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Association of Body Mass Index and Other Metabolic Risk Factors with Pneumonia Outcomes in Critically Ill Patients with Coronavirus Disease-19: An International Multicenter Retrospective Cohort Study

27 Pages Posted: 17 Sep 2020

See all articles by Mikael Chetboun

Mikael Chetboun

University of Lille I - European Genomic Institute for Diabetes

Violeta Raverdy

University of Lille - European Genomic Institute for Diabetes

Julien Labreuche

CHU Lille - ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales

Arthur Simonnet

CHU Lille - Pôle de Réanimation, Hôpital Roger Salengro

Florent Wallet

Hospices Civils de Lyon - Medical Intensive Care Unit

Cyrielle Caussy

Hospices Civils de Lyon - Département Endocrinologie

Massimo Antonelli

Fondazione Policlinico Universitario A. Gemelli IRCCS - Department of Anesthesia and Intensive Care Medicine

Antonio Artigas

Autonomous University of Barcelona - Department of Medecine

Gemma Goma

Corporació Sanitaria Universitaria Parc Tauli - Critical Care Department

Ferhat Meziani

Hôpitaux Universitaires de Strasbourg - Service de Médecine Intensive Réanimation

Julie Helms

Hôpitaux Universitaires de Strasbourg - Service de Médecine Intensive Réanimation

Eleftherios Mylonakis

Brown University - Infectious Diseases Division

Mitchell Levy

Brown University - Warren Alpert Medical School

Markos Kalligeros

Brown University - Infectious Diseases Division

Nicola Latronico

ASST-Spedali Civili of Brescia - Intensive Care and Emergency; University of Brescia - Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health

Simone Piva

ASST-Spedali Civili of Brescia

Charles Cerf

Hôpital Foch - Medico-Surgical ICU

Mathilde Neuville

Hôpital Foch - Medico-Surgical ICU

Kada Klouche

University of Montpellier - Department of Intensive Care Medicine

Romaric Larchar

University of Montpellier - Department of Intensive Care Medicine

Fabienne Tamion

University of Rouen - Medical Intensive Care Unit

Emilie Occhiali

University of Rouen - Department of Anesthesia and Critical Care

Morgane Snacken

Université Libre de Bruxelles - Department of Intensive Care

Jean-Charles Preiser

Université Libre de Bruxelles - Department of Intensive Care

Loay Kontar

Amiens University Hospital - Medical ICU

Antoine Riviere

Abbeville General Hospital - ntensive Care Unit

Stein Silva

University of Toulouse - Toulouse NeuroImaging Center

Benjamine Sarton

University of Toulouse - Toulouse NeuroImaging Center

Raphael Krouchi

Centre hospitalier de Dunkerque - Intensive Care Unit

Victoria Dubar

Centre hospitalier de Dunkerque - Intensive Care Unit

Leonidas Palaiodimos

Albert Einstein College of Medicine, Montefiore Medical Center, Division of Hospital Medicine

Dimitrios Karamanis

University of Piraeus - Department of Economics

Juliette Perche

Centre Hospitalier de Roubaix - Réanimation Polyvalente

Erwan L'Her

Centre Hospitalier Régional et Universitaire de Brest - Intensive Medicine and Resuscitation

Luca Busetto

University of Padova

Dror Dicker

Tel Aviv University - Sackler Faculty of Medicine

Shaul Lev

Tel Aviv University - Sackler Faculty of Medicine

Alain Duhamel

CHU Lille - ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales

Mercèdes Jourdain

CHU Lille - Pôle de Réanimation, Hôpital Roger Salengro

Francois Pattou

CHU Lille - Centre Intégré de l'Obésité

More...

