Clinical profile of patients with obesity and COVID-19 in an outpatient setting in northeastern Brazil: a retrospective cohort study
DOI:
https://doi.org/10.33448/rsd-v11i15.36811Keywords:
Ambulatory Care; COVID-19; Pandemic; Obesidade; Fator de risco.Abstract
Objective: To analyze the clinical profile of obese patients with COVID-19 in ambulatory care during the first wave of the pandemic. Methods: A retrospective observational study conducted in an outpatient setting in Aracaju/SE, Brazil. The patients with COVID-19 received medical care in a referral center from April to August 2020 and were followed remotely. Clinical data was analyzed using Jamovi 1.2.27. Results: Of 1,134 patients with COVID-19, 288 (25.4%) were obese, 59.7% were women. Hypertension, diabetes, dyslipidemia, and chronic kidney disease were more frequent in the obese group. Dyspnea and diarrhea were more frequent in obese individuals, while odynophagia, nausea, and vomiting were more common in non-obese individuals. Attending physicians prescribed more antibiotics, ivermectin, corticosteroids, and heparin for obese patients. Hospital admission (6.6% vs. 3.1%; p=0.008) and use of oxygen therapy (5.1% vs. 2.1%; p=0.011) were more frequent in the obesity group. Obesity was independently associated with hospital admission in multivariate analysis (OR: 2.561, 95% CI 1.352 - 4.853; p=0.004). The lethality rate was higher in obese individuals (2.1% vs. 0.7%; p=0.049). Conclusion: In this outpatient cohort of COVID-19 patients, there were more comorbidities among obese individuals. Despite the low frequency of unfavorable outcomes overall, obesity increased the risk of hospital admission and there were more deaths among patients with obesity.
References
Akoumianakis, I., & Filippatos, T. (2020). The renin–angiotensin–aldosterone system as a link between obesity and coronavirus disease 2019 severity. Obesity Reviews, 21(9), e13077.
Al Heialy, S., Hachim, M. Y., Hachim, I. Y., Naeem, K. B., Hannawi, H., Lakshmanan, J., ... & Hannawi, S. (2021). Combination of obesity and co-morbidities leads to unfavorable outcomes in COVID-19 patients. Saudi Journal of Biological Sciences, 28(2), 1445-1450.
Albashir, A. A. D. (2020). The potential impacts of obesity on COVID-19. Clinical medicine, 20(4), e109.
Bardi, T., Pintado, V., Gomez-Rojo, M., Escudero-Sanchez, R., Lopez, A. A., & Diez-Remesal, Y. Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome. Res Sq [Internet]. 2020: 1---15.
Berger, J. S., & Connors, J. M. (2021). Anticoagulation in COVID-19: reaction to the ACTION trial. The Lancet, 397(10291), 2226-2228.
Bilal, B., Saleem, F., & Fatima, S. S. (2020). Alcohol consumption and obesity: The hidden scare with COVID-19 severity. Medical hypotheses, 144, 110272.
Brasil, Ministério da Saúde. Orientações sobre o tratamento farmacológico do paciente adulto hospitalizado com COVID-19. 2021; 08-09.
Buetti, N., Ruckly, S., de Montmollin, E., Reignier, J., Terzi, N., Cohen, Y., ... & Timsit, J. F. (2021). COVID-19 increased the risk of ICU-acquired bloodstream infections: a case–cohort study from the multicentric OUTCOMEREA network. Intensive care medicine, 47(2), 180-187.
Camargo, L. M. A., Silva, R. P. M., & de Oliveira Meneguetti, D. U. (2019). Tópicos de metodologia de pesquisa: Estudos de coorte ou cohorte prospectivo e retrospectivo. Journal of Human Growth and Development, 29(3), 433.
Chu, Y., Yang, J., Shi, J., Zhang, P., & Wang, X. (2020). Obesity is associated with increased severity of disease in COVID-19 pneumonia: a systematic review and meta-analysis. European journal of medical research, 25(1), 1-15.
Dias, V. M. C. H., Carneiro, M., & Lacerda Vidal, C. F. (2020). Orientações sobre diagnóstico, tratamento e isolamento de pacientes com COVID-19. J Infect Control, 9(2), 56-75.
