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It is becoming more and more apparent obesity It is one of the greatest risk factors for severe COVID-19 disease, especially among younger patients.
Newly released data from New York show that obesity is twice as likely to lead to hospitalization for COVID-19 among people under the age of 60, greatly increasing the likelihood that people will receive intensive care. Is shown.
“Obesity [in people < 60 years] It is a previously unrecognized risk factor for hospitalization, and there seems to be a need for critical care. This has important and practical implications when nearly 40% of US adults are obese in body mass index [BMI] More than 30 ", write Jennifer Lighter, MD, NYU School of Medicine / NYU Langone Health, and colleagues in a research letter Published online April 9 Clinical infection.
A similar finding of an unreviewed preprinted publication from another New York hospital was, Except for old age, obesity (BMI> 40 kg / m2The strongest association with COVID-19 hospitalization increased risk more than 6-fold.
Meanwhile, a new study in France shows that patients admitted to one intensive care unit for COVID-19 have a higher frequency of obesity. In addition, the severity of the disease increased with increasing BMI.
One of the authors said Medscape Medical News Many of the patients presented were young and their only risk factor was obesity.
“Obese patients should avoid COVID-19 contamination by implementing all precautions during the current pandemic,” said the author, headed by Dr. Arthur Simonnet of the Lille Hospital Center in France.
They also emphasize COVID-19 patients.
Obese people are young and get sick very quickly
French article co-author, Published online April 9 obesity, Francois Patou, PhD, PhD Medscape Medical News When patients with COVID-19 began to arrive in the intensive care unit in Lille, there were other non-comorbid young patients.
“They were just obese,” he observed, and they seemed to “have a very specific illness, something different” from what was seen before, making the patient very rapid. I got sick.
Their study investigated 124 consecutive patients who received intensive care with COVID-19 between February 25 and April 5, 2020 and were admitted to the ICU at the same hospital for non-COVID. Comparisons were made with a historical control group of 306 patients. 19-related severe acute respiratory illness in 2019.
By 6 April, 60 COVID-19 patients were discharged from the intensive care unit, 18 died, and 46 remained in the ward. The majority (73%) were males with a median age of 60 years.
Obesity and severe obesity were significantly higher in patients with COVID-19 at 47.6% and 28.2% and in past controls were 25.2% and 10.8% (P <.001 trend).
An important finding is that people with a BMI above 35 kg / m2 Increased the risk of needing more than 7 times Mechanical ventilation (Odds ratio [OR], 7.36. P = .021), compared with BMI <25 kg / m2, Age, diabetes, and High blood pressure.
Obesity under age 60 at least doubles the risk of hospitalization in the United States
Studies in New York are stratified by age and draw similar pictures.
Reiter and colleagues found that, out of 3615 COVID-19 positives in the series, 775 (21%) had a BMI of 30-34 kg / m2 And BMI of 595 (16%) is more than 35 kg / m2.
Obesity was not a predictor of hospitalization for patients over the age of 60 or ICU, but for patients under 60 years of age.
BMI 30-34 kg / m under 60 years old2 Twice as likely to be hospitalized (hazard ratio [HR], 2.0; P <.0001) and critical care (HR, 1.8; P = .006) Compared with under 60s with BMI less than 30kg / m2.
Similarly, people under the age of 60 with a BMI of 35 kg / m or more2 2.2 (P <.0001) and 3.6 (P <.0001) You are more than twice as likely to receive acute and severe care.
“Unfortunately, obesity in people under the age of 60 is a newly identified epidemiological risk factor that may contribute to the increased prevalence.” [with COVID-19] I experienced it in the United States. “
In another US study, Christopher M. Petrilli, MD, New York University Grossman School of Medicine, and colleagues were treated between March 1 and April 2, 2020, and then until April 7. We examined 4103 patients with COVID-19 who received it.
Nearly half (48.7%) of the patients were hospitalized, of which 22.3% required ventilator ventilation and 14.6% died or were discharged to hospice. Research Posted April 11 medRxiv.
Except age, the strongest predictor of hospitalization was BMI> 40 kg / m2 (Or 6.2) and heart failure (Or 4.3).
“It is worth noting that the chronic condition most strongly associated with serious illness was obesity, any odds ratio is significantly higher than any cardiovascular or pulmonary disease,” they point out.
Is it due to inflammation?
Pateau, behind the increased risk of severity seen with COVID-19 obesity, was the inflammation mediated by circulating fibrin deposition seen by his colleagues at necropsy, ” I will block the passage. “
This helps explain why mechanical ventilation fails in these patients.
“The answer is to get rid of this inflammation,” Pateau observed.
Petri and colleagues have also observed that obesity is “well recognized as a proinflammatory condition.”
And their findings indicate “the importance of inflammatory markers in distinguishing future serious from non-severe diseases”, and among these markers, the early C-reactive protein Rise of D dimer “It was most strongly associated with mechanical ventilation or mortality.”
Dr. Livio Luzi of IRCCS MultiMedica in Milan, Italy written About the relationship between influenza He then discussed obesity and the potential lessons of the COVID-19 pandemic with Medscape Medical News.
“Obesity is characterized by an impaired immune response and mild chronic inflammation. In addition, obese subjects have altered lung ventilation dynamics and reduced diaphragm excursion,” Luji said.
We conclude that these factors, along with others, may “help explain” the current results, emphasizing the importance of close monitoring of obesity and COVID-19 patients.
No relevant financial relationships have been declared.
Clin Infect Dis. Published online on April 9, 2020. letter
medRxiv. Published April 11, 2020 Online. Full text
obesity. Published online on April 9, 2020. Full text