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Exp Clin Endocrinol Diabetes 2022; 130(02): 115-124
DOI: 10.1055/a-1552-4449
Article

Clinical Characteristics and Outcomes of COVID-19 Patients with Overweight and Obesity: Turkish Nationwide Cohort Study (TurCObesity)

Ibrahim Sahin
1   Faculty of Medicine, Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey
,
Cem Haymana 
2   Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey
,
Tevfik Demir
3   Faculty of Medicine, Department of Endocrinology and Metabolism, Dokuz Eylul University, Izmir, Turkey
,
Ibrahim Demirci 
2   Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey
,
Ilker Tasci 
4   Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Internal Medicine, University of Health Sciences, Ankara, Turkey
,
Aysegul Atmaca
5   Faculty of Medicine, Department of Endocrinology and Metabolism, Ondokuz Mayis University, Samsun, Turkey
,
Erman Cakal
6   Faculty of Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey
,
Naim Ata
7   Department of Strategy Development, Ministry of Health, Ankara, Turkey
,
Rifat Emral
8   Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara University, Ankara, Turkey
,
Ugur Unluturk 
9   Faculty of Medicine, Department of Endocrinology and Metabolism, Hacettepe University, Ankara, Turkey
,
Derun Ertugrul
10   Faculty of Medicine, Kecioren Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey
,
Serpil Salman 
11   Medica Clinic, Department of Endocrinology and Metabolism, Istanbul, Turkey
,
Mustafa Sahin
11   Medica Clinic, Department of Endocrinology and Metabolism, Istanbul, Turkey
,
Selcuk Dagdelen
4   Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Internal Medicine, University of Health Sciences, Ankara, Turkey
,
Osman Celik
12   Public Hospitals General Directorate, Republic of Turkey, Ministry of Health, Ankara, Turkey
,
Murat Caglayan
13   Ankara Provincial Health Directorate, Ankara, Turkey
,
Ilhan Satman
14   Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul University, Istanbul, Turkey
15   The Health Institutes of Turkey, Institute of Public Health and Chronic Diseases, Istanbul, Turkey
,
Alper Sonmez
16   Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey
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Abstract

Purpose While obesity is related to more severe outcomes of coronavirus disease 2019 (COVID-19), factors leading to poor prognosis still remain unclear. The present study evaluated the outcomes of COVID-19 patients who were overweight or obese and variables associated with severe disease in a large group of consecutive cases.

Methods A nationwide retrospective cohort study was performed using the Turkish National Healthcare Database. Demographic characteristics, laboratory tests, comorbidities, and medications of patients registered between March 11 and May 30, 2020, were recorded.

Results A total of 14, 625 patients (median age:42, IQR:26 years; female 57.4%) with normal weight (34.7%), overweight (35.6%), and obesity (29.7%) were included. Hospitalization, ICU admission, intubation/mechanical ventilation, pulmonary involvement, and mortality were significantly higher in patients who were overweight or obese. In adjusted analyses, both overweight (OR, 95% CI: 1.82, 1.04–3.21; p=0.037) and obesity (OR, 95% CI: 2.69, 1.02–1.05; p<0.001) were associated with a higher intubation/mechanical ventilation rate but only obesity was associated with increased mortality (OR, 95% CI: 2.56, 1.40–4.67; p=0.002). Old age, male gender, chronic kidney disease, and high C reactive protein levels were independently associated with COVID-19 mortality in overweight or obese patients.

Conclusions COVID-19 patients who were overweight or obese were more likely to have adverse outcomes but only obesity was a predictor of mortality. Such patients should receive urgent medical attention and active management, especially the elderly, men, and people with chronic kidney disease.

