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

Ibrahim Sahin; Cem Haymana; Tevfik Demir; Ibrahim Demirci; Ilker Tasci; Aysegul Atmaca; Erman Cakal; Naim Ata; Rifat Emral; Ugur Unluturk; Derun Ertugrul; Serpil Salman; Mustafa Sahin; Selcuk Dagdelen; Osman Celik; Murat Caglayan; Ilhan Satman; Alper Sonmez

doi:10.1055/a-1552-4449

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

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

¹Faculty of Medicine, Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey

,

Cem Haymana

²Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey

,

Tevfik Demir

³Faculty of Medicine, Department of Endocrinology and Metabolism, Dokuz Eylul University, Izmir, Turkey

,

Ibrahim Demirci

²Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey

,

Ilker Tasci

⁴Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Internal Medicine, University of Health Sciences, Ankara, Turkey

,

Aysegul Atmaca

⁵Faculty of Medicine, Department of Endocrinology and Metabolism, Ondokuz Mayis University, Samsun, Turkey

,

Erman Cakal

⁶Faculty of Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey

,

Naim Ata

⁷Department of Strategy Development, Ministry of Health, Ankara, Turkey

,

Rifat Emral

⁸Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara University, Ankara, Turkey

,

Ugur Unluturk

⁹Faculty of Medicine, Department of Endocrinology and Metabolism, Hacettepe University, Ankara, Turkey

,

Derun Ertugrul

¹⁰Faculty of Medicine, Kecioren Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey

,

Serpil Salman

¹¹Medica Clinic, Department of Endocrinology and Metabolism, Istanbul, Turkey

,

Mustafa Sahin

¹¹Medica Clinic, Department of Endocrinology and Metabolism, Istanbul, Turkey

,

Selcuk Dagdelen

⁴Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Internal Medicine, University of Health Sciences, Ankara, Turkey

,

Osman Celik

¹²Public Hospitals General Directorate, Republic of Turkey, Ministry of Health, Ankara, Turkey

,

Murat Caglayan

¹³Ankara Provincial Health Directorate, Ankara, Turkey

,

Ilhan Satman

¹⁴Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul University, Istanbul, Turkey

¹⁵The Health Institutes of Turkey, Institute of Public Health and Chronic Diseases, Istanbul, Turkey

,

Alper Sonmez

¹⁶Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey

› Author Affiliations

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

Full Text

References

References
1 TR Ministry of Health COVID-19 Information Platform. Available at: www.covid19.saglik.gov.tr. Accessed on 24 March
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
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
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
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
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
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
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
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
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
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
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
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
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
15 Green WD, Beck MA. Obesity impairs the adaptive immune response to influenza virus. Ann Am Thorac Soc 2017; 14: 406-409
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
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
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
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
20 Stafford N. Covid-19: why Germany's case fatality rate seems so low. BMJ 2020; 369: m1395
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
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
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
24 Giangreco G. Case fatality rate analysis of Italian COVID-19 outbreak. J Med Virol 2020; 92: 919-923
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
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
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
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
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
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
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
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
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
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
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
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
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
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
39 Kass DA, Dugga lP, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet 2020; 395: 1544-1545
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
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
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
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