Poor clinical outcomes among hospitalized obese patients with COVID-19 are related to inflammation and not respiratory mechanics

Edwards, Jordan N; Ganz, Tomas; Nemeth, Elizabeta; Martin, Emily J; Jackson, Nicholas J; Kim, Airie

doi:10.2478/jccm-2025-0012

References

P N, R N, B V, S R, A S. COVID-19: Invasion, pathogenesis and possible cure - A review. J Virol Methods. 2022;300:114434. doi: 10.1016/j.jviromet.2021.114434.
Open DOI Search in Google Scholar Back to article
Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6–10. doi: 10.1016/j.metabol.2018.09.005.
Open DOI Search in Google Scholar Back to article
Andersen CJ, Murphy KE, Fernandez ML. Impact of Obesity and Metabolic Syndrome on Immunity. Adv Nutr. 2016;7(1):66–75. doi: 10.3945/an.115.010207.
Open DOI Search in Google Scholar Back to article
Huang PL. A comprehensive definition for metabolic syndrome. Dis Model Mech. 2009;2(5–6):231–7. doi: 10.1242/dmm.001180.
Open DOI Search in Google Scholar Back to article
Maggio CA, Pi-Sunyer FX. Obesity and type 2 diabetes. Endocrinol Metab Clin North Am. 2003;32(4):805–22, viii. doi: 10.1016/s0889-8529(03)00071-9.
Open DOI Search in Google Scholar Back to article
Ford ES, Williamson DF, Liu S. Weight change and diabetes incidence: findings from a national cohort of US adults. Am J Epidemiol. 1997;146(3):214–22. doi: 10.1093/oxfordjournals.aje.a009256.
Open DOI Search in Google Scholar Back to article
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052–9. doi: 10.1001/jama.2020.6775.
Open DOI Search in Google Scholar Back to article
Popkin BM, Du S, Green WD, et al. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev. 2020;21(11):e13128. doi: 10.1111/obr.13128.
Open DOI Search in Google Scholar Back to article
Chiappetta S, Sharma AM, Bottino V, Stier C. COVID-19 and the role of chronic inflammation in patients with obesity. Int J Obes (Lond). 2020;44(8):1790–2. doi: 10.1038/s41366-020-0597-4.
Open DOI Search in Google Scholar Back to article
Stefan N, Birkenfeld AL, Schulze MB, Ludwig DS. Obesity and impaired metabolic health in patients with COVID-19. Nat Rev Endocrinol. 2020;16(7):341–2. doi: 10.1038/s41574-020-0364-6.
Open DOI Search in Google Scholar Back to article
Romero Starke K, Reissig D, Petereit-Haack G, Schmauder S, Nienhaus A, Seidler A. The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis. BMJ Glob Health. 2021;6(12). doi: 10.1136/bmjgh-2021-006434.
Open DOI Search in Google Scholar Back to article
Zhang JJ, Dong X, Liu GH, Gao YD. Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clin Rev Allergy Immunol. 2023;64(1):90–107. doi: 10.1007/s12016-022-08921-5.
Open DOI Search in Google Scholar Back to article
Cai Q, Chen F, Wang T, et al. Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China. Diabetes Care. 2020;43(7):1392–8. doi: 10.2337/dc20-0576.
Open DOI Search in Google Scholar Back to article
Goyal P, Choi JJ, Pinheiro LC, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020;382(24):2372–4. doi: 10.1056/NEJMc2010419.
Open DOI Search in Google Scholar Back to article
Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154262. doi: 10.1016/j.metabol.2020.154262.
Open DOI Search in Google Scholar Back to article
Golubnitschaja O, Liskova A, Koklesova L, et al. Caution, “normal” BMI: health risks associated with potentially masked individual underweight-EPMA Position Paper 2021. EPMA J. 2021;12(3):243–64. doi: 10.1007/s13167-021-00251-4.
Open DOI Search in Google Scholar Back to article
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293(15):1861–7. doi: 10.1001/jama.293.15.1861.
Open DOI Search in Google Scholar Back to article
Morgan OW, Bramley A, Fowlkes A, et al. Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease. PLoS One. 2010;5(3):e9694. doi: 10.1371/journal.pone.0009694.
Open DOI Search in Google Scholar Back to article
Honce R, Schultz-Cherry S. Impact of Obesity on Influenza A Virus Pathogenesis, Immune Response, and Evolution. Front Immunol. 2019;10:1071. doi: 10.3389/fimmu.2019.01071.
Open DOI Search in Google Scholar Back to article
de Heredia FP, Gomez-Martinez S, Marcos A. Obesity, inflammation and the immune system. Proc Nutr Soc. 2012;71(2):332–8. doi: 10.1017/S0029665112000092.
Open DOI Search in Google Scholar Back to article
