Impact Of body Mass Index on Cardiopulmonary Outcomes of COVID-19 Hospitalizations Complicated by Severe Sepsis

Sivaram Neppala; Himaja Dutt Chigurupati; Nikhilender Nag Mopuru; Naga Ruthvika Alle; Alpha James; Ami Bhalodia; Sajida Shaik; Revanth Reddy Bandaru; Athmananda Nanjundappa; Praveena Sunkara; Jyotsna Gummadi; Rupak Desai

doi:10.1016/j.obpill.2024.100101

Impact Of body Mass Index on Cardiopulmonary Outcomes of COVID-19 Hospitalizations Complicated by Severe Sepsis

Obes Pillars. 2024 Feb 14:10:100101. doi: 10.1016/j.obpill.2024.100101. eCollection 2024 Jun.

Authors

Affiliations

¹ University of Texas at San Antonio, San Antonio, TX, USA.
² Department of Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA.
³ Department of Medicine, Kamineni Academy of medical sciences and research Centre, Hyderabad, India.
⁴ Department of Medicine, Narayana Medical College, Nellore, India.
⁵ Department of Medicine, Bukovinian State Medical University, Chernivitsi, Ukraine.
⁶ Department of Medicine, Pandit Deendayal Upadhyay Medical College, Gujrat, India.
⁷ Department of Medicine, Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Andhra Pradesh, India.
⁸ Department of Medicine, East Carolina University, Greenville, NC, USA.
⁹ Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA.
¹⁰ Department of Medicine, Medstar Medical group, Charlotte Hall, MD, USA.
¹¹ Independent Outcomes Researcher, Atlanta, GA, USA.

Abstract

Background: Body Mass Index (BMI) has a significant impact on Coronavirus disease (COVID-19) patient outcomes; however, major adverse cardiac and cerebrovascular outcomes in patients with severe sepsis have been poorly understood. Our study aims to explore and provide insight into its association.

Methods: This is an observational study looking at the impact of BMI on COVID-19-severe sepsis hospitalizations. The primary outcomes are adjusted odds of all-cause in-hospital mortality, respiratory failure, and major adverse cardiac and cerebrovascular events (MACCE), which include acute myocardial infarction, cardiac arrest, and acute ischemic stroke. The secondary outcome was healthcare resource utilization. Coexisting comorbidities and patient features were adjusted with multivariable regression analyses.

Results: Of 51,740 patients with severe COVID-19-sepsis admissions, 11.4% were overweight, 24.8% had Class I obesity (BMI 30-34.9), 19.8% had Class II obesity (BMI 35-39.9), and 43.9% had the categorization of Class III obesity (BMI >40) cohorts with age>18 years. The odds of MACCE in patients with class II obesity and class III obesity (OR 1.09 and 1.54; 95CI 0.93-1.29 and 1.33-1.79) were significantly higher than in overweight (p < 0.001). Class I, Class II, and Class III patients with obesity revealed lower odds of respiratory failure compared to overweight (OR 0.89, 0.82, and 0.82; 95CI 0.75-1.05, 0.69-0.97, and 0.70-0.97), but failed to achieve statistical significance (p = 0.079). On multivariable regression analysis, all-cause in-hospital mortality revealed significantly higher odds in patients with Class III obesity, Class II, and Class I (OR 1.56, 1.17, and 1.06; 95CI 1.34-1.81, 0.99-1.38, and 0.91-1.24) vs. overweight patients (p < 0.001).

Conclusions: Patients with Class II and Class III obesity had significantly higher odds of MACCE and in-hospital mortality in COVID-19-severe sepsis admissions.

Keywords: Body mass index/obesity; COVID-19/SARS-CoV-2; Cardiopulmonary outcomes; Mortality; Respiratory failure; Sepsis.