The Association of BMI with Outcomes in Critically Ill Patients with Covid-19

Abstract

Introduction: The novel systemic acute respiratory syndrome coronavirus (SARSCoV-19) severity has been linked to many risk factors like obesity, advanced age, hypertension (HTN), diabetes mellitus (DM), chronic heart diseases, and lung diseases, with many studies showing their influence and effect on the general population and especially on critically ill patients. We retrospectively studied and correlated BMI with in-hospital mortality, the need for mechanical ventilation, renal replacement therapy (RRT), ICU and hospital length of stay (LOS), and mortality among ICU admitted patients with COVID-19 in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia.

Methods: A retrospective cohort study was conducted after ethical approval from the institutional review board of King Abdullah International Medical Research Center (KAIMRC). Subjects were identified by the Data management office of KAIMRC. The data was extracted from electronic medical records using a customized data collection sheet. The study included all adult patients (>18 years) who tested positive for COVID-19 by polymerase chain reaction (PCR) and were admitted to the ICU at KAMC from March 2020 until the end of February 2021. Patients where adequate data was not available, and those for whom adequate data on BMI parameters could not be found were excluded. Patient demographics, comorbid conditions, medications, type of ventilation used, and mortality were recorded.

Results: During the study period (2nd of March 2020 until February 28th, 2021) nearly 2000 patients were hospitalized at KAMC with the diagnosis of COVID-19. After excluding the patients who met the exclusion criteria data was collected for 469 critically ill patients, Male (70.9%); female (29.1%). The most common comorbidities in BMI groups were DM (66.5%) and HTN (66%). No significant differences were found regarding the therapies received among these patients. On the Multivariate Cox Model for Determining Predictors of Cumulative Mortality, overweight and obese patient class I had a lower risk of mortality compared to BMI<24.9 (p<0.0087) (0<0.0391, with an overall mortality of (45.6%) in this study.

Conclusion: Obesity increases the risk of ICU admission and one of the major risk factors for severe-critical COVID-19 infection. For ICU patients with COVID-19, We found a lower mortality rate in COVID-19-treated ICU patients who were overweight or obese class I compared to other groups. Further studies should be done to correlate the impact of obesity on critical ill COVID-19 patients.