Key words

Obesity - overweight - COVID-19 - morbidity - mortality


Publication History

Received: 13 June 2021
Received: 30 June 2021

Accepted: 13 July 2021

Article published online:
12 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 TR Ministry of Health COVID-19 Information Platform. Available at: www.covid19.saglik.gov.tr. Accessed on 24 March
    PubMed
  • 2 Huang C, Wang Y, Li X. et al Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506
    CrossrefPubMedSearch in Google Scholar
  • 3 Wang D, Hu B, Hu C. et al Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069
    CrossrefPubMedSearch in Google Scholar
  • 4 Young BE, Ong SWX, Kalimuddin S. et al Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 2020; 323: 1488-1494 doi:10.1001/jama.2020.3204
    CrossrefPubMedSearch in Google Scholar
  • 5 Williamson EJ, Walker AJ, Bhaskaran K. et al Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020; 584: 430-436 doi:10.1038/s41586-020-2521-4
    CrossrefPubMedSearch in Google Scholar
  • 6 Cai Q, Chen F, Wang T. et al Obesity and COVID-19 severity in a designated hospital in Shenzhen, China. Diabetes Care 2020; 43: 1392-1398 doi:10.2337/dc20-0576
    CrossrefPubMedSearch in Google Scholar
  • 7 Malik P, Patel U, Patel K. et al Obesity a predictor of outcomes of COVID-19 hospitalized patients: a systematic review and meta-analysis. J Med Virol 2021; 93: 1188-1193 doi:10.1002/jmv.26555
    CrossrefPubMedSearch in Google Scholar
  • 8 Simonnet A, Chetboun M, Poissy J. et al High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity 2020; 28: 1195-1199
    CrossrefPubMedSearch in Google Scholar
  • 9 Caussy C, Pattou F, Wallet F. et al Prevalence of obesity among adult inpatients with COVID-19 in France. The Lancet Diabetes & Endocrinol 2020; 8: 562-564 doi:10.1016/S2213-8587(20)30160-1
    CrossrefPubMedSearch in Google Scholar
  • 10 Engin AB, Engin ED, Engin A. Two important controversial risk factors in SARS-CoV-2 infection: obesity and smoking. Environ Toxicol Pharmacol 2020; 78: 103411
    CrossrefPubMedSearch in Google Scholar
  • 11 de Lucena TMC, da Silva Santos AF, de Lima BR. et al Mechanism of inflammatory response in associated comorbidities in COVID-19. Diabetes Metab Syndr 2020; 14: 597-600
    CrossrefPubMedSearch in Google Scholar
  • 12 Tartof SY, Qian L, Hong V. et al Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann Intern Med 2020; 173: 773-781 doi:10.7326/M20-3742
    CrossrefPubMedSearch in Google Scholar
  • 13 Satman I, Demirci I, Haymana C. et al Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul. Diabetes Res Clin Pract 2021; 16: 108753 doi:10.1016/j.diabres.2021.108753
    CrossrefPubMedSearch in Google Scholar
  • 14 Sonmez A, Demirci I, Haymana C. et al Clinical characteristics and outcomes of COVID-19 in patients with type 2 diabetes in Turkey: A nationwide study (TurCoviDia). J Diabetes 2021; 13: 585-595 doi:10.1111/1753-0407.13171
    CrossrefPubMedSearch in Google Scholar
  • 15 Green WD, Beck MA. Obesity impairs the adaptive immune response to influenza virus. Ann Am Thorac Soc 2017; 14: 406-409
    CrossrefPubMedSearch in Google Scholar
  • 16 Mafort TT, Rufino R, Costa CH. et al Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med 2016; 11: 28
    CrossrefPubMedSearch in Google Scholar
  • 17 Kassir R. Risk of COVID-19 for patients with obesity. Obesity reviews: an official journal of the International Association for the Study of Obesity, England. 2020: 1–2
    PubMed
  • 18 Watanabe M, Risi R, Tuccinardi D. et al Obesity and SARS-CoV-2: A population to safeguard. Diabetes Metab Res Rev 2020; e3325 doi:10.1002/dmrr.3325
    PubMed
  • 19 Yang S, Cao P, Du P. et al Early estimation of the case fatality rate of COVID-19 in mainland China: a data-driven analysis. Ann Transl Med 2020; 8: 128
    CrossrefPubMedSearch in Google Scholar
  • 20 Stafford N. Covid-19: why Germany's case fatality rate seems so low. BMJ 2020; 369: m1395
    CrossrefPubMedSearch in Google Scholar
  • 21 Rajgor DD, Lee MH, Archuleta S. et al The many estimates of the COVID-19 case fatality rate. Lancet Infect Dis 2020; 20: 776-777
    CrossrefPubMedSearch in Google Scholar
  • 22 Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020; 323: 1775-1776
    PubMedSearch in Google Scholar
  • 23 Mi YN, Huang TT, Zhang JX. et al Estimating instant case fatality rate of COVID-19 in China. Int J Infect Dis 2020; 97: 1-6
    CrossrefPubMedSearch in Google Scholar
  • 24 Giangreco G. Case fatality rate analysis of Italian COVID-19 outbreak. J Med Virol 2020; 92: 919-923
    CrossrefPubMedSearch in Google Scholar
