Are Patients with Coronavirus Disease 2019 and Obesity at a Higher Risk of Hospital and Intensive Care Unit Admissions? A Systematic Review and Meta-analysis

Anggi Lukman Wicaksana; Nuzul Sri  Hertanti; Raden Bowo  Pramono; Yu-Yun  Hsu

doi:10.3889/oamjms.2021.6585

Authors

Anggi Lukman Wicaksana Department of Medical Surgical Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; The Sleman Health and Demographic Surveillance System, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0000-0001-9813-8830
Nuzul Sri Hertanti Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0000-0002-8004-4307
Raden Bowo Pramono Department of Internal Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Yu-Yun Hsu Department of Nursing, National Cheng Kung University, Tainan, Taiwan, Republic of China

DOI:

https://doi.org/10.3889/oamjms.2021.6585

Keywords:

Coronavirus disease 2019, Hospital admission, Intensive care unit, Meta-regression, Mortality, Obesity, Severe obesity

Abstract

BACKGROUND: Obesity, common condition among patients with COVID-19, contributes to illness severity during hospitalization. To date, knowledge on the prevalence, risk of hospital and intensive care units (ICU) admissions and mortality is limited. Therefore, systematic review and meta-analysis were conducted using a PRISMA guideline. PURPOSE: The study aimed to address the prevalence, risk of hospital and ICU admissions and mortality among patients with COVID-19 and obesity. METHODS: The Newcastle–Ottawa scale was used to assess the quality of a study. Primary outcomes were the prevalence and risk of hospitalization, and secondary outcomes were the risk of ICU admissions and mortality risk. Mantel–Haenszel with random effects was applied, and the effect measure was odds ratio (OR) with 95% confidence interval (CI). RESULTS: Nine studies were included in the systematic review, and only four studies for meta-analysis. Among 29,776 patients with COVID-19, obesity was identified as the second-highest comorbidity. The prevalence rates of obesity and severe obesity among patients with COVID-19 were 26.1% and 15.5%, respectively. Obesity resulted in significantly increased risk of hospital admission (OR = 1.99, 95% CI = 1.12–3.53, p = 0.02) and ICU admission (OR = 1.77, 95% = CI 1.52–2.06, p < 0.00001). Severe obesity had a significantly increased risk of ICU admission (OR = 1.79, 95% CI = 1.42–2.25, p < 0.00001). The mortality rate of patients with COVID-19 and obesity was about 30.5% (438/1,434), and 19.7% (2,777/14,095) of them recovered from COVID-19. CONCLUSION: Obesity poses as nearly twice the risk of hospital and ICU admissions, and severe obesity contributes to almost twice the risk of ICU admissions.

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References

Bello-Chavolla OY. Bahena-López JP, Antonio-Villa NE, Vargas-Vázquez A, Gonzá lez-Dıaz A, Márquez-Salinas A, et al. Predicting mortality due to SARS-CoV-2: A mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico. J Clin Endocrinol Metab. 2020;105(8):dgaa346. https://doi.org/10.1101/2020.04.20.20072223 PMid:32474598 DOI: https://doi.org/10.1101/2020.04.20.20072223

Kalligeros M, Shehadeh F, Mylona EK, Benitez G, Beckwith CG, Chan PA, Mylonakis E. Association of obesity with disease severity among patients with Coronavirus disease 2019. Obesity (Silver Spring). 2020;28(7):1200-4. https://doi.org/10.1002/oby.22859 Mid:32352637 DOI: https://doi.org/10.1002/oby.22859

Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome Coronavirus‐2 (SARS‐CoV‐2) requiring invasive mechanical ventilation. Obesity. 2020;28(7):1195-9. https://doi.org/10.1002/oby.22831 PMid:32271993 DOI: https://doi.org/10.1002/oby.23006

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199-207. PMid:31995857

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323(16):1574-81. PMid:32250385 DOI: https://doi.org/10.1001/jama.2020.4031

Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, Greninger AL, Pipavath S, Wurfel MM, Evans L, Kritek PA. COVID-19 in critically ill patients in the Seattle region-case series. N Engl J Med. 2020;382(21):2012-22. https://doi.org/10.1056/nejmoa2004500 PMid:32227758 DOI: https://doi.org/10.1056/NEJMoa2004500