Abstract

Previous studies unveiled a relation between COVID-19 severity and obesity. The aims of this multicenter retrospective cohort study were to disentangle the association of body mass index (BMI) and associated metabolic risk factors, with pneumonia outcomes in critically ill patients with COVID-19, and explore the impact of age and sex on this relationship. Participants were COVID-19 patients admitted in intensive care in 21 centers in Europe, Israel, and USA, between 02/19/2020 and 05/19/2020. The exposure of interest was BMI. The primary and secondary outcomes were the need for invasive mechanical ventilation (IMV), and 28-day mortality. The covariates were age, sex, and diabetes, hypertension, hyperlipidemia, and current smoking. We enrolled 1,461 patients (median age 64 years (Interquartile range (IQR), 40.9-72.0); 73.2% males; median BMI 28.1 kg/m2 (IQR, 25.4-32.3); 1,080 patients (73.9%) required IMV and the 28-day mortality rate was 36.1% (95% confidence intervals (CI), 33.0-39.5).  Adjusted mixed logistic regression model showed a significant relation between BMI and IMV: odds ratio 1.27 (95% CI, 1.12-1.45) per 5 kg/m2 in the whole cohort, and 1.65 (95% CI, 0.97-2.79) per 5 kg/m2 in females under 50 years. Adjusted Cox proportional hazards regression model showed a significant association between BMI and mortality, which was only increased in obesity class III (≥40 kg/m2) (Hazard Ratio 1.68 (95% CI 1.06-2.64). In conclusion, we observed in critically ill COVID-19 patients, a linear association between BMI and the need for IMV, independent of other metabolic risk factors, and more pronounced in younger females, and a non-linear association between BMI and mortality risk.

Trial Registration: ClinicalTrials.gov Identifier: NCT04391738

Funding Statement: No specific funding.

Declaration of Interests:The authors declared no conflict of interest.

Ethics Approval Statement: The study complied with standard operating procedures in place, in accordance with the European Data Protection Directive (95/46/EC) and, upon its entry into force, Regulation (EU) 2016/679 (also referred to as the General Data Protection Regulation (GDPR)), and French CNIL frameworks n° MR004 regarding the processing of personal data in clinical studies. The institutional review board from other centers in USA and Israel approved the retrospective case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent.

Suggested Citation

Chetboun, Mikael and Raverdy, Violeta and Labreuche, Julien and Simonnet, Arthur and Wallet, Florent and Caussy, Cyrielle and Antonelli, Massimo and Artigas, Antonio and Goma, Gemma and Meziani, Ferhat and Helms, Julie and Mylonakis, Eleftherios and Levy, Mitchell and Kalligeros, Markos and Latronico, Nicola and Piva, Simone and Cerf, Charles and Neuville, Mathilde and Klouche, Kada and Larchar, Romaric and Tamion, Fabienne and Occhiali, Emilie and Snacken, Morgane and Preiser, Jean-Charles and Kontar, Loay and Riviere, Antoine and Silva, Stein and Sarton, Benjamine and Krouchi, Raphael and Dubar, Victoria and Palaiodimos, Leonidas and Karamanis, Dimitrios and Perche, Juliette and L'Her, Erwan and Busetto, Luca and Dicker, Dror and Lev, Shaul and Duhamel, Alain and Jourdain, Mercèdes and Pattou, Francois, Association of Body Mass Index and Other Metabolic Risk Factors with Pneumonia Outcomes in Critically Ill Patients with Coronavirus Disease-19: An International Multicenter Retrospective Cohort Study. Available at SSRN: https://ssrn.com/abstract=3667634 or http://dx.doi.org/10.2139/ssrn.3667634

Mikael Chetboun (Contact Author)

University of Lille I - European Genomic Institute for Diabetes ( email )

France

Violeta Raverdy

University of Lille - European Genomic Institute for Diabetes

France

Julien Labreuche

CHU Lille - ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales

Lille, F-59000
France

Arthur Simonnet

CHU Lille - Pôle de Réanimation, Hôpital Roger Salengro

Lille, F-59000
France

Florent Wallet

Hospices Civils de Lyon - Medical Intensive Care Unit

France

Cyrielle Caussy

Hospices Civils de Lyon - Département Endocrinologie

France

Massimo Antonelli

Fondazione Policlinico Universitario A. Gemelli IRCCS - Department of Anesthesia and Intensive Care Medicine

Italy

Antonio Artigas

Autonomous University of Barcelona - Department of Medecine ( email )