  • 25 Klang E, Kassim G, Soffer S. et al Severe obesity as an independent risk factor for COVID-19 mortality in hospitalized patients younger than 50. Obesity (Silver Spring) 2020; 28: 1595-1599 doi:10.1002/oby.22913
    CrossrefPubMedSearch in Google Scholar
  • 26 Kang IS, Kong KA. Body mass index and severity/fatality from coronavirus disease 2019: A nationwide epidemiological study in Korea. PLoS One 2021; 16: e0253640 doi:10.1371/journal.pone.0253640
    CrossrefPubMedSearch in Google Scholar
  • 27 Hoong CWS, Hussain I, Aravamudan VM. et al Obesity is associated with poor Covid-19 outcomes: a systematic review and meta-analysis. Horm Metab Res 2021; 53: 85-93 doi:10.1055/a-1326-2125. Epub 2021 Jan
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Richardson S, Hirsch JS, Narasimhan M. et al Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. JAMA 2020; 323: 2052-2059 doi:10.1001/jama.2020.6775. Erratum in: JAMA. 2020; 323(20): 2098
    CrossrefPubMedSearch in Google Scholar
  • 29 Dorjee K, Kim H, Bonomo E. et al Prevalence and predictors of death and severe disease in patients hospitalized due to COVID-19: a comprehensive systematic review and meta-analysis of 77 studies and 38,000 patients. PLoS One 2020; 15: e0243191 doi:10.1371/journal.pone.0243191
    Search in Google Scholar
  • 30 Mehanna O, El Askary A, Ali E. et al Impact of Obesity and its associated comorbid conditions on COVID-19 presentation. Diabetes Metab Syndr Obes 2020; 14: 409-415 doi:10.2147/DMSO.S287779
    CrossrefPubMedSearch in Google Scholar
  • 31 Hamer M, Gale CR, Kivimäki M. et al Overweight, obesity, and risk of hospitalization for COVID-19: a community-based cohort study of adults in the United Kingdom. Proc Natl Acad Sci USA 2020; 117: 21011-21013 doi:10.1073/pnas.2011086117
    CrossrefPubMedSearch in Google Scholar
  • 32 Agarwal S, Schechter C, Southern W. et al Preadmission diabetes-specific risk factors for mortality in hospitalized patients with diabetes and coronavirus disease 2019. Diabetes Care 2020; 43: 2339-2344 doi:10.2337/dc20-1543
    CrossrefPubMedSearch in Google Scholar
  • 33 Watanabe M, Caruso D, Tuccinardi D. et al Visceral fat shows the strongest association with the need of intensive care in patients with COVID-19. Metabolism 2020; 111: 154319 doi:10.1016/j.metabol.2020
    CrossrefPubMedSearch in Google Scholar
  • 34 Petersen A, Bressem K, Albrecht J. et al The role of visceral adiposity in the severity of COVID-19: highlights from a unicenter cross-sectional pilot study in Germany. Metabolism 2020; 110: 154317 doi:10. 1016/j.metabol.2020.154317
    CrossrefPubMedSearch in Google Scholar
  • 35 Hockham C, Thompson K, Carcel C. et al What sex-disaggregated metrics are needed to explain sex differences in COVID-19?. Front Glob Women’s Health 2020; 1: 2
    CrossrefPubMedSearch in Google Scholar
  • 36 Naaraayan A, Nimkar A, Pant S. et al Sex disparity in the effect of obesity in hospitalized COVID-19 patients: a retrospective cohort study from the New York City metropolitan area. Cureus 2021; 25: e15235 doi:10.7759/cureus.15235
    PubMedSearch in Google Scholar
  • 37 Mauvais-Jarvis F. Aging, male sex, obesity, and metabolic inflammation create the perfect storm for COVID-19. Diabetes 2020; 69: 1857-1863 doi:10. 2337/dbi19-0023
    CrossrefPubMedSearch in Google Scholar
  • 38 Gebhard C, Regitz-Zagrosek V, Neuhauser HK. et al Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ 2020; 11: 29 doi:10.1186/s13293-020-00304-9
    CrossrefPubMedSearch in Google Scholar
  • 39 Kass DA, Dugga lP, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet 2020; 395: 1544-1545
    CrossrefPubMedSearch in Google Scholar
  • 40 Deng M, Qi Y, Deng L. et al Obesity as a potential predictor of disease severity in young COVID-19 patients: a retrospective study. Obesity (Silver Spring) 2020; 28: 1815-1825 doi:10.1002/oby.22943
    CrossrefPubMedSearch in Google Scholar
  • 41 Cunningham JW, Vaduganathan M, Claggett BL. et al Clinical outcomes in young US adults hospitalized with COVID-19. JAMA Intern Med 2020; (09) 181: 379-381 doi:10.1001/jamainternmed.2020.5313
    PubMedSearch in Google Scholar
  • 42 Tartof SY, Qian L, Hong V. et al Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann Intern Med 2020; (17) 173: 773-781 doi:10.7326/M20-3742
    CrossrefPubMedSearch in Google Scholar
  • 43 Hendren NS, de Lemos JA, Ayers C. et al Association of body mass index and age with morbidity and mortality in patients hospitalized with COVID-19: results from the American Heart Association COVID-19 Cardiovascular Disease Registry. Circulation 2021; 143: 135-144 doi:10.1161/CIRCULATIONAHA.120.051936
    CrossrefPubMedSearch in Google Scholar