Docherty, A. B., Harrison, E. M., Green, C. A., Hardwick, H. E., & Pius, R. (2020). Features of 20133 UK Patients in Hospital with COVID-19 Using the ISARIC WHO Clinical Characterization Protocol: Prospective Observational Cohort Study. BMJ, 369, m1985.
Finer, N., Garnett, S. P., & Bruun, J. M. (2020). COVID‐19 and obesity. Clinical Obesity, 10(3).
Földi, M., Farkas, N., Kiss, S., Zádori, N., Váncsa, S., Szakó, L., ... & KETLAK Study Group. (2020). Obesity is a risk factor for developing critical condition in COVID‐19 patients: a systematic review and meta‐analysis. Obesity Reviews, 21(10), e13095.
Fontelles, M. J., Simões, M. G., Farias, S. H., & Fontelles, R. G. S. (2009). Metodologia da pesquisa científica: diretrizes para a elaboração de um protocolo de pesquisa. Revista paraense de medicina, 23(3), 1-8.
Group, T. R. C. (2020). Dexamethasone in hospitalized patients with Covid-19—preliminary report. The New England journal of medicine.
Hogue, C. W., Stearns, J. D., Colantuoni, E., Robinson, K. A., Stierer, T., Mitter, N., ... & Needham, D. M. (2009). The impact of obesity on outcomes after critical illness: a meta-analysis. Intensive care medicine, 35(7), 1152-1170.
Hussain, A., Mahawar, K., Xia, Z., Yang, W., & Shamsi, E. H. (2020). Obesity and mortality of COVID-19. Meta-analysis. Obesity research & clinical practice, 14(4), 295-300.
Kashyap, V. K., Dhasmana, A., Massey, A., Kotnala, S., Zafar, N., Jaggi, M., ... & Chauhan, S. C. (2020). Smoking and COVID-19: adding fuel to the flame. International journal of molecular sciences, 21(18), 6581.
Kass, D. A., Duggal, P., & Cingolani, O. (2020). Obesity could shift severe COVID-19 disease to younger ages. The Lancet, 395(10236), 1544-1545.
Langford, B. J., So, M., Raybardhan, S., Leung, V., Westwood, D., MacFadden, D. R., ... & Daneman, N. (2020). Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clinical microbiology and infection, 26(12), 1622-1629.
Lighter, J., Phillips, M., Hochman, S., Sterling, S., Johnson, D., Francois, F., & Stachel, A. (2020). Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clinical Infectious Diseases, 71(15), 896-897.
Mattioli, B., Straface, E., Matarrese, P., Quaranta, M. G., Giordani, L., Malorni, W., & Viora, M. (2008). Leptin as an immunological adjuvant: enhanced migratory and CD8+ T cell stimulatory capacity of human dendritic cells exposed to leptin. The FASEB Journal, 22(6), 2012-2022.
Moores, L. K., Tritschler, T., Brosnahan, S., Carrier, M., Collen, J. F., Doerschug, K., ... & Wells, P. (2020). Prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19: CHEST Guideline and Expert Panel Report. Chest, 158(3), 1143-1163.
O’Brien Jr, J. M., Phillips, G. S., Ali, N. A., Lucarelli, M., Marsh, C. B., & Lemeshow, S. (2006). Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Critical care medicine, 34(3), 738.
Palaiodimos, L., Kokkinidis, D. G., Li, W., Karamanis, D., Ognibene, J., Arora, S., ... & Mantzoros, C. S. (2020). 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, 108, 154262.
Peters, S. A., MacMahon, S., & Woodward, M. (2021). Obesity as a risk factor for COVID‐19 mortality in women and men in the UK Biobank: comparisons with influenza/pneumonia and coronary heart disease. Diabetes, Obesity and Metabolism, 23(1), 258-262.
Petrakis, D., Margină, D., Tsarouhas, K., Tekos, F., Stan, M., Nikitovic, D., ... & Tsatsakis, A. (2020). Obesity‑a risk factor for increased COVID‑19 prevalence, severity and lethality. Molecular medicine reports, 22(1), 9-19.
Petrilli, C. M., Jones, S. A., Yang, J., Rajagopalan, H., O’Donnell, L., Chernyak, Y., ... & Horwitz, L. I. (2020). Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City. MedRxiv.
