.: ORİJİNAL ARAŞTIRMA
Obezitenin COVID-19 Pnömonisi Üzerine Etkisi: Analitik Araştırma
Effect of Obesity on COVID-19 Pneumonia: Analytical Research
Turkiye Klinikleri J Med Sci. 2024;44(4):167-75
doi: 10.5336/medsci.2024-102570
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Literatürde, fazla kilolu ve obez hastalarda koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] seyrinin daha kötü olduğunu gösteren pek çok çalışma bulunmaktadır. COVID-19 tanılı 271 hastada beden kitle indeksi (BKİ) yüksekliğinin tedavi süresini, yoğun bakım ünitesi ihtiyacını ve mortaliteye olan etkisini araştırmayı amaçladık. Gereç ve Yöntemler: 01.09.2021-01.04.2022 tarihleri arasında nazo-orofarengeal örnekte şiddetli akut solunum sendromu-koronavirüs-2 polimeraz zincir reaksiyonu pozitifliği saptanan 271 hastada retrospektif gözlemsel kohort bir çalışma olarak gerçekleştirildi. Hastaların demografik bilgiler, risk faktörleri ve altta yatan ek hastalıklar, başvuru semptomları, radyolojik bulgular, yatış süreleri, laboratuvar değerleri değerlendirildi. Hastaları BKİ'ye göre sınıflandırdık ve prognoz için tedavinin 7 veya 10. gününde mortalite, hastanede kalış süresi ve laboratuvar değerlerini başlangıçla karşılaştırdık. Bulgular: Hastaların 61'i (%22,51) normal kilolu, 92'si (%33,95) fazla kilolu, 118'i (%43,54) obez idi. Obez hastalarda akciğer tutulum oranı obez olmayanlara göre daha yüksekti (p=0,005). Obez hastaların ortalama yatış süresi (12,4±7,7), obez olmayan hastalara göre (10,3±3,4) anlamlı olarak yüksekti (p=0,022). Mortalite obez ve fazla kilolu hastalarda normal kilolu hastalara göre daha yüksekti (p<0,001). Sonuç: BKİ yüksek olan hastalarda ağır pnömoni görülme sıklığının daha fazla, hastanede yatış süresinin daha uzun, yoğun bakıma yatış ve entübasyon ihtiyacının daha sık ve mortalitenin daha yüksek olduğu gözlendi. Aşılanmamış obez hastalarda ölüm oranı, tam aşı dozu alanlara göre daha yüksekti.
Anahtar Kelimeler: COVID-19; obezite; beden kitle indeksi; prognoz
Amaç: Literatürde, fazla kilolu ve obez hastalarda koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] seyrinin daha kötü olduğunu gösteren pek çok çalışma bulunmaktadır. COVID-19 tanılı 271 hastada beden kitle indeksi (BKİ) yüksekliğinin tedavi süresini, yoğun bakım ünitesi ihtiyacını ve mortaliteye olan etkisini araştırmayı amaçladık. Gereç ve Yöntemler: 01.09.2021-01.04.2022 tarihleri arasında nazo-orofarengeal örnekte şiddetli akut solunum sendromu-koronavirüs-2 polimeraz zincir reaksiyonu pozitifliği saptanan 271 hastada retrospektif gözlemsel kohort bir çalışma olarak gerçekleştirildi. Hastaların demografik bilgiler, risk faktörleri ve altta yatan ek hastalıklar, başvuru semptomları, radyolojik bulgular, yatış süreleri, laboratuvar değerleri değerlendirildi. Hastaları BKİ'ye göre sınıflandırdık ve prognoz için tedavinin 7 veya 10. gününde mortalite, hastanede kalış süresi ve laboratuvar değerlerini başlangıçla karşılaştırdık. Bulgular: Hastaların 61'i (%22,51) normal kilolu, 92'si (%33,95) fazla kilolu, 118'i (%43,54) obez idi. Obez hastalarda akciğer tutulum oranı obez olmayanlara göre daha yüksekti (p=0,005). Obez hastaların ortalama yatış süresi (12,4±7,7), obez olmayan hastalara göre (10,3±3,4) anlamlı olarak yüksekti (p=0,022). Mortalite obez ve fazla kilolu hastalarda normal kilolu hastalara göre daha yüksekti (p<0,001). Sonuç: BKİ yüksek olan hastalarda ağır pnömoni görülme sıklığının daha fazla, hastanede yatış süresinin daha uzun, yoğun bakıma yatış ve entübasyon ihtiyacının daha sık ve mortalitenin daha yüksek olduğu gözlendi. Aşılanmamış obez hastalarda ölüm oranı, tam aşı dozu alanlara göre daha yüksekti.
