COVID-19 O-005 : Obesity-survival Paradox in Patients with COVID-19: A Nationwide Population-based Analysis

Background Among patients with coronavirus disease 2019 (COVID-19), obesity is an independent predictor of hospital admission and critical illness. However, there are limited clinical data regarding the association of obesity with COVID-19-related mortality. Methods We aimed to assess the possible impact of obesity on mortality in hospitalized patients with COVID-19 using the Korea National Committee for Clinical Management of COVID-19 registry. The World Health Organization body mass index (BMI) guidelines for the Asia-Pacific region was used to categorize patients as underweight, normal, overweight, and obese. Adjusted odds ratios (ORs) were used to compare mortality and severe COVID-19 (a composite outcome of death, respiratory support, and extracorporeal membrane oxygenation) between the groups. Results The present analysis included 4182 patients with COVID-19 who had complete information regarding BMI data, including 193 patients (5%) who were underweight, 1762 patients (42%) who were normal weight, 1012 patients (24%) who were overweight, and 1215 patients (29%) who were obese. Obese patients had higher rates of inflammatory conditions. However, underweight patients had the highest mortality rate in the entire cohort (8%; p<0.001) and among patients with severe COVID-19 (47%; p<0.001). Multivariate analysis revealed that obesity was independently associated with a higher risk of severe COVID-19 (adjusted OR, 2.02; 95% confidence interval [CI], 1.50-2.72; p<0.001). However, underweight was associated with a higher risk of mortality in the entire cohort (adjusted OR, 2.17; 95% CI, 0.90-5.10; p=0.08) and among patients with severe COVID-19 (adjusted OR, 2.86; 95% CI, 1.03-8.26; p=0.046). Conclusions Our data suggest that the obesity-survival paradox may exist for patients with COVID-19. These findings may help guide decision-making regarding clinical management and healthcare resource allocations during the COVID-19 pandemic.