COVID-19Research Paper|Volume 13, Issue 6|pp 7767—7780

Association of body mass index with severity and mortality of COVID-19 pneumonia: a two-center, retrospective cohort study from Wuhan, China

Xiaodong Wu¹, Chenghong Li², Shi Chen², Xin Zhang³, Feilong Wang¹, Ting Shi⁴, Qiang Li¹, Lin Lin^5,⁶

¹Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
²Department of Respiratory Medicine, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
³Department of Pulmonary and Critical Care Medicine, People’s Liberation Army Joint Logistic Support Force 920th Hospital, Yunnan, China
⁴Centre for Global Health, Usher Institute, University of Edinburgh, Scotland, United Kingdom
⁵Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
⁶Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

* Equal contribution

Received: October 26, 2020Accepted: February 15, 2021Published: March 24, 2021

https://doi.org/10.18632/aging.202813

Copyright: © 2021 Wu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

In this study, we aimed to investigate the relationship between body mass index (BMI) and multiple severe outcomes of the coronavirus disease 2019 (COVID-19) pneumonia. A total of 1091 patients hospitalized with COVID-19 pneumonia were included from Wuhan, China. Overall, 2.8% (n = 31) received invasive mechanical ventilation (IMV), 10.8% (n = 118) were admitted to the intensive care unit (ICU), 6.4% (n = 70) developed acute respiratory distress syndrome (ARDS), and 4.4% (n = 48) died. Multivariable-adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) of IMV therapy, ICU admission and ARDS associated with obesity were 2.86 (1.16-7.05), 2.62 (1.52-4.49) and 3.15 (1.69-5.88), respectively; underweight was significantly associated with death (HR 3.85, 95%CI 1.26-11.76). Restricted cubic spline analyses suggested U-shaped associations of BMI with ICU admission and death, but linear relationships of BMI with IMV therapy and ARDS. In conclusion, obesity had an increased risk of IMV therapy, ICU admission and ARDS, while underweight was associated with higher mortality in COVID-19 pneumonia. U-shaped associations of BMI with ICU admission and death, and linear relationships of BMI with IMV therapy and ARDS, were found. These findings indicate that extra caution should be taken when treating COVID-19 patients with underweight and obesity.