Obesity and Severe COVID-19: A Retrospective Analysis of Intensive Care Unit Patients at a Quaternary Medical Center

Introduction In obese patients, it is thought that the excess of macronutrients stimulates adipocytes to generate cytokines such as interleukin-6 creating a pro-inflammatory and oxidative state leading to defective innate immunity. This environment potentially creates a conducive ground for the hyperinflammatory response mediated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Therefore, in addition to accepted risk factors such as advanced age, pregnancy and diabetes, obesity is thought to be an important entity predisposing to severe Coronavirus Disease 2019 (COVID-19) and a potentially worse prognosis. The aim of this study is to understand the impact of obesity on the clinical course and outcome of intensive care unit (ICU) patients with COVID-19. Methods All COVID-19 ICU admissions between March 1st and May 31st, 2020 were obtained from our hospital's data base. Patients age >18 years with a positive SARS-CoV-2 polymerase chain reaction from a nasopharyngeal swab were included. ICU patients who were admitted for non-respiratory reasons with an incidental positive test result were excluded. Patients were divided into two groups obese: (BMI >/=30) and non-obese (BMI 25 as their cutoff whereas we used BMI >/= 30. Another potential explanation is that in our study, obese patients were younger, a factor which may have neutralized the negative impact of obesity. Our study is limited by sample size and the single center factor but suggests that obesity alone may not significantly affect prognosis although this will need to be confirmed by larger studies.