Obesity is a Major Risk Factor for Hospitalization in Community-managed COVID-19 Pneumonia

Cottini, Marcello; Lombardi, Carlo; Berti, Alvise; Gregis, Marco; Gregis, Giorgio; Bello, Luigi; Mazid, Mahmoud; Putignano, Tommaso; Corbellini, Aldo; Belotti, Stefano; Rossi, Sergio; Finazzi, Alfredo; Locatelli, Mario; Zelaschi, Fabrizio; Raimondo, Maria; Miscia, Rossana; Ferrari, Fabio; Chiodini, Annalisa; Rovelli, Monica; Locatelli, Cecilia; Narzisi, Iolanda; Staats, Jutte; Mazzoleni, Leonello; Breviario, Adele; Sequenzia, Federica; Scorpiniti, Anna; Barili, Daniela; Cocchiola, Margherita; Donatini, Rinaldo; Invernici, Rosalba; Sergio, Francesco; Munizza, Titti; Travella, Bruno; Luderin, Lucilla; Gotti, Rossella; Rampinelli, PierLuigi; Roberto, Bettini; Locatelli, Giuseppe

Objective We aimed to investigate whether the stratification of outpatients with Coronavirus disease 2019 (COVID-19) pneumonia by body-mass index (BMI) can help to predict hospitalization and other severe outcomes. Patients and Methods We prospectively collected consecutive cases of community-managed COVID-19 pneumonia from March 1st to April 20th 2020 in the province of Bergamo, and evaluated the association of overweight (25kg/m2≤BMI<30kg/m2) and obesity (≥30kg/m2) with time-to-hospitalization (primary endpoint), low-flow domiciliary O2 need, non-invasive mechanical ventilation (NIV), intubation and death due to COVID-19 (secondary endpoints) in this cohort. We analyzed the primary endpoint using multivariable Cox models. Results Of 338 patients included, 133 (39.35%) were overweight and 77 (22.78%) were obese. Age at diagnosis was lower in obese patients compared to those with over- or normal weight (p<.001), while diabetes, dyslipidemia and heart diseases were differently distributed among BMI categories. Azithromycin, hydroxychloroquine, and prednisolone use was similar between BMI categories (p>.05). Overall, 105 (31.07%) patients were hospitalized, and time-to-hospitalization was significantly shorter for obese versus over- or normal-weight patients (p<0.001). In the final multivariable analysis, obese patients were more likely to require hospitalization than non-obese patients (HR, 5.83; 95%CI, 3.91 to 8.71). Results were similar in multiple sensitivity analyses. Low-flow domiciliary O2 need, hospitalization with NIV, intubation and death were significantly associated with obesity (p<.001). Conclusion In patients with community-managed COVID-19 pneumonia, obesity is associated with a higher hospitalization risk and overall worse outcomes than non-obese patients.