The impact of obesity in hospitalized patients with COVID-19: a retrospective cohort study
Authors: Carra Fábio Alfano , de Melo Maria Edna , Stumpf Matheo A. M. , Cercato Cintia , Fernandes Ariana E. , Mancini Marcio C. ,   EPICCoV Study Group, Hirota Adriana , Kanasiro Alberto Kendy , Crescenzi Alessandra , Fernandes Amanda Coelho , Miethke-Morais Anna , Bellintani Arthur Petrillo , Canasiro Artur Ribeiro , Carneiro Bárbara Vieira , Zanbon Beatriz Keiko , Pinheiro Bernardo , Batista Senna Nogueira , Nicolao Bianca Ruiz , Besen Bruno Adler Maccagnan Pinheiro , Biselli Bruno , De Macedo Bruno Rocha , De Toledo Caio Machado Gomes , De Carvalho Carlos Roberto Ribeiro , Mol Caroline Gomes , Stipanich Cassio , Bueno Caue Gasparotto , Garzillo Cibele , Tanaka Clarice , Forte Daniel Neves , Joelsons Daniel , Robira Daniele , Costa Eduardo Leite Vieira , Da Silva Júnior Elson Mendes , Regalio Fabiane Aliotti , Segura Gabriela Cardoso , Louro Giulia Sefrin , Marcelino Gustavo Brasil , Ho Yeh-Li , Ferreira Isabela Argollo , Gois Jeison Oliveira , Da Silva-Jr Joao Manoel , Junior Jose Otto Reusing , Ribeiro Julia Fray , Ferreira Juliana Carvalho , Galleti Karine Vusberg , Silva Katia Regina , Isensee Larissa Padrao , Oliveira Larissa Santos , Taniguchi Leandro Utino , Letaif Leila Suemi , Lima Lígia Trombetta , Park Lucas Yongsoo , Netto Lucas Chaves , Nobrega Luciana Cassimiro , Haddad Luciana Bertocco Paiva , Hajjar Ludhmila Abrahao , Malbouisson Luiz Marcelo Sa , Pandolfi Manuela Cristina Adsuara , Park Marcelo , Carmona Maria José Carvalho , Andrade Maria Castilho Prandini H. , Santos Mariana Moreira , Bateloche Matheus Pereira , Suiama Mayra Akimi , de Oliveira Mayron Faria , Sousa Mayson Laercio , Garcia Michelle Louvaes , Huemer Natassja , Mendes Pedro Vitale , Lins Paulo Ricardo Gessolo , Dos Santos Pedro Gaspar , Moreira Pedro Ferreira Paiva , Guazzelli Renata Mello , Dos Reis Renato Batista , Daltro-Oliveira Renato , Roepke Roberta Muriel Longo , Pedro Rodolpho Augusto Moura , Kondo Rodrigo , Rached Samia Zahi , Da Fonseca Sergio Roberto Silveira , Borges Thais Sousa , Ferreira Thalissa , Junior Vilson Cobello , Sales Vivian Vieira Tenório , Ferreira Willaby Serafim Cassa 
Published: January 2024

Abstract
Background
Obesity is believed to be a risk factor for COVID-19 and unfavorable outcomes, although data on this remains to be better elucidated.

Objective
To evaluate the impact of obesity on the endpoints of patients hospitalized due to SARS-CoV-2.

Methods
This retrospective cohort study evaluated patients hospitalized at a tertiary hospital (Hospital das Clínicas da Faculdade de Medicina da USP) from March to December 2020. Only patients positive for COVID-19 (real-time PCR or serology) were included. Data were collected from medical records and included clinical and demographic information, weight and height, SAPS-3 score, comorbidities, and patient-centered outcomes (mortality, and need for mechanical ventilation, renal replacement therapy, or vasoactive drugs). Patients were divided into categories according to their BMI (underweight, eutrophic, overweight and obesity) for comparison porpoise.

Results
A total of 2547 patients were included. The mean age was 60.3 years, 56.2% were men, 65.2% were white and the mean BMI was 28.1 kg/m2. SAPS-3 score was a risk factor for all patient-centered outcomes (HR 1.032 for mortality, OR 1.03 for dialysis, OR 1.07 for vasoactive drug use, and OR 1.08 for intubation, p < 0.05). Male sex increased the risk of death (HR 1.175, p = 0.027) and dialysis (OR 1.64, p < 0.001), and underweight was protective for vasoactive drug use (OR 0.45, p = 0.027) and intubation (OR 0.31, p < 0.003).

Conclusion
Obesity itself was not an independent factor for worse patient-centered outcomes. Critical clinical state (indirectly evaluated by SAPS-3) appears to be the most important variable related to hard outcomes in patients infected with COVID-19.