• Michaela R Anderson, Joshua Geleris, David R Anderson, Jason Zucker, Yael R Nobel, Daniel Freedberg, Jennifer Small-Saunders, Kartik N Rajagopalan, Richard Greendyk, Sae-Rom Chae, Karthik Natarajan, David Roh, Ethan Edwin, Dympna Gallagher, Anna Podolanczuk, R Graham Barr, Anthony W Ferrante, and Matthew R Baldwin.
• Columbia University Irving Medical Center, New York, New York (M.R.A., J.G., J.Z., Y.R.N., D.F., J.S., K.N.R., S.C., K.N., D.R., E.E., A.P., A.W.F., M.R.B.).
• Ann. Intern. Med. 2020 Nov 17; 173 (10): 782-790.

BackgroundObesity is a risk factor for pneumonia and acute respiratory distress syndrome.ObjectiveTo determine whether obesity is associated with intubation or death, inflammation, cardiac injury, or fibrinolysis in coronavirus disease 2019 (COVID-19).DesignRetrospective cohort study.SettingA quaternary academic medical center and community hospital in New York City.Participants2466 adults hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection over a 45-day period with at least 47 days of in-hospital observation.MeasurementsBody mass index (BMI), admission biomarkers of inflammation (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), cardiac injury (troponin level), and fibrinolysis (D-dimer level). The primary end point was a composite of intubation or death in time-to-event analysis.ResultsOver a median hospital length of stay of 7 days (interquartile range, 3 to 14 days), 533 patients (22%) were intubated, 627 (25%) died, and 59 (2%) remained hospitalized. Compared with overweight patients, patients with obesity had higher risk for intubation or death, with the highest risk among those with class 3 obesity (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]). This association was primarily observed among patients younger than 65 years and not in older patients (P for interaction by age = 0.042). Body mass index was not associated with admission levels of biomarkers of inflammation, cardiac injury, or fibrinolysis.LimitationsBody mass index was missing for 28% of patients. The primary analyses were conducted with multiple imputation for missing BMI. Upper bounding factor analysis suggested that the results are robust to possible selection bias.ConclusionObesity is associated with increased risk for intubation or death from COVID-19 in adults younger than 65 years, but not in adults aged 65 years or older.Primary Funding SourceNational Institutes of Health.

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