COVID-19 and Obesity in Atlanta

Introduction: Obesity is a complex disease that exhibits alteration in immune function. Due to the imbalance between anti-and pro-inflammatory mediators secreted by adipocytes and immune cells, the scales are tipped toward a chronic inflammatory state. As the body mass index (BMI) increases, the visceral adipocytes have been found to secrete higher levels of pro-inflammatory cytokines such as interleukin (IL-) 6, which contribute to alterations in coagulation signaling. These findings raise concerns that obesity-mediated inflammation may be responsible for the observed findings of higher risk of severity from SARS-CoV-2 in this population. This study examines the effect of obesity on levels of inflammatory markers and severity of illness from COVID-19 in a cohort of critically ill patients. Methods: Data were collected from the electronic medical record (EMR) by the Emory COVID-19 Quality and Clinical Research Collaborative. We analyzed data of patients admitted with COVID-19 within the Emory Healthcare System between March 6, 2020 and May 5, 2020 who spent any time in the intensive care unit during their hospitalization. We used the Chi-square test to determine if death or intubation were associated with obesity (BMI > 30) and t-tests when comparing inflammatory markers between obese and non-obese patients. Multivariate logistic regression was completed to evaluate the role of BMI and severity of illness on death. Results: Results for BMI were available for 285 patients in the cohort, and 149 patients (52.3%) were considered obese with a BMI of 30 or greater. Obese patients in our cohort were younger on average by 10 years (59 years vs. 69 years, p<0.0001), and there was no significant difference in gender. Intubation rates were significantly higher in the obese population (80.5% vs. 64.7%, p=0.0026), and death rates were significantly lower in this group with a BMI greater than 30 (26.2% vs. 43.4%, p=0.0022). Values for inflammatory markers (CRP, IL-6, D-dimer, and WBC) were not significantly different between obese and nonobese individuals. Multivariate logistic regression analysis determined that patients with higher BMIs had a significantly lower risk of mortality when controlled for severity of illness as indicated by sequential organ failure assessment (SOFA) score and age (OR 0.94, 95% CI 0.90-0.98, p=0.0014). Conclusions: In our cohort of critically ill patients with COVID-19, obesity is associated with a greater risk of mechanical ventilation, but a lower risk of death even when accounting for severity of illness and age.