Piazza, G., & Morrow, D. A. (2020). Diagnosis, management, and pathophysiology of arterial and venous thrombosis in COVID-19. Jama, 324(24), 2548-2549.
Piazza, G., Campia, U., Hurwitz, S., Snyder, J. E., Rizzo, S. M., Pfeferman, M. B., ... & Goldhaber, S. Z. (2020). Registry of arterial and venous thromboembolic complications in patients with COVID-19. Journal of the American College of Cardiology, 76(18), 2060-2072.
Poly, T. N., Islam, M. M., Yang, H. C., Lin, M. C., Jian, W. S., Hsu, M. H., & Jack Li, Y. C. (2021). Obesity and mortality among patients diagnosed with COVID-19: a systematic review and meta-analysis. Frontiers in medicine, 8, 620044.
Popkin, B. M., Du, S., Green, W. D., Beck, M. A., Algaith, T., Herbst, C. H., ... & Shekar, M. (2020). Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obesity Reviews, 21(11), e13128.
Popp, M., Stegemann, M., Metzendorf, M. I., Gould, S., Kranke, P., Meybohm, P., ... & Weibel, S. (2021). Ivermectin for preventing and treating COVID‐19. Cochrane Database of Systematic Reviews, (7).
R Core Team (2018). A Language and envionment for statistical computing. Computer software. Retrieved from: https://cran.r-project.org/.
Richardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn, T., Davidson, K. W., ... & Northwell COVID-19 Research Consortium. (2020). Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. Jama, 323(20), 2052-2059.
Rosa, M. E. E., Matos, M. J. R. D., Furtado, R. S. O. D. P., Brito, V. M., Amaral, L. T. W., Beraldo, G. L., ... & Funari, M. B. D. G. (2020). Achados da COVID-19 identificados na tomografia computadorizada de tórax: ensaio pictórico. Einstein (São Paulo), 18.
Ryan, P. M., & Caplice, N. M. (2020). Is adipose tissue a reservoir for viral spread, immune activation, and cytokine amplification in coronavirus disease 2019? Obesity, 28(7), 1191-1194.
Sharma, A., Garg, A., Rout, A., & Lavie, C. J. (2020, September). Association of obesity with more critical illness in COVID-19. In Mayo Clinic Proceedings (Vol. 95, No. 9, pp. 2040-2042). Elsevier.
Simonnet, A., Chetboun, M., Poissy, J., Raverdy, V., Noulette, J., Duhamel, A., ... & Verkindt, H. (2020). High prevalence of obesity in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) requiring invasive mechanical ventilation. Obesity, 28(7), 1195-1199.
Stefan, N., Birkenfeld, A. L., Schulze, M. B., & Ludwig, D. S. (2020). Obesity and impaired metabolic health in patients with COVID-19. Nature Reviews Endocrinology, 16(7), 341-342.
Sun, P., Qie, S., Liu, Z., Ren, J., Li, K., & Xi, J. (2020). Clinical characteristics of 50466 hospitalized patients with 2019-nCoV infection. medRxiv [Internet]. 2020 Feb [cited 2020 July 8].
Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., ... & Peng, Z. (2020). Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama, 323(11), 1061-1069.
Williamson, E. J., Walker, A. J., Bhaskaran, K., Bacon, S., Bates, C., Morton, C. E., ... & Goldacre, B. (2020). Factors associated with COVID-19-related death using OpenSAFELY. Nature, 584(7821), 430-436.
Yang, J., Ma, Z., & Lei, Y. (2021). A meta-analysis of the association between obesity and COVID-19. Epidemiology & Infection, 149.
Zhou, Y., Chi, J., Lv, W., & Wang, Y. (2021). Obesity and diabetes as high‐risk factors for severe coronavirus disease 2019 (Covid‐19). Diabetes/metabolism research and reviews, 37(2), e3377.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Mellyne Henriques Guerra; Marília Souza Alves Gois; Brunna Karolyne Souza Hora; Catharine Mattos Melo; Ana Monize Ribeiro Fonseca; Rafaela Mota de Jesus ; Rívia Siqueira Amorim; Ingrid Cristiane Pereira Gomes; Karla Freire Rezende; Nathalie Oliveira de Santana
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
