacientes obesos (n = 1909) eran más jóvenes (61 vs. 65 años, p < 0,001) y con un nivel más bajo de APACHE II (13 [9–17] frente a 13[10−17, p < 0,01) que los no obesos. La mortalidad global en la UCI fue del 28,5% y no fue diferente entre obesos (28,9%) y no obesos (28,3%,p = 0,65). Sólo la obesidad clase III (OR = 2,19; IC del 95%: 1,44−3,34) se asoció con la mortalidad en la UCI en el análisis multivariante y SRC.

Conclusiones

Los pacientes con COVID-19 con un IMC > 40 tienen un alto riesgo de mala evolución en la UCI. Debe recomendarse un calendario de vacunación eficaz y un distanciamiento social prolongado.

Palabras clave:
Obesidad
COVID-19
Pronóstico

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