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Obesity As an Independent Risk Factor for Covid-19 Severity and Mortality Publisher Pubmed



Tadayon Najafabadi B1 ; Rayner DG2 ; Shokraee K3 ; Shokraie K4 ; Panahi P5 ; Rastgou P6 ; Seirafianpour F7 ; Momeni Landi F8 ; Alinia P4 ; Parnianfard N9 ; Hemmati N3 ; Banivaheb B3 ; Radmanesh R10, 11 ; Alvand S12 Show All Authors
Authors
  1. Tadayon Najafabadi B1
  2. Rayner DG2
  3. Shokraee K3
  4. Shokraie K4
  5. Panahi P5
  6. Rastgou P6
  7. Seirafianpour F7
  8. Momeni Landi F8
  9. Alinia P4
  10. Parnianfard N9
  11. Hemmati N3
  12. Banivaheb B3
  13. Radmanesh R10, 11
  14. Alvand S12
  15. Shahbazi P13
  16. Dehghanbanadaki H14
  17. Shaker E15
  18. Same K4
  19. Mohammadi E15
  20. Malik A16
  21. Srivastava A16
  22. Nejat P4
  23. Tamara A17, 18
  24. Chi Y19, 20
  25. Yuan Y21
  26. Hajizadeh N13
  27. Chan C22
  28. Zhen J22
  29. Tahapary D17, 23
  30. Anderson L24
  31. Apatu E24
  32. Schoonees A25
  33. Naude CE25
  34. Thabane L1
  35. Foroutan F1

Source: Cochrane Database of Systematic Reviews Published:2023


Abstract

Background: Since December 2019, the world has struggled with the COVID-19 pandemic. Even after the introduction of various vaccines, this disease still takes a considerable toll. In order to improve the optimal allocation of resources and communication of prognosis, healthcare providers and patients need an accurate understanding of factors (such as obesity) that are associated with a higher risk of adverse outcomes from the COVID-19 infection. Objectives: To evaluate obesity as an independent prognostic factor for COVID-19 severity and mortality among adult patients in whom infection with the COVID-19 virus is confirmed. Search methods: MEDLINE, Embase, two COVID-19 reference collections, and four Chinese biomedical databases were searched up to April 2021. Selection criteria: We included case-control, case-series, prospective and retrospective cohort studies, and secondary analyses of randomised controlled trials if they evaluated associations between obesity and COVID-19 adverse outcomes including mortality, mechanical ventilation, intensive care unit (ICU) admission, hospitalisation, severe COVID, and COVID pneumonia. Given our interest in ascertaining the independent association between obesity and these outcomes, we selected studies that adjusted for at least one factor other than obesity. Studies were evaluated for inclusion by two independent reviewers working in duplicate. Data collection and analysis: Using standardised data extraction forms, we extracted relevant information from the included studies. When appropriate, we pooled the estimates of association across studies with the use of random-effects meta-analyses. The Quality in Prognostic Studies (QUIPS) tool provided the platform for assessing the risk of bias across each included study. In our main comparison, we conducted meta-analyses for each obesity class separately. We also meta-analysed unclassified obesity and obesity as a continuous variable (5 kg/m2 increase in BMI (body mass index)). We used the GRADE framework to rate our certainty in the importance of the association observed between obesity and each outcome. As obesity is closely associated with other comorbidities, we decided to prespecify the minimum adjustment set of variables including age, sex, diabetes, hypertension, and cardiovascular disease for subgroup analysis. Main results: We identified 171 studies, 149 of which were included in meta-analyses. As compared to 'normal' BMI (18.5 to 24.9 kg/m2) or patients without obesity, those with obesity classes I (BMI 30 to 35 kg/m2), and II (BMI 35 to 40 kg/m2) were not at increased odds for mortality (Class I: odds ratio [OR] 1.04, 95% confidence interval [CI] 0.94 to 1.16, high certainty (15 studies, 335,209 participants); Class II: OR 1.16, 95% CI 0.99 to 1.36, high certainty (11 studies, 317,925 participants)). However, those with class III obesity (BMI 40 kg/m2 and above) may be at increased odds for mortality (Class III: OR 1.67, 95% CI 1.39 to 2.00, low certainty, (19 studies, 354,967 participants)) compared to normal BMI or patients without obesity. For mechanical ventilation, we observed increasing odds with higher classes of obesity in comparison to normal BMI or patients without obesity (class I: OR 1.38, 95% CI 1.20 to 1.59, 10 studies, 187,895 participants, moderate certainty; class II: OR 1.67, 95% CI 1.42 to 1.96, 6 studies, 171,149 participants, high certainty; class III: OR 2.17, 95% CI 1.59 to 2.97, 12 studies, 174,520 participants, high certainty). However, we did not observe a dose-response relationship across increasing obesity classifications for ICU admission and hospitalisation. Authors' conclusions: Our findings suggest that obesity is an important independent prognostic factor in the setting of COVID-19. Consideration of obesity may inform the optimal management and allocation of limited resources in the care of COVID-19 patients. Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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