The association between obesity and mortality in otherwise metabolically healthy COVID-19 patients with cardiac arrest: insights from a National Inpatient Sample in the US, 2020
Authors: Singh S , Gandhi M , Srivastava A , Perera A , Bellamkonda M K , Modi D , Sunkara P , Nanjundappa A , Akki Vivekananand V , Desai R 
Published: November 2023

Abstract

Background
Existing studies suggest poor outcomes among SARS-CoV-2 patients who had underlying obesity and metabolic syndrome (MBS). Therefore, we planned to do this study as no study so far has assessed the association of obesity with outcomes in individuals with SARS-CoV-2 infection who are metabolically healthy.

Methods
We queried the National Inpatient Sample (2019) using the ICD-10 codes for COVID-19 patients who had a cardiac arrest and were metabolically healthy (without Hypertension, Hyperlipidemia and Diabetes). Baseline characteristics, comorbidities, healthcare resource utilization statistics, and all-cause mortality were compared between obese and non-obese cohorts. Multivariable regression analyses were performed adjusting for demographics, hospital-level characteristics, and relevant comorbidities.

Results
After cleaning the data for missing data total COVID-19 with cardiac arrest-related hospitalizations were 5885 (obese 1410 vs non-obese 4475). Propensity score matching, 1:1 ratio, for age, sex and race led to a final population of 2140 (obese 1070 vs non-obese 1070). In propensity-matched samples, COVID-19 with cardiac arrest with obesity were mainly black (42.1% vs 37.9%; p=0.03), private payer (43.1% vs 24.5%; p&lt;0.001), visiting the urban non-teaching hospital (26.2% vs 16.8%; p&lt;0.001) compared to non-obese. Besides, COVID-19 patients with cardiac arrest were smokers (15.4% vs 13.6%), high burden of peripheral vascular disease, and had prior coronary artery bypass grafts. Before matching, 1510 obese patients with COVID-19 with cardiac arrest, 1300 (86.10%) died vs 4105 (81.7%) of 5025 non-obese with cardiac arrest; p&lt;0.05. Besides, obese patients had significantly high all-cause mortality (83.6% vs 78.0%; p=0.001), transfer to short-term hospital (17.1% vs 11.4%; p=0.001), and high hospital cost (median $434336 vs $338450; p=0.001) compared to non-obese patients in propensity match cohort [Table 1]. Furthermore, in the subgroup analysis, high mortality in obese patients was noted in young Age 18-44 years, 45-64 years, in females, White, black, low household income,0-25, (88.9% vs 77.9%;p&lt;0.001) compared to non-obese patients. However, after adjustment for covariates, the odd for all-cause mortality in patients with obesity was high (OR 1.67; CI 95%, 0.99-2.82), but failed to attain significance [Table 2].

Conclusion
The burden of obesity in otherwise metabolically healthy COVID-19 patients admitted with cardiac arrest remained very high (nearly 1 in every 4 patients). COVID-19 patients with cardiac arrest had higher mortality in obese patients, especially those of young age, female and low-income patients. However, when adjusted for covariates the multivariate analysis failed to reach a statistical significance which warrant further large-scale studies to understand the independent association of higher BMI or obesity on survival in this high-risk patient population.