TY - JOUR
T1 - Obesity, Inflammation, and Clinical Outcomes in COVID-19
T2 - A Multicenter Prospective Cohort Study
AU - Hutten, Christina G
AU - Padalia, Kishan
AU - Vasbinder, Alexi
AU - Huang, Yiyuan
AU - Ismail, Anis
AU - Pizzo, Ian
AU - Machado Diaz, Kristen
AU - Catalan, Tonimarie
AU - Presswalla, Feriel
AU - Anderson, Elizabeth
AU - Erne, Grace
AU - Bitterman, Brayden
AU - Blakely, Pennelope
AU - Giamarellos-Bourboulis, Evangelos J
AU - Loosen, Sven H
AU - Tacke, Frank
AU - Chalkias, Athanasios
AU - Reiser, Jochen
AU - Eugen-Olsen, Jesper
AU - Banerjee, Mousumi
AU - Pop-Busui, Rodica
AU - Hayek, Salim S
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.
PY - 2024/10/15
Y1 - 2024/10/15
N2 - CONTEXT: Obesity is a risk factor for coronavirus disease 2019 (COVID-19)-related outcomes; however, the mechanism remains unclear.OBJECTIVE: The objective of this analysis was to determine whether inflammation mediates the association between obesity and COVID-19 outcomes.METHODS: The International Study of Inflammation in COVID-19 (ISIC): A Prospective Multi-Center Observational Study Examining the Role of Biomarkers of Inflammation in Predicting Covid-19 Related Outcomes in Hospitalized Patients, was conducted at 10 hospitals in the United States and Europe. Participants were adults hospitalized specifically for COVID-19 between February 1, 2020, through October 19, 2022. Inflammatory biomarkers, including soluble urokinase plasminogen activator receptor (suPAR), were measured at admission. Associations were examined between body mass index (BMI, kg/m2) and a composite of death, need for mechanical ventilation, and renal replacement therapy, stratified by pre- and post-Omicron variants. The contribution of inflammation to the relationship between obesity and outcomes was assessed.RESULTS: Among 4644 participants (mean age 59.3, 45.6% male, 21.8% BMI ≥ 35), those with BMI > 40 (n = 485) had 55% higher odds of the composite outcome (95% CI, 1.21-1.98) compared with nonobese individuals (BMI < 30, n = 2358) in multivariable analysis. In multiple mediation analysis, only suPAR remained a significant mediator between BMI and composite outcome. Associations were amplified for participants younger than 65 years and with pre-Omicron variants.CONCLUSION: Obesity is associated with worse outcomes in COVID-19, notably in younger participants and in the pre-Omicron era. Inflammation, as measured by suPAR, is a significant mediator of the association between obesity and COVID-19 outcomes.
AB - CONTEXT: Obesity is a risk factor for coronavirus disease 2019 (COVID-19)-related outcomes; however, the mechanism remains unclear.OBJECTIVE: The objective of this analysis was to determine whether inflammation mediates the association between obesity and COVID-19 outcomes.METHODS: The International Study of Inflammation in COVID-19 (ISIC): A Prospective Multi-Center Observational Study Examining the Role of Biomarkers of Inflammation in Predicting Covid-19 Related Outcomes in Hospitalized Patients, was conducted at 10 hospitals in the United States and Europe. Participants were adults hospitalized specifically for COVID-19 between February 1, 2020, through October 19, 2022. Inflammatory biomarkers, including soluble urokinase plasminogen activator receptor (suPAR), were measured at admission. Associations were examined between body mass index (BMI, kg/m2) and a composite of death, need for mechanical ventilation, and renal replacement therapy, stratified by pre- and post-Omicron variants. The contribution of inflammation to the relationship between obesity and outcomes was assessed.RESULTS: Among 4644 participants (mean age 59.3, 45.6% male, 21.8% BMI ≥ 35), those with BMI > 40 (n = 485) had 55% higher odds of the composite outcome (95% CI, 1.21-1.98) compared with nonobese individuals (BMI < 30, n = 2358) in multivariable analysis. In multiple mediation analysis, only suPAR remained a significant mediator between BMI and composite outcome. Associations were amplified for participants younger than 65 years and with pre-Omicron variants.CONCLUSION: Obesity is associated with worse outcomes in COVID-19, notably in younger participants and in the pre-Omicron era. Inflammation, as measured by suPAR, is a significant mediator of the association between obesity and COVID-19 outcomes.
KW - Adult
KW - Aged
KW - Biomarkers/blood
KW - Body Mass Index
KW - COVID-19/complications
KW - Europe/epidemiology
KW - Female
KW - Hospitalization/statistics & numerical data
KW - Humans
KW - Inflammation/blood
KW - Male
KW - Middle Aged
KW - Obesity/complications
KW - Prospective Studies
KW - Receptors, Urokinase Plasminogen Activator/blood
KW - Risk Factors
KW - SARS-CoV-2
KW - United States/epidemiology
KW - biomarkers
KW - coronavirus
KW - COVID-19
KW - inflammation
KW - obesity
KW - BMI
UR - http://www.scopus.com/inward/record.url?scp=85204617595&partnerID=8YFLogxK
U2 - 10.1210/clinem/dgae273
DO - 10.1210/clinem/dgae273
M3 - Journal article
C2 - 38635301
SN - 0021-972X
VL - 109
SP - 2745
EP - 2753
JO - The Journal of clinical endocrinology and metabolism
JF - The Journal of clinical endocrinology and metabolism
IS - 11
ER -