Related Experiment Video
Updated: Jul 3, 2025
Identification and Quantification of Deranged Metabolites in Critically Ill Patients Using NMR-Based Metabolomics
Published on: November 29, 2024
Association of Body Mass Index with Multiple Organ Failure in Hospitalized Patients with COVID-19: A Multicenter
Timothy Phillips1,2, Abdallah Mughrabi1,2, Levindo J Garcia1,2
1Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA.
Insights
Higher body mass index (BMI) in COVID-19 patients is linked to increased inflammation and severe organ failure. This association weakens when adjusting for C-reactive protein (CRP) levels, suggesting inflammation mediates the risk.
Area of Science:
- Medical research
- Inflammation and immunology
- Infectious disease epidemiology
Background:
- Obesity, measured by body mass index (BMI), is a growing global health concern.
- Systemic inflammation plays a critical role in the pathogenesis of severe COVID-19.
- The relationship between excessive adipose tissue and COVID-19 severity requires further elucidation.
Purpose of the Study:
- To investigate the association between body mass index (BMI) and systemic inflammation markers in COVID-19 patients.
- To determine if higher BMI correlates with an increased risk of severe acute organ failure in hospitalized COVID-19 patients.
- To explore the role of inflammation as a mediator between adipose tissue and organ dysfunction in COVID-19.
Main Methods:
- A multicenter retrospective cohort study involving 1370 hospitalized COVID-19 patients during the initial pandemic wave.
- Analysis of patient-level data from electronic medical records, focusing on BMI at hospital admission.
- Multivariable logistic regression models were used to assess the association of BMI with a composite outcome of acute respiratory distress syndrome (ARDS), severe acute kidney injury (AKI), or in-hospital death.
Main Results:
- A BMI > 40 kg/m² was significantly associated with increased odds of ARDS, severe AKI, or in-hospital death (adjusted odds ratio [ORadj] 1.69).
- Elevated BMI, treated as a continuous variable, remained independently associated with the composite outcome (ORadj 1.13 per 5-kg/m² increase).
- Higher BMI categories correlated with significantly higher peak C-reactive protein (CRP) levels (P=.01). The association between BMI and the composite outcome was no longer significant after adjusting for peak CRP levels in a sub-cohort.
Conclusions:
- In hospitalized COVID-19 patients, elevated BMI is linked to a higher risk of severe organ failure and in-hospital mortality.
- The observed association between BMI and adverse COVID-19 outcomes appears to be mediated by systemic inflammation, as indicated by CRP levels.
- These findings support the hypothesis that inflammation is a key downstream mediator through which adipose tissue influences acute organ dysfunction in COVID-19.
Abstract:
Purpose: This study examines whether excessive adipose tissue, as measured by the body mass index (BMI), is associated with higher systemic markers of inflammation and higher risk of severe acute organ failure among patients with coronavirus disease 2019 (COVID-19). Methods: This was a multicenter retrospective cohort study of 1370 hospitalized adults (18 years or older) with COVID-19 during the first wave of the pandemic. Patient-level variables were extracted from the electronic medical record. The primary predictor variable was the BMI at time of hospital admission, in accordance with the World Health Organization classification. Multivariable logistic regression analyses examined the association of BMI with the composite of acute respiratory distress syndrome (ARDS), as defined by the use of high-flow nasal canula, non-invasive ventilation, or mechanical ventilation, severe acute kidney injury (AKI), as defined by acute dialysis requirement, or in-hospital death. Results: After adjustment for important cofounders, the BMI stratum of > 40 kg/m2 (compared to the BMI < 25 kg/m2 reference group) was associated with higher odds for the composite of ARDS, severe AKI, or in-hospital death (adjusted odds ratio [ORadj] 1.69; 95% confidence interval [CI]1.03, 2.78). As a continuous variable, BMI (per 5-kg/m2 increase) remained independently associated with the composite outcome (ORadj 1.13; 95% CI 1.03, 1.23); patients in higher BMI categories exhibited significantly higher peak levels of C-reactive protein (CRP), a systemic marker of inflammation (P = .01). In a sub-cohort of 889 patients, the association of BMI with the composite outcome was no longer significant after adjustment for the peak level of CRP. Conclusions: Among hospitalized patients with COVID-19, a higher BMI is associated with higher risk of severe organ failure or in-hospital death, which dissipates after adjustment for CRP level. This supports the hypothesis that inflammation is a downstream mediator of adipose tissue on acute organ dysfunction.
More Related Videos
03:35Determining Gender-Based Differences in Retinal and Choroidal Thickness in Underweight Individuals via Swept-Source Optical Coherence Tomography
Published on: December 1, 2023
04:05Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
Related Concept Videos
01:24Obesity
01:30Pneumonia III: Complications and Assessment
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:30Acute Respiratory Failure-III
01:18Factors Affecting Illness
For instance, risk factors are connected to illness,...
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...