Plaça Cívica
Cerdañola del Valles
Barcelona, Barcelona 08193
Spain

Gemma Goma

Corporació Sanitaria Universitaria Parc Tauli - Critical Care Department ( email )

Sabadell
Spain

Ferhat Meziani

Hôpitaux Universitaires de Strasbourg - Service de Médecine Intensive Réanimation ( email )

Strasbourg
France

Julie Helms

Hôpitaux Universitaires de Strasbourg - Service de Médecine Intensive Réanimation ( email )

Strasbourg
France

Eleftherios Mylonakis

Brown University - Infectious Diseases Division ( email )

Providence, RI
United States

Mitchell Levy

Brown University - Warren Alpert Medical School ( email )

222 Richmond St.
Providence, RI 02903
United States

Markos Kalligeros

Brown University - Infectious Diseases Division

Providence, RI
United States

Nicola Latronico

ASST-Spedali Civili of Brescia - Intensive Care and Emergency ( email )

Italy

University of Brescia - Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health ( email )

Piazza del Mercato
Brescia
Italy

Simone Piva

ASST-Spedali Civili of Brescia

Via Nikolajewka, 13
25133 Brescia
Italy

Charles Cerf

Hôpital Foch - Medico-Surgical ICU ( email )

Suresnes
France

Mathilde Neuville

Hôpital Foch - Medico-Surgical ICU ( email )

Suresnes
France

Kada Klouche

University of Montpellier - Department of Intensive Care Medicine ( email )

163 rue Auguste Broussonnet
France

Romaric Larchar

University of Montpellier - Department of Intensive Care Medicine ( email )

163 rue Auguste Broussonnet
France

Fabienne Tamion

University of Rouen - Medical Intensive Care Unit ( email )

37 Boulevard Gambetta
Rouen, 76000
France

Emilie Occhiali

University of Rouen - Department of Anesthesia and Critical Care ( email )

37 Boulevard Gambetta
Rouen, 76000
France

Morgane Snacken

Université Libre de Bruxelles - Department of Intensive Care ( email )

Jean-Charles Preiser

Université Libre de Bruxelles - Department of Intensive Care ( email )

Loay Kontar

Amiens University Hospital - Medical ICU ( email )

Amiens
France

Antoine Riviere

Abbeville General Hospital - ntensive Care Unit ( email )

Abbeville, 80100
France

Stein Silva

University of Toulouse - Toulouse NeuroImaging Center ( email )

41 Allées Jules Guesde - CS 61321
Toulouse
France

Benjamine Sarton

University of Toulouse - Toulouse NeuroImaging Center ( email )

41 Allées Jules Guesde - CS 61321
Toulouse
France

Raphael Krouchi

Centre hospitalier de Dunkerque - Intensive Care Unit ( email )

Dunkerque, 59240
France

Victoria Dubar

Centre hospitalier de Dunkerque - Intensive Care Unit ( email )

Dunkerque, 59240
France

Leonidas Palaiodimos

Albert Einstein College of Medicine, Montefiore Medical Center, Division of Hospital Medicine ( email )

Bronx, NY
United States

Dimitrios Karamanis

University of Piraeus - Department of Economics

Athens
Greece

Juliette Perche

Centre Hospitalier de Roubaix - Réanimation Polyvalente ( email )

Roubaix, 59100
France

Erwan L'Her

Centre Hospitalier Régional et Universitaire de Brest - Intensive Medicine and Resuscitation ( email )

Bvd Tanguy-Prigent
29609 BREST Cedex
France

Luca Busetto

University of Padova

Via 8 Febbraio, 2
Padova, Vicenza 35122
Italy

Dror Dicker

Tel Aviv University - Sackler Faculty of Medicine ( email )

Tel Aviv University
Ramat Aviv, 69978
Israel

Shaul Lev

Tel Aviv University - Sackler Faculty of Medicine ( email )

Tel Aviv University
Ramat Aviv, 69978
Israel

Alain Duhamel

CHU Lille - ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales ( email )

France

Mercèdes Jourdain

CHU Lille - Pôle de Réanimation, Hôpital Roger Salengro ( email )

France

Francois Pattou

CHU Lille - Centre Intégré de l'Obésité ( email )

France

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