Impact of Obesity on Critical Care Outcome in COVID-19 Patients in Sweden-A Cohort Study

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PLoS One. 2021 Oct 13; 16 (10): e0257891. doi: 10.1371 / journal.pone.0257891. Electronic collection 2021.


BACKGROUND: Previous studies have shown that a high body mass index (BMI) is a risk factor for severe COVID-19. The aim of the present study was to assess whether a high BMI affects the risk of death or extended length of stay (LOS) in patients with COVID-19 during intensive care in Sweden.

METHODS AND RESULTS: In this registry-based observational study, we included COVID-19 patients from the Swedish Intensive Care Registry admitted to intensive care units (ICUs) in Sweden. The outcomes assessed were death during intensive care and a length of ICU stay ≥ 14 days. We used logistic regression models to assess the association (odds ratio [OR] and 95% confidence interval [CI]) between BMI and results. Valid weight and height information could be retrieved from 1,649 patients (1,227 (74.4%) male) with COVID-19. We found a significant association between BMI and the risk of composite death or lifespan ≥ 14 days in survivors (OR by standard deviation [SD] increase of 1.30, 95% CI 1.16-1.44, adjusted for sex, age and comorbidities), and this association remained after further adjustment for disease severity (acute physiology score simplified; SAPS3) at ICU admission (OR 1.30 by SD, 95% CI 1.17-1.45). Individuals with a BMI ≥ 35 kg / m2 had a doubled risk of the composite result. A high BMI was also associated with death during intensive care and an extended length of stay in survivors assessed as separate outcomes. The main limitations were the restriction to the first wave of the pandemic and the lack of information on socio-economic status as well as on smoking.

CONCLUSIONS: In this large cohort of Swedish intensive care patients with COVID-19, an elevated BMI was associated with an increased risk of death and an extended length of stay in intensive care. Based on our results, we suggest that obese people be monitored more closely when hospitalized for COVID-19.

IDPM: 34644316 | DOI: 10.1371 / journal.pone.0257891

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