Risk Factors for COVID-19 Mortality Include Obesity

By Will Boggs MD

June 02, 2020

NEW YORK (Reuters Health) - Obesity should be added to the risk factors for higher mortality among patients hospitalized for COVID-19, according to a prospective study in the UK.

Dr. Malcolm G. Semple of Alder Hey Children's Hospital and the University of Liverpool and colleagues used data from 208 acute-care hospitals in England, Wales and Scotland to characterize the clinical features of more than 20,000 patients hospitalized with COVID-19 during the growth phase of the first wave of the outbreak.

The median age of patients was 73 years (range, 0-104 years), and the median time from onset of symptoms to presentation at hospital was four days.

As in other studies, the most common symptoms were cough, fever, and shortness of breath, and 4.5% of patients reported no symptoms on admission, according to the online report in The BMJ.

Common major comorbidities included chronic cardiac disease (30.9% of patients), uncomplicated diabetes (20.7%), chronic pulmonary disease excluding asthma (17.7%), chronic kidney disease (16.2%), and asthma (14.5%). Nearly a quarter (22.5%) had no documented major comorbidity.

About one in six patients required admission to high-dependency or intensive-care units, and 55% received high-flow oxygen at some point during their admission, 16% were treated with noninvasive ventilation, and 10% received invasive ventilation.

More than a quarter of patients died (26%), 41% were discharged alive, and 34% continued to receive care at the date of reporting. The median age of patients who died was 80 years, and only 11% of those who died had no documented major comorbidity.

Death rates were higher among patients admitted to critical care (32%) than among patients who received only ward care (26%). More than a third of patients who received mechanical ventilation died (37%), despite being younger than the overall cohort.

Compared with patients younger than 50 years, the risk of death was significantly higher among those in the older age groups and was especially evident among those 70-79 years (8.51-fold higher) and among those aged 80 years and older (11.09-fold higher).

Obesity was associated with a 33% increased risk of death from COVID-19 (P<0.001). Other factors associated with a significantly increased risk of death were moderate/severe liver disease (hazard ratio, 1.51), dementia (HR, 1.40), chronic kidney disease (HR, 1.28), chronic pulmonary disease (HR, 1.17), chronic neurological disorder (HR, 1.17), chronic cardiac disease (HR, 1.16), and malignancy (HR, 1.13).

Female sex was independently associated with a significant 19% reduced risk of death, compared with male sex.

Dr. Jeffrey A. Linder of Northwestern University Feinberg School of Medicine, in Chicago, who co-authored an editorial related to this report, told Reuters Health by email, "There have now been over a dozen studies of hospitalized patients with COVID, and we know many likely risk factors for a poor clinical course: older age, non-White-race, obesity, chronic medical conditions."

"Obesity was an independent risk factor for death, which could be very concerning if that holds true for the United States, where a third of adults are obese," he said.

"We need to learn much more about the care of patients with COVID-19 before they get to the hospital (who can safely stay at home, when should they go to the hospital, and can we prevent ED visits and hospitalizations with supportive therapies), aspects of supportive hospital care that improve outcomes, and care after patients are discharged from the hospital," Dr. Linder said.

"I hope I'm wrong, but I think there's a good chance we are going to be living with coronavirus for years," he said. "I am actually pretty pessimistic that we are going to find a 'game-changing' treatment for coronavirus. We've never had one for viral pneumonia before."

"It is much less sexy than 'the cure for coronavirus,' but we're likely to save more lives by optimizing supportive care at home, knowing when people need higher-level care, and providing better supportive care in the hospital," Dr. Linder concluded.

He added, "I keep seeing people on social media and in the press holding out their favorite molecule, hormone, or dietary component as 'the explanation' for all things related to COVID (e.g., zinc, vitamin D). Unfortunately, our bodies (with hundreds of cell types and at least tens of thousands of molecules), viral infections, and our inflammatory responses are not that simple."

Dr. Semple did not respond to a request for comments.

SOURCE: https://bit.ly/2TMkRtf and https://bit.ly/36DCII9 The BMJ, online May 22, 2020.