Predicting mortality attributable to SARS-CoV-2: A mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico

Bello-Chavolla, O. Y.; Bahena-Lopez, J. P.; Antonio-Villa, N. E.; Vargas-Vazquez, A.; Gonzalez-Diaz, A.; Marquez-Salinas, A.; Fermin-Martinez, C. A.; Naveja, J. J.; Aguilar-Salinas, C. A.

BACKGROUND AND AIMS: The SARS-CoV-2 outbreak has posed a challenge to the healthcare systems due to high complications rates observed in patients with cardiometabolic diseases, such as diabetes and obesity. Despite the high prevalence of these conditions, a mechanistic association of its interactions in COVID-19 remain unclear. Here, we identify risk factors and propose a clinical score to predict 30-day lethality in COVID-19 cases, including specific factors for diabetes and obesity and its role in improving risk prediction. METHODS: We obtained data of suspected, confirmed and negative COVID-19 cases and their demographic and health characteristics from the General Directorate of Epidemiology of Mexican Ministry of Health. We investigated specific risk factors associated to SARS-CoV-2 positivity and mortality due to COVID-19. Additionally, we explored the impact of diabetes and obesity on COVID-19 related outcomes and their interaction with other comorbidities in modifying COVID-19 related lethality. Finally, we built our clinical score to predict 30-day lethality using the previously identified risk factors. RESULTS: Among 49,570 evaluated subjects (at April 19th, 2020), we observed an increased risk of SARS-CoV-2 positivity (n=8,261) in those with diabetes, obesity, male subjects and in patients with diabetes and age <40 years (early-onset). Risk factors for increased lethality in COVID-19 includes early-onset diabetes obesity, chronic obstructive pulmonary disease, advanced age, immunosuppression, and chronic kidney disease; we also found that obesity mediates 47.8% of the effect of diabetes on COVID-19 lethality. Early-onset diabetes conferred an increased risk of hospitalization and obesity conferred an increased risk for ICU admission and intubation. Our predictive score for COVID-19 lethality included age [≥]65 years, diabetes, diabetes & age <40 years, obesity, age <40 years, CKD, pregnancy and immunosuppression and a categorization of low-risk, mild-risk, moderate-risk, high-risk and very high-risk significantly discriminates lethal from non-lethal COVID-19 cases (c-statistic=0.837). CONCLUSIONS: Here, we propose a mechanistic approach to evaluate risk for complication and lethality attributable to COVID-19 in patients with obesity and diabetes patients in a country with high susceptibility. Furthermore, our novel score offers a clinical tool for quick determination of high-risk susceptibility patients in a first contact scenario.