Anahtar Kelimeler: COVID-19; obezite; beden kitle indeksi; prognoz
ABSTRACT
Objective: There are many studies in the literature showing that the course of coronavirus disease-2019 (COVID-19) is worse in overweight and obese patients. We aimed to investigate the effect of high body mass index on treatment duration, intensive care unit requirement, and mortality in 271 patients with COVID-19. Material and Methods: Between September 1, 2021 and April 1, 2022, a retrospective observational cohort study was conducted in 271 patients with severe acute respiratory syndrome-coronavirus-2 (SARS CoV-2) polymerase chain reaction (PCR) positivity in nasooropharyngeal specimens. Demographic information, risk factors and underlying comorbidities, presenting symptoms, radiologic findings, length of hospital stay, and laboratory values were evaluated. We stratified patients according to body mass index and compared mortality, length of hospital stay, and laboratory values on day 7 or 10 of treatment with baseline for prognostication. Results: Of the patients, 61 (22.51%) were normal weight, 92 (33.95%) were overweight, and 118 (43.54%) were obese. The rate of lung involvement was higher in obese patients compared to non-obese patients (p=0.005), and the mean length of hospital stay was significantly higher in obese patients (12.4±7.7) compared to non-obese patients (10.3±3.4) (p=0.022). Mortality was higher in obese and overweight patients than in patients with normal BMI (p<0.001). Conclusion: Patients with a higher BMI had a higher incidence of severe pneumonia, longer hospital stays, more intensive care unit admissions and intubation, and higher mortality. Mortality was higher in unvaccinated obese patients than in those who received a full dose of vaccine.
Keywords: COVID-19; obesity; body mass index; prognosis
Objective: There are many studies in the literature showing that the course of coronavirus disease-2019 (COVID-19) is worse in overweight and obese patients. We aimed to investigate the effect of high body mass index on treatment duration, intensive care unit requirement, and mortality in 271 patients with COVID-19. Material and Methods: Between September 1, 2021 and April 1, 2022, a retrospective observational cohort study was conducted in 271 patients with severe acute respiratory syndrome-coronavirus-2 (SARS CoV-2) polymerase chain reaction (PCR) positivity in nasooropharyngeal specimens. Demographic information, risk factors and underlying comorbidities, presenting symptoms, radiologic findings, length of hospital stay, and laboratory values were evaluated. We stratified patients according to body mass index and compared mortality, length of hospital stay, and laboratory values on day 7 or 10 of treatment with baseline for prognostication. Results: Of the patients, 61 (22.51%) were normal weight, 92 (33.95%) were overweight, and 118 (43.54%) were obese. The rate of lung involvement was higher in obese patients compared to non-obese patients (p=0.005), and the mean length of hospital stay was significantly higher in obese patients (12.4±7.7) compared to non-obese patients (10.3±3.4) (p=0.022). Mortality was higher in obese and overweight patients than in patients with normal BMI (p<0.001). Conclusion: Patients with a higher BMI had a higher incidence of severe pneumonia, longer hospital stays, more intensive care unit admissions and intubation, and higher mortality. Mortality was higher in unvaccinated obese patients than in those who received a full dose of vaccine.
Keywords: COVID-19; obesity; body mass index; prognosis
REFERANSLAR:
- Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46(5):846-8. Erratum in: Intensive Care Med. 2020;46(6):1294-7. [Crossref] [PubMed] [PMC]
- Ryan DH, Ravussin E, Heymsfield S. COVID 19 and the patient with obesity - the editors speak out. Obesity (Silver Spring). 2020;28(5):847. [Crossref] [PubMed] [PMC]
- Aaseth J, Ellefsen S, Alehagen U, Sundfør TM, Alexander J. Diets and drugs for weight loss and health in obesity - an update. Biomed Pharmacother. 2021;140:111789. [Crossref] [PubMed]
- Khaodhiar L, McCowen KC, Blackburn GL. Obesity and its comorbid conditions. Clin Cornerstone. 1999;2(3):17-31. [Crossref] [PubMed]
