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Body mass index and critical care outcomes in hospitalized COVID-19 patients-A national cohort study
Yolanda Bonilla1,2, Daniel High1,2, Jose Acosta Rullan1,2
1Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, Florida, United States of America.
Insights
Obesity independently increased the risk of adverse outcomes in hospitalized COVID-19 patients. This highlights the importance of body mass index (BMI) in managing acute COVID-19 cases.
Area of Science:
- Medical Research
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic resulted in substantial global mortality.
- Obesity is a known risk factor for severe COVID-19 outcomes.
- Pre-vaccine data is crucial for understanding initial pandemic impacts.
Purpose of the Study:
- To investigate the association between body mass index (BMI) and clinical outcomes in hospitalized COVID-19 patients.
- To analyze the relationship between BMI, interventions, and mortality in a large, pre-vaccine cohort.
- To identify BMI as a prognostic factor in acute COVID-19 management.
Main Methods:
- Retrospective cohort study utilizing de-identified electronic health records from 149 HCA Healthcare hospitals.
- Inclusion criteria: Adults hospitalized with confirmed SARS-CoV-2 infection between March 1 and December 31, 2022.
- Primary outcome: Composite of in-hospital mortality or discharge to hospice, analyzed by BMI category. Secondary outcomes included mechanical ventilation, tracheostomy, and ICU length of stay.
Main Results:
- Obese patients showed higher rates of mechanical ventilation, tracheostomy placement, and longer ICU stays compared to normal BMI patients.
- Adjusted analyses revealed obesity was independently associated with increased odds of all-cause mortality or hospice discharge (OR 1.29).
- Obesity significantly predicted increased inpatient mortality (OR 1.67), need for invasive mechanical ventilation (OR 1.55), and tracheostomy placement (OR 1.57).
Conclusions:
- Obesity is independently linked to a higher risk of adverse clinical outcomes in hospitalized COVID-19 patients.
- BMI serves as a significant prognostic indicator for acute COVID-19.
- These findings underscore the need to consider BMI in the clinical management of COVID-19.
Background:
The COVID-19 pandemic caused significant global mortality. Obesity is associated with worse COVID-19 outcomes. This study examined the relationship between BMI, clinical interventions, and outcomes in hospitalized COVID-19 patients using pre-vaccine national data.
Methods:
We conducted a retrospective cohort study using de-identified electronic health records from the HCA Healthcare database, comprising 149 hospitals across 18 U.S. states. Adults (≥18 years) hospitalized with confirmed SARS-CoV-2 infection between March 1 and December 31, 2022, were included. The primary outcome was a composite of in-hospital mortality or discharge to hospice, analyzed by BMI category. Secondary outcomes included inpatient mortality, need for mechanical ventilation or tracheostomy, duration of mechanical ventilation, and ICU (Intensive Care Unit) length of stay.
Results:
Out of 38,321 hospital encounters, 21,996 met the inclusion criteria. Unadjusted analyses showed no significant differences in rates of all-cause mortality or hospice discharge across BMI categories. However, obese patients had higher rates of mechanical ventilation (7.8% vs. 4.6%, p < 0.001), tracheostomy placement (1.2% vs. 0.6%, p < 0.001), longer duration of mechanical ventilation (mean 11.5 ± 15.1 vs. 6.8 ± 8.7 days, p < 0.001), and longer ICU stays (8.3 ± 10.4 vs. 5.1 ± 6.4 days, p < 0.001) than normal BMI patients. In adjusted analyses controlling for age, sex, race, ethnicity, and comorbidities, obesity was independently associated with increased odds of all-cause mortality or hospice discharge (OR 1.29, 95% CI: 1.08-1.55, p < 0.05), inpatient mortality (OR 1.67, 95% CI: 1.34-2.08, p < 0.001), need for invasive mechanical ventilation (OR 1.55, 95% CI: 1.31-1.82, p < 0.001), and tracheostomy placement (OR 1.57, 95% CI: 1.03-2.41, p < 0.05). Obesity was a significant predictor of longer duration of mechanical ventilation (β = 3.67 days, 95% CI: 1.28-6.06, p < 0.001) and ICU stay (β = 2.90 days, 95% CI: 2.08-3.72, p < 0.001).
Conclusion:
Obesity was independently associated with increased risk of adverse clinical outcomes among hospitalized COVID-19 patients. These findings highlight the importance of BMI as a prognostic factor in acute COVID-19 management.
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