COVID-19 Patients with Obesity at Risk for Worse Outcomes Despite Younger Age and Fewer Inflammatory Derangements

Le Guen, Claire L.; King, Neil A.; Zhao, Huaqing; Renza-Stingone, Elizabeth P.; Gerhard, Glenn S.; Soans, Rohit S.

BACKGROUND: COVID-19 is a viral pulmonary infection which can progress to cytokine storm syndrome as a result of widespread dysregulated inflammatory response. Many patients at risk for severe COVID-19 manifestation have been identified as those with pre-existing conditions of pulmonary origin, as well as conditions which impair appropriate immune response, such as obesity. OBJECTIVES: The aim of this study is to describe the manifestation, clinical course, and inflammatory biomarker milieu of COVID-19 in patients with obesity. SETTING: Philadelphia, Pennsylvania. METHODS: In this retrospective cohort study, 600 COVID-19 positive patients were stratified by World Health Organization (WHO) obesity class and their presenting symptoms, disease biomarkers, demographics, and outcomes [intubation rate, intensive care unit (ICU) admission, length of stay (LOS), mortality)] were investigated. RESULTS: Age was inversely related to obesity class; patients of obesity class III presented 12.9 years younger than patients of normal weight (p<0.0001). Initial ferritin lab values were negatively correlated with increasing obesity class (p=0.0192). Normal or near-normal lymphocyte profile was noted in patients with obesity compared to patients without obesity (p=0.0017). Patients with obesity had an increased rate of ICU admission (p=0.0215), increased length of stay (p=0.0004), but no differences in intubation rate (p=0.3705) or mortality (p=0.2486). CONCLUSIONS: Patients with obesity were more likely to present to the hospital at a younger age, with reduced levels of COVID-19 related biomarker disturbances, increased LOS and ICU admission rates, though were not at increased risk for mortality.