- Ruch Y, Kaeuffer C, Ohana M, Labani A, Fabacher T, Bilbault P, et al. CT lung lesions as predictors of early death or ICU admission in COVID-19 patients. Clin Microbiol Infect. 2020;26(10):1417.e5-1417.e8. [Crossref] [PubMed] [PMC]
- World Health Organization. Obesity and Overweight. 2018. Geneva: WHO; 2018. [Link]
- [Link]
- Copin MC, Parmentier E, Duburcq T, Poissy J, Mathieu D; Lille COVID-19 ICU and Anatomopathology Group. Time to consider histologic pattern of lung injury to treat critically ill patients with COVID-19 infection. Intensive Care Med. 2020;46(6):1124-6. [Crossref] [PubMed] [PMC]
- Hendren NS, de Lemos JA, Ayers C, Das SR, Rao A, Carter S, et al. Association of body mass index and age with morbidity and mortality in patients hospitalized with COVID-19: results from the American Heart Association COVID-19 Cardiovascular Disease Registry. Circulation. 2021;143(2):135-44. [Crossref] [PubMed]
- Kalligeros M, Shehadeh F, Mylona EK, Benitez G, Beckwith CG, Chan PA, et al. Association of obesity with disease severity among patients with coronavirus disease 2019. Obesity (Silver Spring). 2020;28(7):1200-4. [Crossref] [PubMed] [PMC]
- Kang Z, Luo S, Gui Y, Zhou H, Zhang Z, Tian C, et al. Obesity is a potential risk factor contributing to clinical manifestations of COVID-19. International Journal of Obesity. 2020;44(12):2479-85. [Crossref] [PubMed] [PMC]
- Hajifathalian K, Kumar S, Newberry C, Shah S, Fortune B, Krisko T, et al. Obesity is associated with worse outcomes in COVID-19: analysis of early data from New York City. Obesity (Silver Spring). 2020;28(9):1606-12. [Crossref] [PubMed] [PMC]
- Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One. 2020;15(11):e0241955. Erratum in: PLoS One. 2022;17(5):e0269291. [Crossref] [PubMed] [PMC]
- Li R, Shen M, Yang Q, Fairley CK, Chai Z, McIntyre R, et al. Global diabetes prevalence in COVID-19 patients and contribution to COVID-19- related severity and mortality: a systematic review and meta-analysis. Diabetes Care. 2023;46(4):890-7. [Crossref] [PubMed] [PMC]
- Boulet LP, Turcotte H, Martin J, Poirier P. Effect of bariatric surgery on airway response and lung function in obese subjects with asthma. Respir Med. 2012;106(5):651-60. [Crossref] [PubMed]
- Goyal P, Ringel JB, Rajan M, Choi JJ, Pinheiro LC, Li HA, et al. Obesity and COVID-19 in New York City: a retrospective cohort study. Ann Intern Med. 2020;173(10):855-8. [Crossref] [PubMed] [PMC]
- Zhang Q, Wei Y, Chen M, Wan Q, Chen X. Clinical analysis of risk factors for severe COVID-19 patients with type 2 diabetes. J Diabetes Complications. 2020;34(10):107666. [Crossref] [PubMed] [PMC]
- Cai Q, Chen F, Wang T, Luo F, Liu X, Wu Q, et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China. Diabetes Care. 2020;43(7):1392-8. [Crossref] [PubMed]
- Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City. MedRxiv. 2020. [Crossref]
- Tartof SY, Qian L, Hong V, Wei R, Nadjafi RF, Fischer H, et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med. 2020;173(10):773-81. [Crossref] [PubMed] [PMC]
- Özyurda F, Ardıçoğlu Akışın Y, Mert T, Poyraz B, Özkan Y, Turan M, et al. TOBB ETÜ Hastanesi çalışanlarında üç doz CoronaVac ile iki doz CoronaVac ve bir doz comirnaty aşısı sonrası humoral ve hücresel immünite düzeylerinin incelenmesi [Investigation of humoral and cellular immunity in TOBB ETU Hospital workers after three doses of CoronaVac vaccination and after one dose of comirnaty vaccination following two doses of CoronaVac]. Mikrobiyol Bul. 2022;56(3):387-403. [Crossref] [PubMed]
- Yıldırım S, Kirakli C, Özdemir Y, Tosun S, Ermin S, Polat G, et al. Impact of vaccination on ICU admissions of hospitalized COVID-19 patients in a country with a heterologous vaccine policy. J Infect Dev Ctries. 2024;18(4):513-9. [Crossref] [PubMed]
- Djuric O, Ottone M, Vicentini M, Venturelli F, Pezzarossi A, Manicardi V, et al; Reggio Emilia Covid-19 Working Group. Diabetes and COVID-19 testing, positivity, and mortality: a population-wide study in Northern Italy. Diabetes Res Clin Pract. 2022;191:110051. [Crossref] [PubMed] [PMC]
- de Almeida-Pititto B, Dualib PM, Zajdenverg L, Dantas JR, de Souza FD, Rodacki M, et al; Brazilian Diabetes Society Study Group (SBD). Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis. Diabetol Metab Syndr. 2020;12:75. [Crossref] [PubMed] [PMC]
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