Age Moderates the Effect of Obesity on Mortality Risk in Critically Ill Patients With COVID-19: A Nationwide Observational Cohort Study*

Dutch COVID-19 Research Consortium, Corstiaan A den Uil*, Fabian Termorshuizen, Wim J R Rietdijk, Roos S G Sablerolles, Hugo P M van der Kuy, Lenneke E M Haas, Peter H J van der Voort, Dylan W de Lange, Peter Pickkers, Nicolette F de Keizer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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Abstract

OBJECTIVES: A high body mass index (BMI) is associated with an unfavorable disease course in COVID-19, but not among those who require admission to the ICU. This has not been examined across different age groups. We examined whether age modifies the association between BMI and mortality among critically ill COVID-19 patients.

DESIGN: An observational cohort study.

SETTING: A nationwide registry analysis of critically ill patients with COVID-19 registered in the National Intensive Care Evaluation registry.

PATIENTS: We included 15,701 critically ill patients with COVID-19 (10,768 males [68.6%] with median [interquartile range] age 64 yr [55-71 yr]), of whom 1,402 (8.9%) patients were less than 45 years.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: In the total sample and after adjustment for age, gender, Acute Physiology and Chronic Health Evaluation IV, mechanical ventilation, and use of vasoactive drugs, we found that a BMI greater than or equal to 30 kg/m2 does not affect hospital mortality (adjusted odds ratio [ORadj] = 0.98; 95% CI, 0.90-1.06; p = 0.62). For patients less than 45 years old, but not for those greater than or equal to 45 years old, a BMI greater than or equal to 30 kg/m2 was associated with a lower hospital mortality (ORadj = 0.59; 95% CI, 0.36-0.96; p = 0.03).

CONCLUSIONS: A higher BMI may be favorably associated with a lower mortality among those less than 45 years old. This is in line with the so-called "obesity paradox" that was established for other groups of critically ill patients in broad age ranges. Further research is needed to understand this favorable association in young critically ill patients with COVID-19.

Original languageEnglish
Pages (from-to)484-491
Number of pages8
JournalCritical Care Medicine
Volume51
Issue number4
Early online date10 Feb 2023
DOIs
Publication statusPublished - Apr 2023

Bibliographical note

Funding Information:
Supported, in part, by The Netherlands Organisation for Health Research and Development (ZonMw) COVID-19 Programme in the bottom-up focus area 1 “Predictive diagnostics and treatment” for theme 3 “Risk analysis and prognostics” (project number 10430 01 201 0011: IRIS). The funder had no role in the design of the study or in the writing of the article.

Funding Information:
Dr. Rietdijk, Sablerolles, and van der Kuy received funding for conducting COVID-19 research from the Leading Online Entrepreneur of the Year (LOEY) foundation. Drs. Termorshuizen’s and de Keizer’s institutions received funding from the National Intensive Care Evaluation (NICE) Foundation. Dr. Termorshuizen received funding from the Mental Health Care Institute Rivierduinen. Dr. de Keizer’s institution received funding from The Netherlands Organisation for Health Research and Development (ZonMw) COVID-19 Programme; she disclosed that she is a NICE board member. Although, the LOEY foundation and ZonMw provided a grant to conduct COVID-19 research, they were not involved in the design, execution, and/or publication of this study. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.

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