Smith AG, Sheridan PA, Harp JB, Beck MA. Diet-induced obese mice have increased mortality and altered immune responses when infected with influenza virus. J Nutr. 2007;137(5):1236–43. doi: 10.1093/jn/137.5.1236.
Open DOI Search in Google Scholar Back to article
Paich HA, Sheridan PA, Handy J, et al. Overweight and obese adult humans have a defective cellular immune response to pandemic H1N1 influenza A virus. Obesity (Silver Spring). 2013;21(11):2377–86. doi: 10.1002/oby.20383.
Open DOI Search in Google Scholar Back to article
Lonnqvist F, Thorne A, Large V, Arner P. Sex differences in visceral fat lipolysis and metabolic complications of obesity. Arterioscler Thromb Vasc Biol. 1997;17(7):1472–80. doi: 10.1161/01.atv.17.7.1472.
Open DOI Search in Google Scholar Back to article
Ziegler AK, Damgaard A, Mackey AL, et al. An anti-inflammatory phenotype in visceral adipose tissue of old lean mice, augmented by exercise. Sci Rep. 2019;9(1):12069. doi: 10.1038/s41598-019-48587-2.
Open DOI Search in Google Scholar Back to article
Alexopoulos N, Katritsis D, Raggi P. Visceral adipose tissue as a source of inflammation and promoter of atherosclerosis. Atherosclerosis. 2014;233(1):104–12. doi: 10.1016/j.atherosclerosis.2013.12.023.
Open DOI Search in Google Scholar Back to article
Battisti S, Pedone C, Napoli N, et al. Computed Tomography Highlights Increased Visceral Adiposity Associated With Critical Illness in COVID-19. Diabetes Care. 2020;43(10):e129–e30. doi: 10.2337/dc20-1333.
Open DOI Search in Google Scholar Back to article
Watanabe M, Caruso D, Tuccinardi D, et al. Visceral fat shows the strongest association with the need of intensive care in patients with COVID-19. Metabolism. 2020;111:154319. doi: 10.1016/j.metabol.2020.154319.
Open DOI Search in Google Scholar Back to article
Dixon AE, Peters U. The effect of obesity on lung function. Expert Rev Respir Med. 2018;12(9):755–67. doi: 10.1080/17476348.2018.1506331.
Open DOI Search in Google Scholar Back to article
Holley HS, Milic-Emili J, Becklake MR, Bates DV. Regional distribution of pulmonary ventilation and perfusion in obesity. J Clin Invest. 1967;46(4):475–81. doi: 10.1172/JCI105549.
Open DOI Search in Google Scholar Back to article
Rivas E, Arismendi E, Agusti A, et al. Ventilation/Perfusion distribution abnormalities in morbidly obese subjects before and after bariatric surgery. Chest. 2015;147(4):1127–34. doi: 10.1378/chest.14-1749.
Open DOI Search in Google Scholar Back to article
Zhang W, Wang Y, Li W, Wang J. Association Between Obesity and Short-And Long-Term Mortality in Patients With Acute Respiratory Distress Syndrome Based on the Berlin Definition. Front Endocrinol (Lausanne). 2020;11:611435. doi: 10.3389/fendo.2020.611435.
Open DOI Search in Google Scholar Back to article
Zhi G, Xin W, Ying W, Guohong X, Shuying L. “Obesity Paradox” in Acute Respiratory Distress Syndrome: Asystematic Review and Meta-Analysis. PLoS One. 2016;11(9):e0163677. doi: 10.1371/journal.pone.0163677.
Open DOI Search in Google Scholar Back to article
Corrales-Medina VF, Valayam J, Serpa JA, Rueda AM, Musher DM. The obesity paradox in community-acquired bacterial pneumonia. Int J Infect Dis. 2011;15(1):e54–7. doi: 10.1016/j.ijid.2010.09.011.
Open DOI Search in Google Scholar Back to article
Kim RY, Glick C, Furmanek S, Ramirez JA, Cavallazzi R. Association between body mass index and mortality in hospitalised patients with community-acquired pneumonia. ERJ Open Res. 2021;7(1). doi: 10.1183/23120541.00736-2020.
Open DOI Search in Google Scholar Back to article
Gao M, Piernas C, Astbury NM, et al. Associations between body-mass index and COVID-19 severity in 6.9 million people in England: a prospective, community-based, cohort study. Lancet Diabetes Endocrinol. 2021;9(6):350–9. doi: 10.1016/S2213-8587(21)00089-9.
Open DOI Search in Google Scholar Back to article
Poly TN, Islam MM, Yang HC, et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2021;8:620044. doi: 10.3389/fmed.2021.620044.
Open DOI Search in Google Scholar Back to article

Poor clinical outcomes among hospitalized obese patients with COVID-19 are related to inflammation and not respiratory mechanics

References

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