Severe obesity is associated with higher in-hospital mortality in a cohort of patients with COVID-19 in the Bronx, New York

Palaiodimos, Leonidas; Kokkinidis, Damianos G.; Li, Weijia; Karamanis, Dimitrios; Ognibene, Jennifer; Arora, Shitij; Southern, William N.; Mantzoros, Christos S.

BACKGROUND & AIMS: New York is the current epicenter of Coronavirus disease 2019 (COVID-19) pandemic. The underrepresented minorities, where the prevalence of obesity is higher, appear to be affected disproportionately. Our objectives were to assess the characteristics and early outcomes of patients hospitalized with COVID-19 in the Bronx and investigate whether obesity is associated with worse outcomes independently from age, gender and other comorbidities. METHODS: This retrospective study included the first 200 patients admitted to a tertiary medical center with COVID-19. The electronic medical records were reviewed at least three weeks after admission. The primary endpoint was in-hospital mortality. RESULTS: 200 patients were included (female sex: 102, African American: 102). The median BMI was 30 kg/m(2). The median age was 64 years. Hypertension (76%), hyperlipidemia (46.2%), and diabetes (39.5%) were the three most common comorbidities. Fever (86%), cough (76.5%), and dyspnea (68%) were the three most common symptoms. 24% died during hospitalization (BMI < 25 kg/m(2): 31.6%, BMI 25–34 kg/m(2): 17.2%, BMI ≥ 35 kg/m(2): 34.8%, p = 0.03). Increasing age (analyzed in quartiles), male sex, BMI ≥ 35 kg/m(2) (reference: BMI 25–34 kg/m(2)), heart failure, CAD, and CKD or ESRD were found to have a significant univariate association with mortality. The multivariate analysis demonstrated that BMI ≥ 35 kg/m(2) (reference: BMI 25–34 kg/m(2), OR: 3.78; 95% CI: 1.45–9.83; p = 0.006), male sex (OR: 2.74; 95% CI: 1.25–5.98; p = 0.011) and increasing age (analyzed in quartiles, OR: 1.73; 95% CI: 1.13–2.63; p = 0.011) were independently associated with higher in-hospital mortality. Similarly, age, male sex, BMI ≥ 35 kg/m(2) and current or prior smoking were significant predictors for increasing oxygenation requirements in the multivariate analysis, while male sex, age and BMI ≥ 35 kg/m(2) were significant predictors in the multivariate analysis for the outcome of intubation. CONCLUSIONS: In this cohort of hospitalized patients with COVID-19 in a minority-predominant population, severe obesity, increasing age, and male sex were independently associated with higher in-hospital mortality and in general worse in-hospital outcomes.