Sattar N, McInnes IB, McMurray JJ. Obesity is a risk factor for severe COVID-19 infection: Multiple potential mechanisms. Circulation. 2020;142(1):4-6. https://doi.org/10.1161/circulationaha.120.047659 PMid:32320270 DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.047659

Zheng KI, Gao F, Wang XB, Sun QF, Pan KH, Wang TY, et al. Letter to the editor: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease. Metabolism. 2020;108:154244. https://doi.org/10.1016/j.metabol.2020.154244 PMid:32320741 DOI: https://doi.org/10.1016/j.metabol.2020.154244

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID- 19 in the New York City area. JAMA. 2020;323(20):2052-9. https://doi.org/10.1001/jama.2020.6775 PMid:32320003 DOI: https://doi.org/10.1001/jama.2020.6775

Lighter J, Phillips M, Hochman S, Sterling S, Johnson D, Francois F, et al. Obesity in patients younger than 60 years is a risk factor for COVID-19 hospital admission. Clin Infect Dis. 2020;71(15):896-7. https://doi.org/10.1093/cid/ciaa415 PMid:32271368 DOI: https://doi.org/10.1093/cid/ciaa415

Petrilli CM, Jones SA, Yang J. Factors associated with hospital admission and critical illness among 5279 patients with Coronavirus disease 2019 in New York city prospective cohort study. BMJ. 2020;369:m1966. https://doi.org/10.1136/bmj.m1966 PMid:32444366 DOI: https://doi.org/10.1136/bmj.m1966

Jose RJ, Manuel A. Does Coronavirus disease 2019 disprove the obesity paradox in acute respiratory distress syndrome? Obesity (Silver Spring). 2020;28(6):1007. https://doi.org/10.1002/oby.22835 PMid:32294322 DOI: https://doi.org/10.1002/oby.22835

Dietz W, Santos‐Burgoa C. Obesity and its implications for COVID‐19 mortality. Obesity (Silver Spring). 2020;28(6):1005. PMid:32237206 DOI: https://doi.org/10.1002/oby.22818

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg. 2010;8(5):336-41. https://doi.org/10.1016/j.ijsu.2010.02.007 PMid:20171303 DOI: https://doi.org/10.1016/j.ijsu.2010.02.007

Wells GA, Shea B, O’connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality if Nonrandomized Studies in Meta-Analyses. Ottawa Hospital Research Institute. Clinical Epidemiology; 2016. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. [Last accessed on 2020 Aug 13].

Roncon L, Zuin M, Rigatelli G, Zuliani G. Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. J Clin Virol. 2020;127:104354. https://doi.org/10.1016/j.jcv.2020.104354 PMid:32305882 DOI: https://doi.org/10.1016/j.jcv.2020.104354

Borenstein M. Software for publication bias. In: Rothstein HR, Sutton AJ, Borenstein M, editors. Publication Bias in Meta- Analysis: Prevention, Assessment and Adjustments. England: John Wiley and Sons; 2005. https://doi.org/10.1002/0470870168 DOI: https://doi.org/10.1002/0470870168.ch11

Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-34. https://doi.org/10.1136/bmj.315.7109.629 PMid:9310563 DOI: https://doi.org/10.1136/bmj.315.7109.629

Collaboration C. Review Manager (RevMan) [computer program] Version 5.2. 3, The Nordic Cochrane Centre, Copenhagen, 2012. Health Psychol Rev. 2014;17.

Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Comprehensive Meta-Analysis. 2nd ed. United Kindom: Biostat; 2009.

Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I² index?. Psychol Methods. 2006;11(2):193-206. https://doi.org/10.1037/1082-989x.11.2.193 PMid:16784338 DOI: https://doi.org/10.1037/1082-989X.11.2.193

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60. https://doi.org/10.1136/bmj.327.7414.557 PMid:12958120 DOI: https://doi.org/10.1136/bmj.327.7414.557

Thompson SG, Higgins JP. How should meta‐regression analyses be undertaken and interpreted? Stat Med. 2002;21(11):1559-73. https://doi.org/10.1002/sim.1187 PMid:12111920 DOI: https://doi.org/10.1002/sim.1187

Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: A prospective cohort study. Lancet. 2020;395(10239):1763-70. https://doi.org/10.1016/s0140-6736(20)31189-2 PMid:32442528 DOI: https://doi.org/10.1016/S0140-6736(20)31189-2

Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed Coronavirus disease 2019-COVID-NET, 14 States, March 1-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458-64. https://doi.org/10.15585/mmwr.mm6915e3 PMid:32298251 DOI: https://doi.org/10.15585/mmwr.mm6915e3

Malik P, Patel U, Patel K, Martin M, Shah C, Mehta D, Malik FA, Sharma A. Obesity a predictor of outcomes of COVID‐19 hospitalized patients-a systematic review and meta‐analysis. J Med Virol. 2021;93(2):1188-93. https://doi.org/10.1002/jmv.26555 PMid:32975814 DOI: https://doi.org/10.1002/jmv.26555

Hill MA, Mantzoros C, Sowers JR. Commentary: COVID-19 in patients with diabetes. Metabolism. 2020;107:154217. https://doi.org/10.1016/j.metabol.2020.154217 PMid:32220611 DOI: https://doi.org/10.1016/j.metabol.2020.154217

Wicaksana AL, Hertanti NS, Ferdiana A, Pramono RB. Diabetes management and specific considerations for patients with diabetes during coronavirus diseases pandemic: A scoping review. Diabetes Metab Syndr. 2020;14(5):1109-20. https://doi.org/10.1016/j.dsx.2020.06.070 PMid:32659694 DOI: https://doi.org/10.1016/j.dsx.2020.06.070

Karyono DR, Wicaksana AL. Current prevalence, characteristics, and comorbidities of patients with COVID-19 in Indonesia. J Community Empowerment Health. 2020;3(2):77-84. https://doi.org/10.22146/jcoemph.57325 DOI: https://doi.org/10.22146/jcoemph.57325

Huang Y, Lu Y, Huang YM, Wang M, Ling W, Sui Y, et al. Obesity in patients with COVID-19: A systematic review and meta-analysis. Metabolism. 2020;28:154378. https://doi.org/10.1016/j.metabol.2020.154378 PMid:33002478 DOI: https://doi.org/10.1016/j.metabol.2020.154378

Helvaci N, Eyupoglu ND, Karabulut E, Yildiz BO. Prevalence of obesity and its impact on outcome in patients with COVID-19: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2021;12:598249. https://doi.org/10.3389/fendo.2021.598249 PMid:33716962 DOI: https://doi.org/10.3389/fendo.2021.598249

Zhang X, Lewis AM, Moley JR, Brestoff JR. A systematic review and meta-analysis of obesity and COVID-19 outcomes. Sci Rep. 2021;11(1):7193. https://doi.org/10.1038/s41598-021-86694-1 PMid:33785830 DOI: https://doi.org/10.1038/s41598-021-86694-1

Watanabe M, Risi R, Tuccinardi D, Baquero CJ, Manfrini S, Gnessi L. Obesity and SARS‐CoV‐2: A population to safeguard. Diabetes Metab Res Rev. 2020;36(7):e3325. https://doi.org/10.1002/dmrr.3325 PMid:32314503 DOI: https://doi.org/10.1002/dmrr.3325

Dixon AE, Peters U. The effect of obesity on lung function. Expert Rev Respir Med. 2018;12(9):755-67. PMid:30056777 DOI: https://doi.org/10.1080/17476348.2018.1506331

Watson RA, Pride NB, Thomas EL, Fitzpatrick J, Durighel G, McCarthy J, et al. Reduction of total lung capacity in obese men: Comparison of total intrathoracic and gas volumes. J Appl Physiol. 2010;108(6):1605-12. https://doi.org/10.1152/japplphysiol.01267.2009 PMid:20299612 DOI: https://doi.org/10.1152/japplphysiol.01267.2009

Huttunen R, Syrjänen J. Obesity and the risk and outcome of infection. Int J Obes (Lond). 2013;37(3):333-40. PMid:22546772 DOI: https://doi.org/10.1038/ijo.2012.62

Zhang X, Zheng J, Zhang L, Liu Y, Chen GP, Wang L, et al. Systemic inflammation mediates the detrimental effects of obesity on asthma control. Allergy Asthma Proc. 2018;39(1):43-50. https://doi.org/10.2500/aap.2018.39.4096 PMid:29279059 DOI: https://doi.org/10.2500/aap.2018.39.4096

McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, et al. Epidemiology of COVID-19 in a long-term care facility in King County, Washington. N Engl J Med. 2020;382(21):2005-11. PMid:32220208 DOI: https://doi.org/10.1056/NEJMoa2005412